Factors affecting the Prognosis of Patients with Pyelonephritis

Introduction: Emphysematous pyelonephritis (EPN) is thenecrotizing infection of renal parenchyma with the presence ofgas in the renal parenchyma, collecting system or perinephrictissue. EPN is an uncommon life-threatening conditionprecipitated mainly by poorly controlled blood sugars andurinary tract obstruction. Current research aimed to study theclinical and biochemical factors determining the prognosis ofpatients with acute pyelonephritis.Material and Methods: The study was conducted from June2016 to June 2017 in Tirunelveli Medical college among 50patients of pyelonephritis with classical clinical features. Allbasic blood investigations were done and radiological imaginglike USG, KUB and CT abdomen was done for more detailingand followed up.Results: Females above 50 years of age were more frequentlyaffected by pyelonephritis. Altered sensorium, hypotension,HbA1c values > .5 and thrombocytopenia were noticed ina significant number of cases. Prognosis of cases with thesecomorbid conditions was found to be low. 6 patients died inthis study due to poor glycaemic control, thrombocytopeniaand renal dysfunction.Conclusion: Long-standing and uncontrolled type II diabetesmellitus, hypotension, renal dysfunction, thrombocytopeniaand radiological features of the high-risk disease are allassociated with a poor prognosis.

Conventional Radiation Therapy with Chemo Boost in Locally Advanced Squamous Cell Carcinoma of Head and Neck

Introduction: Combining chemotherapy with radiation toimprove tumor control and organ preservation rates havebeen the subject of intensive investigation in various cancersduring the last several decades. Cytotoxic agents have beengiven before (induction or neoadjuvant chemotherapy), after(adjuvant chemotherapy), or concurrently with radiation.Study aimed to evaluate the efficacy and acute radiationtoxicities by using concomitant chemo boost schedule in thetreatment of squamous cell carcinoma of Head and Neckregion' in Locally advanced diseases.Material and Methods: 28 patients with squamous cellcarcinoma of Head and Neck region' in Locally advanceddiseases were randomly assigned to radiation therapy byConventional 200 cGy / # /35# / 7 weeks or chemotherapyadded at last two weeks (Days 26 - 35) 10 days.Results: The overall local control rate with concomitant boostschedule in our study is 79%. This is 17% higher than that ofconventional fractionation schedule (62%). The incidence ofGrade 1 and 2 mucositis is 43% (control 38%). No patienthad Grade 3 or 4 mucositis requiring parenteral nutrition ortreatment interruptions.Conclusion: Concomitant chemo boost schedule offers theprospect of an improvement in the therapeutic ratio in clinicalradiotherapy.

Correlation between Mitral Annular Systolic Velocity and Left Atrial Appendage Function in Mitral Stenosis

The left atrial appendage is a long, tubular and trabecular structure and has a narrow junction with the left atrium. The left atrial appendage has been the focus of clinicians’ interests, because it is a potential site for the development of thrombus in several diseases. Aim: To study the correlation between mitral annular systolic velocity and left atrial appendage function in mitral stenosis. Methods: 60 patient with moderate to severe Mitral Stenosis with MVO <1.5 cm2 were included in the study. All eligible patients underwent a detailed history and clinical examination. A 12 lead electrocardiogram was taken. Echocardiographic evaluation was done for all patients Atrial fibrillation diagnosis was based on the electrocardiogram. Result: There was a positive correlation between these two variables which are statistically significant. (r=0.944, p-value<0.001). There was a positive correlation between left atrial appendage emptying velocity and mitral annular late diastolic velocity in patients in sinus rhythm. (r=0.695(p<0.001) The cut off value of peak annulus systolic velocity which is derived from the analysis of the receiver operator characteristic curve is 13.5cm/sec. The area under the curve is 0.840 with confidence interval 0.689 to 0.936 and the p-value<0.001. This value predicts inactive LAA (Laaev<25cm/sec) with a sensitivity of 92% and specificity of 96.5%. Conclusion: The systolic and diastolic annular velocities obtained by Doppler tissue imaging are reduced in patients with mitral stenosis. There is a positive correlation between annular systolic and left atrial appendage emptying velocities in mitral stenosis. The annular systolic velocity is an independent predictor for the presence of inactive left atrial appendage in mitral stenosis patients with sinus rhythm.

