Comparison of Lumbar Transforaminal Epidural Dexamethasone and Triamcinolone for Lumbar Radiculopathy

Epidural blockade is becoming one of the most useful and versatile procedures in modern anaesthesiology. What is unique is its application to clinical practice, as it can be placed virtually at any spinal level of vertebral column that allows considerable flexibility. Epidural steroid injections through lumbar transforaminal route to treat pain in lower back where radiculopathy is also associated with, are used widely. It has been reported that these procedures in lumber spine are effective clinically for improved physical function in patients as well as relief of pain of short- and long-term duration. We wanted to determine as to whether there is a difference in the efficacy between nonparticulate (e.g. dexamethasone phosphate) and particulate (e.g. triamcinolone acetate) steroids in Lumbar Epidural via transforaminal approach for acute radicular pain in lumber region and adverse effects of the drugs if any. METHODS66 patients, 33 in each group, with dexamethasone phosphate 8 mg or triamcinolone acetate 40 mg for lumbar transforaminal approach epidural steroid injection, were randomized. Observation was done through visual analog scale, short McGill pain questionnaire, revised Oswestry Disability Index before intervention and a month later. RESULTSA difference which was significant statistically in the visual analog score (2.85 ± 0.83 in group T, 5.76 ± 0.75 in group Dx), McGill Pain Questionnaire (3.73 ± 1.15 in group T, 6.55 ± 0.51 in group Dx) and Oswestry Disability Index (18.67 ± 7.13 in group T, 35.83 ± 5.10 in group Dx ) was found in both but was more in triamcinolone group. CONCLUSIONSEfficacy is more in particulate (triamcinolone) than non-particulate (dexamethasone) in epidural injection through lumbar transforaminal with no drug related complication, performed for radiculopathy in lumbar region.

Role of an Anaesthesiologist in the Management of an Embolised ASD Closure Device - Journey from Cathlab to OT

Percutaneous device closure of Atrial Septal Defect (ASD) is a commonly used technique as an alternative to surgery with advantages of avoidance of sternotomy, short hospital stay, and fewer complications. However, it may lead to life-threatening complications such as device embolization. We here, report such a case of embolization of the ASD occluder device causing right ventricular inflow obstruction and severe cardiopulmonary compromise. The anaesthesiologist plays the role of a team leader in diagnosing and managing such an emergency from cath lab to transfer of the patient till the retrieval of the device and discharge of the patient.Atrial septal defect is one of the commonest congenital heart diseases (3.78 / 10000). Shunts from ASD are detected in childhood or young adulthood and are well tolerated in infants and young children, but symptoms of mild fatigue, poor growth or dyspnoea on exertion may be present.(1) Thus, early closure should be considered in such infants. If the defect is small, it may not require any intervention. The shunt, tends to increase with age, and repair is required when ASD is diagnosed.1 Patients with huge defect closure to be done between 2 - 5 yrs. Total intravenous anaesthesia or MAC (Monitored Anaesthesia Care) is given in maximum interventional cardiology procedures as patient is required to stay still for up to 1 hr.2 Percutaneous transcatheter closure of the defect is most frequently done for ASD closure.3,4 It avoids the need for surgery, and is related to few complications.3,5 However, complications such as cardiac perforation, fistula formation, thrombosis, arrhythmia (2.6 %) device dislodgement (3.5 %) both to the systemic and pulmonary circulation.6 They may lead to haemodynamic compromise, inflow or outflow obstruction, which calls for immediate retraction. This is a case of right ventricular inflow obstruction due to embolised closure device.

