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Homologous blood transfusion, despite numerous and serious transfusion associated hazards, is an important treatment modality. Transmission of infectious agents like HIV, hepatitis Viruses, malaria, etc is a distinct possibility notwithstanding careful screening of the blood. Predeposit autologous blood transfusion (PABT) and per operative acute normovolemic haemodilution (ANH) are two comparatively safer, simpler and practical alternatives. Unfortunately, their potential remains unexploited. Earnest motivation efforts at PABT and ANH have paid handsome dividends in our hospital. These have now become very popular amongst surgeons as well as the patients. These techniques can be easily adapted at all hospitals to reduce the demand for homologous blood transfusion. ANH can be safely practised even in hospitals without a blood bank.

Efficacy of intraperitoneal instillation of bupivacaine at the time of laparoscopic sterilisation to provide postoperative analgesia was studied. In 40 patients undergoing laparoscopic sterilisation 0.75ml/kg of 0.125% bupivacaine was instilled in the peritoneal cavity (Group-I) and another 40 patients where the topical anaesthetic was not used served as controls (Group-II). Pain scores on Visual Analog Scale (VAS) were studied 1,2,4,6 and 24 hours after surgery in both groups. Mean VAS score was significantly lower in Group-I, 1,2 and 4 hours after surgery (p<0.05). Rescue analgesia was required in 20% patients of Group-I compared to 52.5% in Group-II which is definitely significant (p<0.001). No complications or side effects were noted in the bupivacaine treated group. This simple technique provides excellent analgesia in the immediate postoperative period following laparoscopic sterilisation which will go a long way in enhancing patient satisfaction and motivating other eligible clients to come forward for laparoscopic sterilisation.

Efficacy of acute normovolemic hemodilution in patients undergoing elective major surgery was studied with the aim to evaluate optimum technique, safety and utility in the service. Forty adult patients undergoing elective major surgery, who were in ASA GD I with preoperative haemoglobin more than 10.0g% were included in this study after a detailed explanation of the procedure and obtaining consent. 350-700 ml of patients' blood was collected before induction of anaesthesia and was kept in the operation theatre at room temperature. This was followed by rapid infusion of crystalloid calculated at the rate of 3ml for every ml of blood withdrawn. Intraoperative blood loss, serial haemoglobin assessment, change in pulse rate, blood pressure, SpO and urine output were carefully monitored. The blood was reinfused once haemostasis was secured at the end of surgery. All the vital parameters were maintained within normal limits throughout the procedure. This simple, easy and inexpensive technique was found to be very useful in obviating the necessity of other forms of blood transfusion and preventing all transfusion related hazards. It was found that this method has an important role in patients with uncommon blood groups and has an excellent patient acceptability. This technique has an important role in peripheral service hospitals, where formal blood bank facilities do not exist.