Prognostic Significance of Left Atrial Volume Index in Acute Myocardial Infarction and its Angiographic Correlation

Evaluating left atrium volume is a good way to estimate prognosis in acute myocardial infarction patients because it indicates to time and severity of diastolic dysfunction and longer-term results of acute myocardial infarction. Left atrial (LA) volume is a prognostic predictor across a wide spectrum of cardiac and non-cardiac diseases. Aim: To assess the left atrial volume index in Myocardial Infarction & Angiographic correlation and to assess any correlation between with left atrial volume index and outcomes of MI such as heart failure, short term mortality, arrhythmias, and ejection fraction. Methods: 100 patients with ST elevation in ECG, with history, examination, ECG changes and elevated CK-MB, Anterior, Inferior, Right ventricle & Posterior wall Myocardial infarction were included. The patients were studied considering demographic factors, risk factors, echocardiography indexes such as systolic and diastolic functions and left atrium volume and angiography. Results: Among LAVI >34, 22 had (70-90%) of RCA, 7 had (70-90%) of LCX, 29 had (70-90%) of LAD. Among LAVI>34, 14 patients had TVD, 5 had DVD, 29 had SVD, 9 normal coronaries, which are not statistically significant. Among LAVI >34, 22 patients undergone PCI, 7 patients underwent CABG, 1 patient had CHB, 3 patient had VT and 9 patients had AF, which is statistically significant. Among LAVI>34, 24 patients had HF at 30 days follow-up. Among LAVI>34, in 30 days follow up 1 patient expired. When compared with LAVI <34 it was not statistically significant. Conclusion: LA Volume index provides prognostic information incremental to clinical data and standard Echocardiographic predictors of outcome, including LV systolic function and Doppler assessment of Diastolic Function.

Wilsons disease and autoimmune liver disease overlap syndrome: a clinical study

Background: The coexistence of Wilson’s disease and autoimmune liver disease in a same patient is a rare entity. Combined treatment with steroid and D-penicillamine may be effective. Aim of the study was analyse the clinical, histological, laboratory profile for patients with chronic liver disease with aim of finding the etiology of the disease.Methods: It is an observational study. Common clinical presentations were evaluated. Laboratory investigations done include complete blood count, renal and liver function tests, prothrombin time, viral markers for hepatitis A, B, C and E, USG abdomen and pelvis, portal Doppler studies and upper GI endoscopy. Specific tests include ANA, AMA, ASMA, Anti LKM-1Ab, serum ceruloplasmin and 24hrs urinary copper were done. Liver biopsy was done in selected patients.Results: Commonest clinical presentation was abdominal distension (80%), abdominal pain (30%), pedal edema (60%), splenomegaly (40%) and upper GI bleed (40%). Laboratory investigation revealed anemia (50%), thrombocytopenia (70%), prothrombin time prolongation in (60%), normal liver function in 60%, abnormal liver function in (40%). Autoimmune markers revealed ANA strong positivity in (40%), mild positivity in (60%). AMA, ASMA, Anti-LKM-1 were negative in all cases (100%). Liver biopsy showed features of autoimmune liver disease and Periportal copper deposition in 80% of cases.Conclusions: Coexistence of Wilson’s disease and autoimmune liver disease is a rare entity and medical treatment with steroids and D-penicillamine simultaneously to be started in these patients.

A Study of Characterstics Autopsy Findings in Hair Dye Poisoning

Incidence of hair dye poisoning has been rising in many regions of the country due to easy availability. Mortality rates vary between 0.03% -60%. Post mortem findings in all the cases include laryngeal oedema, oedema of vocal cords and epiglottis. Cause of death in all the cases was probably asphyxia, multiorgan failure, and cardiac toxicity. Aim: To ascertain the cause of death in all the cases who died of hair dye poisoning. Methods: 24 patients who died of hair dye poisoning and who underwent an autopsy in Thoothukudi Government Medical College Hospital for the period from April 2009 to March 2010 were included in the study. Results: Facial puffiness, protruded tongue clinched in between the teeth, swollen neck, blood mixed froth oozing from the mouth, Bluish discoloration of extremities and conjunctival ecchymosis were seen in all the 24 patients. Histological examination of lung parenchyma showed infiltrated of lymphocytes and mononuclear cells, congestion in the pulmonary vasculature, mucosal and submucosal oedema in the laryngeal region along with infiltrates of mast cells, mononuclear cells, and lymphocytes. Pulmonary oedema and petechial haemorrhages on the myocardial surface were also noted. Conclusion: There are a high incidence and the rapid rise of hair dye poisoning in this area. All the autopsies in patients who died of hair dye poisoning showed severe cervicofacial oedema, bluish discoloration of extremities, conjunctival congestion and protruded tongue. All of them had evidence of asphyxia as the cause of death.