Evaluation of Acromio-Axillary-Suprasternal Notch Index in Predicting Difficulty in Visualization of Larynxs in Adult Patients

In medical specialty, expertise in airway management is essential. Maintaining the airway and providing oxygenation is the responsibility of the anaesthesiologist. He is also responsible for reducing the morbidity, and mortality related to difficult intubation. To reduce the risk associated with difficult visualization of larynx, preoperative assessment of airway is required. To protect patient’s airway, endotracheal intubation is the gold standard. Direct laryngoscopy easily enables the securing the airway. This study was for predictive validity of the current system called acromio-axillo-suprasternal notch index in the assessment of difficult airway management. METHODSA total of 60 adult patients, of either gender, aged 18 - 65 years, of ASA class 1 and 2, undergoing elective surgery under general anaesthesia requiring tracheal intubation participated in this prospective, comparative, observational study. AASI was used for preoperative assessment of airway. Sensitivity, and specificity were calculated for AASI. In this study, data analysis was done using chi- square. p < 0.05 was considered statistically significant. RESULTSDifficult Visualization of Larynx was observed in 3.6 % [95 % confidence interval (1.9 – 5.4 %)] patients. Our study found that sensitivity and specificity were 75 % and 95.7 % respectively. CONCLUSIONSAcromio-Axillary-Suprasternal Notch Index (≥ 0.5) is a clear indicator of difficult larynx visualization with direct laryngoscopy.

Effectiveness of Transverse Abdominis Plane Block as a Method of Regional Anaesthesia in Unilateral Inguinal Hernia Repair

The Transverses Abdominis Plane (TAP) block is a relatively new regional technique which is often used for sensory blockade of the lower abdominal wall mainly for post-operative pain relief. It causes sensory blockade mainly because of injection of local anaesthetic between the internal oblique and the transverse abdominis muscle. TAP block was performed using a blind landmark technique in the lumbar petit triangle. Nowadays USG guided TAP block is being performed in many centers. TAP block is known to improve postoperative pain, reduce the opioid demand, and also reduce the time to rescue analgesia in patients undergoing lower abdominal surgeries. In our study, we have used TAP block as a main anaesthetic technique in patients posted for unilateral inguinal hernia repair under elective conditions. TAP Block in this study was given with 0.5 % bupivacaine. Duration of anaesthesia / analgesia, effectiveness of block, period of block, cardiac stability and haemodynamic stability were studied. METHODSA prospective observational study was conducted on 30 randomly selected individuals posted for elective inguinal hernia repair who belonged to American Society of Anaesthesiologists classification 1 and 2; age group between 20 and 70 years; satisfying all inclusion and exclusion criteria. All the patients received 0.5 % bupivacaine for TAP block, dose not more than 2.5 mg / Kg body weight. RESULTSWe have found that TAP block gives good anaesthesia for patients posted for inguinal hernia repair with good haemodynamic stability. With inj. Bupivacaine 0.5 % having an onset of anaesthesia at about 7.45 + / - 2.32 minutes (p value < 0.001). The block was complete and effectively elevated nociceptive stimuli. The block lasted till the end of surgery in all cases, with no complications. CONCLUSIONSTAP block other than being the main anaesthetic technique for lower abdominal surgery, also provides good post-operative analgesia with minimal post-operative analgesic requirement with less haemodynamic variations.

Comparison of Greater Palatine Nerve Block with Intravenous Fentanyl for Postoperative Analgesia Following Palatoplasty in Children

Good pain relief after palatoplasty is important as inadequate analgesia with vigorous cry leads to wound dehiscence, removal of sutures and extra nursing care. Decrease in oxygen requirement and cardio-respiratory demand occur with good pain relief and also promotes early recovery. Preoperative opioids have concerns like sedation, respiratory depression and airway compromise. Greater palatine nerve block with bupivacaine is safe and effective without the risk of respiratory depression. The study was done to compare pain relief postoperatively with intravenous fentanyl and greater palatine nerve block in children following palatoplasty. Methods80 children of ASA I & II, between 1 to 7 years were included and allocated into two groups of 40 each. Analgesic medication was given preoperatively after induction of general anaesthesia, children in Group B received greater palatine nerve block with 2 mL 0.25% inj. Bupivacaine (1 mL on each side) and Group F received 2 μg Kg-1 I.V. fentanyl as 2 mL solution. Assessment of pain was done by FLACC scale and recovery profile by Modified Aldrete Score. Haemodynamic monitoring along with side effects was assessed. Data was analysed using SPSS software (Statistical Package of Social Science) version 17.0. p-value of < 0.05 was considered significant. ResultsPatients receiving block showed significantly better recovery profile (9.22 ± 0.39) vs (8.78 ± 0.61), duration of analgesia (482.59 +93.76) vs (174.13 +84.91) and less mean paracetamol consumption (126.66 +18.70) vs (151.79 +60.03) with comparable haemodynamics and side effects. ConclusionsGreater palatine nerve block provides effective postoperative pain relief after palatoplasty in children compared to I.V. fentanyl. It is safe, easy to perform, and free of complications.

