Objective: To compare the frequency of pain in patients undergoing elective lower limb surgery between valsalva maneuver versus control group during spinal anesthesia. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anesthesia, Dow University of Health Sciences, Civil Hospital, Karachi from 1st June 2018 to 30th November 2018. Methodology: All patients aged 25 to 50 years of either sex having ASA status I and II undergoing for surgery in sitting position under sub-arachnoid block through midline approach were taken as study participants. Randomization was done and divided in two groups; Group A were those who did not perform valsalva group B were those who perform valsalva. Puncture pain was assessed and measured by visual analogue scale in which 0 indicates no pain whereas, 10 is considered as most painful. Results: The mean age was 39.76±8.43 years. There were 31 (51.7%) males and 29 (48.3%) females with body mass index in 21 (35%) have ≤25 kg/m2 and 39 (65%) have >25kg/m2. Mean VAS score was 4.27±2.09 and showed a significant association of pain between groups (p<0.001). Conclusion: Pain was found significantly lower in patients undergoing elective lower limb surgery with valsalva maneuver during spinal anesthesia. Keywords: Pain, Elective lower limb surgery, Valsalva maneuver, Spinal anesthesia

Objective: To compare the effectiveness of large antecubital vein versus small vein on dorsum of hand in prevention of propofol injection pain in patients undergoing surgery in general anaesthesia.. Design of the Study: The study design was randomized control trial. Study Settings: Study was conducted at Department of Anesthesia, Dow University of Health sciences, Civil Hospital, Karachi from 23-05-18 till 23-11-18. Material and Methods: After obtaining a patient's permission, data was gathered in the future. A total of 76 patients were studied (38 in group A and 38 in group B). Mean and standard deviation were used to represent demographic data, whereas frequency or percentages were used to represent the qualitative factors. As part of the post-segregation chi square test, which was applied to the data, the significance level was set at 0.01. Results of the Study:. A total of 76 patients were enrolled in the study (38 in each of the two groups). The average age in groups A and B was 39.25 ±3.91 and 38.71 ±4.01, respectively. The efficiency of the large antecubital vein vs the small vein on the dorsum of the hand in preventing propofol injection was 81.6 percent vs. 36.87 percent out of 38 patients in groups A and B. Conclusion: Using a large antecubital vein for propofol injection was found to be more effective than a small vein on the dorsum of the hand for preventing pain. Keywords: General anesthesia, elective surgery, propofol injection pain, VAS score

Objective: To compare the mean change in hemodynamics between patients undergoing endotracheal intubation with lidocaine vs fentanyl. Design of the Study: randomized controlled trial. Study Settings: This study was conducted at Department of Anaesthesiology, SICU and Pain Management, Civil Hospital Karachi, Dow University of Health Sciences from 21 September 2019 to 21 March 2020. Material and Methods: A total of 92 patient’s elective surgery was randomly allocated into two groups, 46 Patients in group A were treated with lidocaine and 46 in group B were treated with fentanyl. Heart rate and MAP was recorded 5 minutes post-intubation by independent observer (postgraduate trainee 1-2 years). Results of the Study: Attenuating the hemodynamic response was most successfully accomplished by administering IV fentanyl 3 g/kg 5 minutes prior to induction, in our case. Conclusion: Attenuating the hemodynamic response was most successfully accomplished by administering IV fentanyl 3 g/kg 5 minutes prior to induction, in our case. It is a standard aspect of anaesthetic care and has been shown to reduce the hemodynamic response to laryngoscopy and intubation in a safe and effective manner. Keywords: Hemodynamics, Endotracheal intubation, Lidocaine, Fentanyl

Aim: To compare duration and onset of motor and sensory block by using dexmedetomidine and dexamethasone as adjuvant to bupivicaine in supraclavicular brachial plexusblock. Place and duration of study: Department of Anaesthesiology, Surgical Intensive Care & Pain Management, Civil Hospital, Dow University of Health Sciences Karachi from 29th June 2022 to 29th December 2022. Design: Randomized controlled trial study Methodology: Sixty patientswere enrolled in the study that had an elective upper-limb surgery performed under supraclavicular anesthesia of hand, wrist, forearmand elbow were allocated through randomization into two groups. Thirty patients in group A treated with bupivacaine 25 ml of 0.5% with dexamethasone 8mg (2 ML) and 30 in group B treated with bupivicaine 25 ml of 0.5% with dexmedetomidine 1µg/kg (2ml). Patients were observed in post-anesthesiacareunitpost-surgery. Duration of onset of pain was noted by patient’s first request for analgesia. Results:Themean age of patients was 34.88±9.39 years. Mean onset time of sensory and motor block was significantly low in group A than group B. Mean duration of sensory block and motor block was significantly high in group B than group A [813.87±113.72 vs. 752.63±27.96; p=0.006] and [734.13± 84.44 vs533.07±88.38;p=0.0005]. The time to request for 1st rescue analgesic was significantly increased in group B as compare to group A(p=0.0005). Practical Implication: Regional anesthesia in orthopedic procedures is superior to general anesthesia in terms of better postoperative pain relief, less central nervous system depressant effect of drugs and early discharge from hospital. Conclusion:The duration of block prolonged in cases where dexmedetomidine was added to the bupivacaine was longer but onset was reduced in comparison to the dexamethasone cases. Keywords: Brachial plexus block, Supraclavicular block, Dexmedetomidine, Dexamethasone