Comparison between intramuscular oxytocin versus oxytocin with sublingual misoprostol in blood loss reduction among risk of postpartum hemorrhage vaginal deliveries

Background: This study compares the efficacy of intramuscular oxytocin and oxytocin with sublingual misoprostol administration among the primary postpartum hemorrhage (PPH) mothers of vaginal deliveries. The aim is to compare the effectiveness of intramuscular oxytocin versus oxytocin with sublingual misoprostol in blood loss reduction among women at risk of PPH undergoing vaginal deliveries.Methods: Each group, 50 mothers were selected from the risk of PPH vaginal mothers in the labour ward of the study area.Results: The two groups’ mothers were not statistically significantly differed (P>0.05) in respect of their demographic and clinical variables such as age, gravida, risk factors, the onset of labour and type of delivery. The mean blood loss of group I was 315.4±111.4 ml and group II mean blood loss was 241.4±191.2 ml. The difference between the two groups’ blood losses was statistically significant (P<0.05).Conclusions: Oxytocin with sublingual misoprostol significantly reduced the blood loss during 3rd stage labour than only oxytocin administration.

Risk factor analysis and angiographic findings in young myocardial infarction patients in tertiary care centre of rural population in South India

Background: Coronary Artery Disease (CAD) is the leading cause of death and accounts for around 12million deaths annually worldwide. The pattern of coronary artery involvement and clinical outcome varies with age suggesting different underlying pathophysiology. Better understanding this specific problem will lead to further improvement in management. The aim was to study the risk factors and angiographic findings in young patients with acute myocardial infarction.Methods: Thirty-nine patients were included in this study. Patients included in the study underwent elective angiographic performed by the percutaneous femoral approach using standard angiographic techniques. Echo and lipid profile were done to all patients. Data were analysed using MS-Excel.Results: In this study, 39 patients were included, 37 male and 2 female patients, the average age of the patients was 35.12 years. 59% of patients had hypertriglyceridemia, 23.1% of patients hypercholesteremia. 45.9% of male patients were having a history of smoking and alcoholism. 84.6% of patients had obstructive CAD, single vessel disease was observed in 59%, double vessel disease in 7.7%, triple vessel in 2.6% patients.Conclusions: Acute myocardial infarction in young predominantly affects males. Dyslipidemia, smoking and alcoholism were found to be common associated factors in young MI. This emphasizes the need for lifestyle modification for primary prevention. Coronary angiography revealed normal coronaries in 12% suggesting different underlying process other than atherosclerosis. With timely intervention and appropriate management, prognosis is good in young MI patients.

Survival analysis pattern of patients treated with biliary metallic stent versus patients treated with surgical procedures for hepato-biliary malignancies in a rural tertiary care centre in South India

Background: Tumors of the biliary tract show spectrum ranging from benign to malignant lesions. Only 20% of tumors are resectable at the time of presentation. The operative mortality was approximately 5 to 20%. The morbidity rate associated with the surgery is approximately 65%. Options for palliative therapy of biliary tree obstruction include the surgical bypass, percutaneous external drainage/stenting and endoscopic stenting. The aim was to compare the survival pattern of patients treated with biliary Self Expandable Metallic Stents (SEMS) as a palliative procedure to that of patients treated by curative surgery.Methods: This was a retrospective study. 6-months survival pattern were analysed in 20 patients treated by SEMS and compared with that of 10 patients treated with plastic biliary stents followed by curative surgery.Results: Survival pattern analysis was done for all 20 patients with SEMS. 7 patients were in >1-year survival, 5 were in >6months survival, 6 expired within 6months, 2 patients were lost to follow up. Survival pattern was compared with 10 patients who had plastic stents followed by curative surgery. Only 1 patient had survival rate >1year post-surgery, 5 patients expired post-surgery in <6months, 2 patients expired few weeks after plastic stent deployment, 2 patients were lost to follow up.Conclusions: In patients with biliary malignancies with obstruction, biliary SEMS followed up by palliative chemotherapy had better survival rate than patients who had plastic stents followed up with curative surgical procedures.