Comparative Evaluation of Baska Mask and LMA Supreme in Patients Undergoing Short Surgical Procedures Under General Anaesthesia.

Supraglottic airway devices (SAD) are used for airway management in patients undergoing general anaesthesia, averting the need of tracheal intubation. Laryngeal mask airway is easy to insert and can be inserted by paramedics also in case of emergency. Here we primarily compared the efficacy of Baska Mask and LMA supreme in terms of ease of insertion. The secondary outcome was assessment of oropharyngeal seal pressure and post op laryngopharyngeal complications. MethodsA sample size of 30 was calculated in each group. Patients were divided into 2 groups, Group B and Group S. After giving premedication, Anaesthesia was induced with propofol 3 mg/Kg and anaesthetic depth will be deepened with 2% sevoflurane in oxygen using bag mask ventilation. An appropriately sized prior lubricated Baska mask and LMA supreme was inserted in Group B and Group S, respectively and ease of insertion was assessed. ResultsThe BM was successfully inserted in 23 patients (76.6%) in the first attempt and LMA supreme was successfully inserted in 29 patients (96.6%) in the first attempt. The difference was found to be statistically significant (P= 0.028). BM created a significantly higher oropharyngeal seal pressure than the LMA supreme group (P < 0.001). No significant difference in postoperative laryngopharyngeal complications was observed. ConclusionsFrom the present study, it is concluded that LMA supreme is easier to insert than BM. The BM creates higher oropharyngeal seal pressure and thus provides a better airway seal than the LMA supreme. The incidence of postoperative laryngopharyngeal complications is similar in both the groups.

Comparison of Intrathecal Dexmedetomidine and Nalbuphine as an Adjuvant in Hyperbaric Bupivacaine for Saddle Block and Postoperative Analgesia in Patients Undergoing Perianal Surgeries.

Saddle block is the most commonly used anaesthetic technique for perianal surgeries in adults. Perianal surgeries under saddle block are considered as day care surgeries. Major disadvantage is that the low volume of spinally given drug won’t prolong duration of postoperative analgesia. Inj. Dexmedetomidine (α2-Adrenoceptor agonist) and Inj. Nalbuphine (opioid agonist-antagonist) were studied as an adjuvant as to whether they increase the duration of post-operative analgesia. Secondary objectives of this study were to compare hemodynamic stability and side effects among Inj. Dexmedetomidine and Inj. Nalbuphine. METHODSA total of 60 patients with American Society of Anaesthesiologist physical Status I and II scheduled for elective perianal surgeries were randomly allocated into two equal groups in this randomized prospective comparative study. Group D received 0.5% hyperbaric bupivacaine 0.8 mL + 5 mcg dexmedetomidine and group N received 0.5% hyperbaric bupivacaine 0.8 mL + 0.6 mg nalbuphine. Onset and duration of sensory and motor blockade, and duration of analgesia were recorded. Post-operative analgesic consumption and side effects were studied for 24 hours. Statistical analysis was done by using descriptive and inferential statistics using Chi- square test and Student’s t-test. RESULTSDemographic characteristics, duration of surgery, onset of sensory and motor block were comparable. Duration of analgesia was 320.26 ± 89.52 min for dexmedetomidine (D) whereas it was 222.23 ± 25.43 min for nalbuphine (N) with a P value of <0.05. No side effects were noted. CONCLUSIONA dose of 5 mcg dexmedetomidine as an adjuvant seems to be optimal for providing postoperative analgesia with better hemodynamic stability.

Comparison between Supraclavicular and Infraclavicular Brachial Plexus Block in Patients Undergoing Forearm Surgeries.

Of the various modalities of achieving surgical anaesthesia of the forearm, brachialplexus block by injecting local anaesthetic is considered highly beneficial andpractical. Supraclavicular and infra-clavicular approaches of brachial plexus blocksprovide comprehensive anaesthesia for surgeries of the forearm. The primaryoutcome measured was the comparison of two blocks with respect to sparing of anydermatome, whereas the secondary outcomes measured were block performancetime, duration of analgesia, and complications associated with each technique.METHODSSixty adult patients of either sex belonging to the American Society ofAnesthesiologists (ASA) physical status I and II in the age range of 20–70 yearsscheduled to undergo surgeries of the forearm were divided into two groups:Supraclavicular (SCB group) and Infraclavicular (ICB group) of 30 each. Both theblocks were given by 30 mL of 0.375% injection Bupivacaine using a 22G, 5 cminsulated needle and nerve locator. Both the groups were compared with respect tosparing of dermatomes, block performance time, duration of analgesia andcomplications like Horner’s syndrome, vascular puncture, and pneumothorax.Statistical analysis was performed with Student unpaired t‑test and Chi‑square testand p < 0.05 was considered to be statistically significant.RESULTSBlock performance time was similar in both the groups. Duration of analgesia wascomparable among the two groups. The incidence of incomplete radial block wassignificantly higher in ICB group as compared to SCB group (p= 0.046, S). Incidenceof Horner’s syndrome in SCB group were higher than in ICB group, but they werestatistically insignificant. (p=0.15, NS). One patient in SCB group had subclavian veinpuncture as compared to none in ICB group and was statistically insignificant.CONCLUSIONSSupraclavicular approach for brachial plexus block provides reliable andcomprehensive anaesthesia for forearm surgeries without any significantdermatomal sparing unlike infraclavicular approach. Both groups had similar blockperformance time and duration of analgesia for forearm surgeries. Even though SCBwas associated with complications like Horner’s syndrome and vascular puncture, itwas transient and statistically insignificant. Hence supraclavicular approach isconsidered to be superior to infraclavicular approach.

Efficacy of Topical Heparin in Prevention of Superficial Thrombophlebitis before Peripheral Venous Cannulation.

Thrombophlebitis can be very commonly associated with peripheral venous cannulation. Many a times, thrombophlebitis may go undiagnosed. With serious complications and uncertainty of the treatment, it is always better to prevent its development. Prophylactic topical heparin application can significantly reduce the incidence of thrombophlebitis and also the complications related like deep venous thrombosis and pulmonary embolism which increase the hospital stay. Thus, this study was conducted to evaluate the efficacy of topical heparin in prevention of development of superficial thrombophlebitis.METHODS150 patients in the age group of 20 - 60 years, were randomly allocated to group H (Heparin), group C (Control), with 75 patients in each group. Group C received placebo (normal saline) and group H received topical heparin QPS before the insertion of the cannula on the dorsum of the upper limb and were observed at an interval of 8 hours until 72 hours using Visual Infusion Phlebitis Scale.RESULTSAt the end of 72 hours, score of 0, I, II, and III was observed in 5.33%, 44.00%, 29.33% and 21.33% patients, respectively, in Group C; whereas score of 0, I, and II was observed in 60%, 25.33%, and 14.67% patients, respectively in Group H (P = 0.0001). In Group C, score up to III was observed, whereas maximum score was II in Group H and that too at 72 h in only 14.67% of patients which proves the efficacy of topical QPS of heparin [Table 2].CONCLUSIONSProphylactic topical application of QPS heparin was effective in preventing development of superficial thrombophlebitis.