Serum Sodium and Potassium in Newly Diagnosed Essential Hypertensive Patients

Background:Hypertension is one of the most common worldwide diseases afflicting humans & is one of the leading causes of death and disability among adults all over the world. It remains the major risk factor for coronary, cerebral and peripheral vascular disease. Aim: To study the levels of sodium and potassium in serum in patients with Essential Hypertension and to correlate it with Blood pressure in case of newly detected Essential Hypertensives. Methods:Prospective comparative study in patients with 100 (50 cases +50 controls) patients with essential hypertension. All the patients were subjected to detailed history taking, careful physical examination and biochemical analysis to exclude secondary hypertension. Results: The results of the study, between cases and controls were statistically significant. The mean value of serum sodium was 146 ± 2.81 mmol/L in males and 148 ± 4.2 mmol/L in females. The mean and standard deviation of serum potassium among cases was 3.79 ±0.179 mmols/L while on control groups it was 4.25 ±0.22 mmol/L. Conclusion: The conclusions of the study are serum sodium was significantly more among hypertensives and it was independent of associated risk factors and gender.

Prevalence and Spectrum of Leprosy in Thoothukudi District, Tamilnadu

Background: Leprosy is a disease involving the skin, and the peripheral nerves is a public health problem. The prevalence and pattern had changed after the vigorous implementation of MDT. Aim: The aim of the study is to study the changing patterns and spectrum of leprosy in Thoothukudi district, Tamilnadu, India. Methods: This is a retrospective study analyzing the spectrum and prevalence of the disease for a 12 years period from 2005 to 2017.All the new patients enrolled for MDT in the Deputy Director (Leprosy) office, Thoothukudi and Skin Dept, Govt. Thoothukudi Medical College Hospital from April 2005 to March 2017 was included in the study. Results: A total of 935 patient’s profile was analyzed. Among 935 patients analyzed an inclination towards the multibacillary spectrum was noticed in contrast to declining prevalence. Conclusion: Though the prevalence is declining a thorough, surveillance activities and early treatment will eliminate leprosy as a public health problem shortly.

Prevalence of Iron Deficiency Anemia in Patients with Chronic Heart Failure

Background:Introduction: Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Aim: To study the prevalence anemia in patients with chronic heart failure. Methods: In this prospective study, chronic heart failure patients were evaluated for anemia. Investigations included are complete blood count, peripheral smear, renal function test, ESR, CRP, serum ferritin and total iron binding capacity. Results: In our population, the prevalence of anemia was 38% of patients, and Iron deficiency anemia was detected in 11 out of 103 patients (11%). The prevalence of anemia of chronic disease was 27 out of 103 patients (26%), and the remaining patients (64%) had normal hemoglobin levels. Conclusion: Early diagnosis and treatment of anemia can improve Ejection Fraction in patients with CHF.

A Comparative Study of Brainstem Evoked Response Audiometry in Patients with Diabetic Neuropathy and Retinopathy

Background: Diabetes mellitus (DM) causes pathophysiological changes at multiple organ system. With evoked potential techniques, the brain stem auditory response represents a simple procedure to detect both acoustic nerve and central nervous system pathway damage. Aim: To find the evidence of neuropathy and retinopathy in diabetes patients by analyzing brainstem audiometry electric response obtained by auditory evoked potentials. Methods: The study was carried out on 28 diabetic patients both insulin requiring and oral hypoglycemic agents. Patients were divided into 2 groups, with neurological disorder and without neurological disorder. Results: 14 patients were male (Mean age: 45 yrs) and 14 female (Mean age: 41.2 yrs). The duration of illness since diagnosis, ranged from 5 years – 20 years. There was no significant change in nephropathy whereas in patients without retinopathy the amplitude and interpeak latency in wave III and V showed significant change. Conclusion: BERA is a simple, non-invasive procedure to detect early impairment of acoustic nerve, and CNS pathways, even in the absence of specific symptoms. This study suggests that if BERA is carried out in diabetic patients; involvement of central neuronal axis can be detected earlier.