Effectiveness of Intra-Articular Ropivacaine for Post-Operative Analgesia in Arthroscopic Knee Surgeries.

Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anaesthetic drugs and routes of administration. The aim of this study was to evaluate the efficacy and safety of intraarticularly administered inj. ropivacaine 0.25% 20 ml, after arthroscopic knee surgery performed under spinal anaesthesia, for prolonging the duration of post-operative analgesia.METHODSThis is a prospective randomized study conducted among 80 patients of both sexes, of American Society of Anesthesiologists, physical status I and II, undergoing day care arthroscopic knee surgery who were randomly assigned into two groups (R, C). Group R received 20 ml of 0.25% ropivacaine, whereas group C received 20 ml of 0.9% inj. normal saline through intra-articular route at the end of the procedure. Pain was assessed using visual analog scale (VAS) and paracetamol given as rescue analgesic when VAS >4. Time of first analgesic request and total rescue analgesic were noted.RESULTSTime for the requirement of first post-operative rescue analgesia (255.15±26.35 vs. 92.40±12.54) min and total mean rescue analgesic requirement was (1.32±0.52 vs. 3.0±1.0) in group R and C respectively. Group C had higher mean VAS score throughout the study period. No side effects were found among the groups. These two results were clinically and statistically significant (p<0.05).CONCLUSIONSAdministration of intra-articular inj. ropivacaine 0.25%, 20ml, is effective & safe method of management of postoperative pain in patients undergoing arthroscopic knee surgeries, as it prolongs the duration of postoperative analgesia, provides better quality of analgesia with reduced requirement of rescue analgesia without significant side effects.

A Comparative Study of Intrathecal 0.5% Hyperbaric Bupivacaine & Intrathecal 0.75% Isobaric Ropivacaine in Lower Abdominal Surgeries

Ropivacaine, a long acting amide local anaesthetic, has reduced potential for neurotoxicity and cardiotoxicity and is considered to block sensory nerves to a greater degree than motor nerves. In today’s world, faster recovery along with minimal side effects and early ambulation after surgeries under spinal anaesthesia are very important. So, this prospective randomized study was aimed at evaluating and comparing the efficacy and safety of intrathecally injected isobaric ropivacaine and intrathecally injected hyperbaric bupivacaine in patients posted for lower abdominal surgeries under spinal anaesthesia.METHODS90 patients belonging to ASA physical status I & II scheduled for lower abdomen surgeries were randomly selected for the study and were divided into two groups of 45 each. Group B received 3 ml of 0.5% hyperbaric (15 mg) bupivacaine intrathecally. Group R received 3 ml of 0.75% isobaric (22.5 mg) ropivacaine intrathecally. Onset and extent of sensory block, onset and duration of motor block, maximum height of sensory block, duration of analgesia, hemodynamic parameters and adverse effects if any were studied. SPSS 20.0 and GraphPad Prism 6.0 were used for the analysis of the data.RESULTSThe mean time for onset of sensory block was significantly faster in group B as compared to group R (8.28±2.2 min v/s 7.98±2.2 min). There was no significant difference between the groups regarding the time for two segment regression. Mean time of onset of motor block was significantly faster in group B. The mean duration of motor blockade was 146.89±14.11 min in group R and 208.91±14.62 min in group B. The mean duration of analgesia was comparable in both the groups. Hemodynamic parameters and side effects were comparable in both the groups.CONCLUSIONS0.75% isobaric ropivacaine provided similar duration of analgesia with a shorter duration of motor block as compared to hyperbaric 0.5% bupivacaine and it also provided adequate level of sensory block for the surgery with minimal intraoperative and postoperative side effects and stable haemodynamics throughout the surgery.

A Comparative Study of Intraperitoneal Ropivacaine and Bupivacaine for Postoperative Analgesia in Laparoscopic Cholecystectomy

Every surgical procedure inflicts pain during the procedure which also continues in the post-operative period as post-operative pain. Intraperitoneal instillation of local anaesthetics in laparoscopic cholecystectomy has been used to reduce postoperative pain and to decrease the need for postoperative analgesics. We wanted to compare intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.METHODSAfter obtaining ethical committee’s clearance and informed consent, sixty patients, aged 20–60 years, of either gender, and American Society of Anaesthesiologists physical status I to II scheduled for laparoscopic cholecystectomy were included and categorized into two groups (n=30). Group B patients received 20 mL of 0.5% bupivacaine intraperitoneally after cholecystectomy and Group R patients received 20 mL of 0.75% ropivacaine intraperitoneally after cholecystectomy. Mean duration of postoperative analgesia and number of doses of rescue analgesic required were observed. Patients were assessed at 0, 2, 4, 8, 12, 18 and 24 hours postoperatively with respect to quality of analgesia (VAS), hemodynamic parameters and side effects.RESULTSMean Time for first rescue analgesic requirement was 148.04 ± 53.47 min in group B and 295.38 ± 74.15 in group R and the difference was statistically significant (p=0.0001). In group R 17 (56.6%) patients did not require any rescue analgesic throughout the study period as compared to 8 (26.6%) patients in group B. The difference between the two groups was statistically significant. (p=0.019). A lower VAS score was observed in group R as compared to group B, with statistically significant difference at 2, 4 and 8 hours respectively. (p= 0.001, 0.003 and 0.032).CONCLUSIONS0.75% ropivacaine is a better alternative to 0.5% bupivacaine when given intraperitoneally for management of postoperative pain in patients undergoing laparoscopic cholecystectomy under general anaesthesia as it prolongs the duration of analgesia, provides a better quality of analgesia till 8 hours postoperatively, with lesser demand and requirement of rescue analgesic in the postoperative period, and has lesser side effects.

Evaluation of Role of Tranexamic Acid in Reducing Blood Loss and Transfusion Rate in Patients Undergoing Lower Limb Orthopaedic Surgeries.

Major surgeries like hip arthroplasty, knee arthroplasty etc.; are associated with excessive bleeding. Uncontrolled bleeding can lead to increased morbidity and mortality and may necessitate blood transfusions. This prospective, randomized study was designed to evaluate the efficacy and safety of injection tranexamic acid in reducing blood loss and rate of blood transfusion in lower limb orthopaedic surgeries without tourniquet under subarachnoid block.METHODSAfter approval from institutional ethical committee, the study was carried out on 80 patients who were divided into two groups of 40 patients each. Patients in group T received a bolus dose of 10 mg/Kg injection tranexamic acid 10 minutes before induction of anaesthesia and patients in group C received 0.9% 10 ml normal saline. Intraoperative and postoperative blood loss were recorded and added together for total blood loss. Postoperative haemoglobin and haematocrit were evaluated 24 hrs. after surgery. The number of patients who received blood transfusion and the number of units of blood transfused postoperatively were recorded. Early adverse reactions of tranexamic acid were recorded and treated. p<0.05 was considered significant.RESULTSMean intraoperative blood loss in group C (489.75+123.63 ml) was more than group T (450 + 138.66 ml) (p> 0.05). Postoperative blood loss was significantly less in group T (163.67 ± 44.13 ml) as compared to group C (205.43 ± 63.31 ml) (p<0.05). The mean total blood loss was significantly less in group T (613.67 ± 167.40 ml) as compared to group C (695.2 ± 162.44 ml) (p< 0.05). The drop in postoperative haemoglobin and haematocrit was significantly higher in group C as compared to group T (p < 0.0001). Significantly higher number of patients in group C (15) received postoperative blood transfusion as compared to group T (7) (p< 0.05). Acute adverse effects of tranexamic acid and complication of blood transfusion were not seen.CONCLUSIONSInjection tranexamic acid in a bolus dose of 10 mg/Kg is an effective and safe strategy to reduce blood loss and to minimise the rate of blood transfusions in lower limb orthopaedic surgeries without tourniquet under spinal anaesthesia.