Comparison of Anesthetic Efficacy of IANB - Classical and Gow-Gates Technique during Surgical Removal of Impacted Mandibular Third Molar

Background: The most frequently used mandibular injection technique is inferior alveolar nerve (IANB) block for achieving local anesthesia for dental treatment. The IANB block does not always give success. The interruption of sensory transmission to its best, by depositing anesthetic solution at lingula has not been proved. Aim: To compare the degree of patient acceptability and clinical efficacy of IANB and GG techniques in patients undergoing surgical removal of impacted mandibular third molar under local anesthesia. Methods: The split-mouth design was conducted on 20 healthy and ambulatory individuals (10 male and 10 female) aged between 40 and 50 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar reporting. Results: VAS of IANB was 4.60±1.82 and GG was 1.95±1.64 with GG more comfortable and no difference in case of aspiration. Onset of Anesthesia was better in IANB than GG with no difference in duration of anesthesia in both groups. Conclusion: To conclude GG is considered better than IANB in Mandibular block anesthesia

A Study of Clinico-Histopathological and Management of Soft Tissue Sarcoma

Background: Soft tissue tumors are a diverse and heterogeneous group of tumors. The incidence of benign soft tissue tumors are high relative to malignant tumors. The natural course of soft tissue tumors is un predictable and very aggressive if not diagnosed early. Aim: To study the clinicopathological presentation and modes of treatment of soft tissue sarcomas and to analyse the morbidity and mortality after treatment. Methods: In this retrospective 31 histologically confirmed cases of Soft tissue sarcomas cases were included. A detailed gross examination of the soft tissue specimen was performed to record the tumor size, shape, colour, consistency and distance from the deep resected margins. Results: The maximum incidence of soft tissue sarcomas was in the 4th, 5th, 6th, & 7th decades and together they made up about 67.74% of cases studied. Malignant fibrous histiocytoma and dermatofibrosarcoma protuberans had the maximum occurrence followed by rhabdomyosarcoma. The commonest site of the primary tumour was the lower extremity followed by the trunk &retroperitoneum and together they account for 58.06% of the primary tumours. Surgery is the main treatment modality and radical clearance of the primary with minimum functional disability should be the aim. Conclusion: Even though soft tissue sarcomas are rare, they are life threatening posing a significant diagnostic and therapeutic challenge and must be diagnosed early for better management.

Prevalence of Dengue Fever and Comparative Analysis of IgM and IgG Antibodies in Dengue Fever in Thoothukudi- Southern Coastal City, Tamil Nadu.

Background: The most challenging problem associated with patient management in Dengue infection is early diagnosis. Secondary infection with dengue virus is the most accepted risk factor for the development of dengue haemorrhagic fever. Serologic diagnosis of dengue virus infection using ELISA of both IgM and IgG distinguishes primary and secondary infections. Aim: To determine the prevalence of Dengue Fever in Thoothukudi, the coastal district of Tamilnadu by serological tests IgM ELISA and IgG ELISA, to compare the IgM and IgG status of the dengue cases to differentiate between the primary and secondary dengue cases. Methods: A cross sectional comparative study in patients with fever suspicious of dengue, fevers with other causes excluded. Detailed history is obtained and complete clinical examination done. IgM and IgG Elisa test were performed. Results: Out of 50 patients, 28 (56%) were positive for dengue and 22 (44%) were negative. 13 cases had primary Dengue (IgM positive) and 15 had secondary Dengue (IgM and IgG positive and IgG positive). Among the 28 positive cases 16 are paediatric, 10 cases had hemorrhagic manifestations, all were secondary dengue. Conclusion: As this study was conducted during an outbreak in Thoothukudi, unusually high prevalence is seen particularly among the pediatric ages. Higher morbidity is seen in secondary dengue cases. Thus, early discrimination of primary and secondary dengue helps to reduce the morbidity and mortality.

Analgesic Efficacy of Ropivacaine With or Without Clonidine in Bilateral Superficial Cervical Plexus Block in Thyroid Surgeries.