Anatomical Landmark Guided versus Ultrasound-Guided Technique for Subclavian Vein Cannulation in Critically Ill Patients.

Background: Central Venous Access (CVA) is acommon requirement in the critically ill patient for avariety of indications including Central VenousPressure (CVP) monitoring, haemodialysis, placementof pulmonary artery catheters, cardiac pacing and foradministration of drugs especially vasoactive,chemotherapy agents and parenteral nutrition.Traditionally, Central Venous Catheter (CVC)placement is performed using Landmark (LM)technique and is associated with complications likearterial puncture, pneumothorax, hemothorax, airembolism, catheter embolism, and cardiac arrhythmias.Use of Ultrasound (US) is currently indicated forvarious clinical situations to reduce complication rate ofLM technique. Aim and Objectives: The purpose of thisstudy was to determine whether US guidance couldimprove the success rate, number of attempts, and rateof acute complications like inadvertent arterialpuncture, hematoma formation, and pneumothorax ofsubclavian venous catheterization. Material andMethods: Sixty patients in need of central venouscatheter were prospectively randomized in two groupsof 30 each. In the LM group patients were catheterizedusing the LM method and in US group patients werecatheterized by real-time US-guidance. Number ofattempts, success rate, access time and complicationslike accidental subclavian artery puncture, haematomaformation, pneumothorax, were recorded. p values<0.05 were considered statistically significant. Results:In the US group 30 (100%) of patients were successfullycannulated with the US guidance while the landmarktechnique was successful in 26 (86.66%) of patients. Inthe US group the success on first attempt was 83.33 %which was a significantly higher from 56.67% achievedin the LM group (p=0.025). The average number ofattempts for successful cannulation in the US group was1.16 ± 0.4, while in the LM group it was 1.56 ± 0.9 withstatistically significant difference (p=0.046). Accesstime was 27.26 ± 04.62 seconds in the US group, whilethe access time was significantly more in the LM group36.56 ± 17.35 seconds (p=0.0062). Conclusion: USguidance during subclavian vein catheterizationincreases overall and first attempt success, improvesaccess time with reduced average number of attemptsand complications.

Comparative Evaluation of Dexmedetomedine versus Clonidine as an Adjuvant in Supraclavicular Brachial Plexus Block.

Background: Supraclavicular block is considered to be the ideal block for upper extremity surgeries as it provides ideal operative conditions by complete muscle relaxation and stable intra operative hemodynamics. Aim and Objectives: The aim of the study was to evaluate the efficacy and safety of Clonidine and Dexmedetomedine as an adjuvant to Ropivacaine in supraclavicular brachial plexus block. Material and Methods: Ninety patients were divided randomly into 3 groups of 30 each. Group CL: Patients received injection Ropivacaine 0.5% (30 ml) + normal saline (1 ml), Group CD: Patients received injection Ropivacaine 0.5% (30 ml) + injection Clonidine (150 μg), Group DX: Patients received injection Ropivacaine 0.5% (30 ml) + injection Dexmedetomidine (100 μg). Onset of sensory and motor block, duration of analgesia and motor block, complications and side effects of the study drugs were compared among the three groups. Results: The onset of sensory and motor block was earliest in Group DX, followed by Group CD, f llowed by Group CL. Complete sensory and motor block were earliest in Group DX, followed by Group CD, followed by Group CL. Similarly duration of sensory and motor block was maximum in Group DX, followed by Group CD, followed by Group CL (p<0.05). Conclusion: Dexmedetomedine and Clonidine when added to Ropivacaine for supraclavicular brachial plexus block prolong the duration of analgesia. But Dexmedetomedine is a better adjuvant as compared to Clonidine