Background: Bilateral Superficial cervical plexus block (BSCPB) is one method of post op analgesia given before General anesthesia as this avoids polypharmacy. Objectives: This prospective randomized, controlled clinical study compared the post-operative analgesic efficacy of BSCPB using Ropivacaine (0.5%) with or without Clonidine (2mcg/kg).It also evaluated the intra operative opioid dosage and hemodynamic responses in patients undergoing thyroid surgeries. Methods: 60 Patients undergoing thyroidectomy were randomized into 3 groups,(Group A) BSCPB using normal saline ,(group B)Ropivacaine (0.5%) , (group C) Ropivacaine (0.5%) with Clonidine (2mcg/kg) before GA. Intra and post-operative hemodynamic responses, fentanyl dosage and the time of rescue analgesia were assessed. Post op pain scores using VAS, nausea, vomiting and sedation were assessed for 24 hours.Results: The mean duration of analgesia is highly significant (p<0.001) in group C. Intra operative fentanyl requirement was significantly lesser in groups B and C (P<0.001). Intra operative hemodynamic changes were significant in Group B and C. Post operative pain scores were significantly lower in groups B and C for the first 24 hours (P<0.001).The time of rescue analgesia in group A was early when compared to group B and C (P<0.001) and in group B when compared to group C .Post operative nausea, vomiting were lower in group B and C. Conclusion: BSCPB performed prior to GA using 0.5% Ropivacaine with or without clonidine was effective in reducing intra and post-operative analgesic requirements. The addition of Clonidine 2mcg/kg had highest analgesic efficacy when compared to Ropivacaine alone.

USG Guided Infraclavicular Perineural Infusion of Bupivacaine with Additives Adenosine and Magnesium Sulphate Compared for Upper Limb Surgeries.

Background: Brachial plexus block has revolutionized the field of regional anesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without major complications. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Methods: 40 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/ hand divided into two groups A (n-20) and B (n-20) randomly. Group A - adenosine 6mgs with 28 ml 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 6mgs of adenosine (2ml) at a rate of 5ml/hr. Group B - magnesium sulphate 75 mgs (in 2ml) with 28ml of 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 75mgs of magnesium sulphate (in 2ml) at a rate of 5ml/hr in USG guided placement of infraclavicular catheter. Results: Statistical analysis showed Group A had a faster onset time of sensory and motor block and faster recovery when compared to group B. Group A needed more rescue analgesia than group B. Though Group B had a higher incidence of sedation and vomiting than group A, it was not significant. Conclusion: Though the addition of adenosine and magnesium sulphate to bupivacaine as additive gives prolonged analgesia, magnesium sulphate exceeds adenosine in achieving prolonged postoperative analgesia and better pain score and may be a better choice than adenosine.

Randomized Clinical Comparison of Three Different Doses of Bupivacaine with Fentanyl for TURP-Search for Optimal Dose to Be Used in Day Care Urological Procedures.

Background: Patients who are candidates for TURP are elderly with cardiovascular and respiratory diseases with anticipated problems during spinal anesthesia. Aim: To compare three different doses (5mg, 7.5mg and 10mg) of Bupivacaine after adding 25 mcg of fentanyl during spinal anesthesia in transurethral resection of prostate surgeries. Methods: Single blinded Randomized clinical study conducted in 75 patients. The subjects were allocated in to three groups. Group A - received Inj. 0.5% Bupivacaine 5 mg, Group B- received Inj. 0.5% Bupivacaine 7.5 mg, Group C - received Inj.0.5% Bupivacaine 10 mg added with 25 mcg of Fentanyl. Baseline and intraoperative vital parameters, time to sensory block at t10, maximum sensory height, time to two segment sensory regression, total duration of sensory blockade, grading of motor blockade and total duration of motor blockade were recorded. Results: Maximum sensory level achieved in Group A was T9, Group B T7 and in Group C it was T5. Time to T10 level in Group A was 7.88 ±0.80 minutes, Group B 5.41 ±0.50 minutes and Group C 3.33 ±0.65 minutes. Two segment sensory regression times in Group A was 56.8±13.61 minutes, Group B 79.58 ±25.32 minutes, and Group C was 116.25 ±9.35 minutes. Total duration of pain free interval in Group A was 84.6 ±20.41 minutes, Group B 104.12 ±45.89 minutes. Group C was 194.20 ±41.53 minutes. Conclusion: Low dose of Bupivacaine (5mg) with addition of Fentanyl 25μg can be used for painless TURP surgeries when compared to higher doses (7.5mg and 10 mg) without any major side effects and facilitates early discharge.