Ultrasound-guided erector spinae plane block versus port site infiltration for postoperative pain and quality of recovery in adult patients undergoing laparoscopic cholecystectomy: An assessor-blinded randomised controlled trial.

Background and Aim: Pain following laparoscopic cholecystectomy (LC) is common and results in poor quality of recovery. Our study aimed to compare the analgesic efficacy of port site local infiltration, novel erector spinae plane (ESP) block, and standard regimen in patients undergoing LC and its impact on functional recovery. Methods: After ethical approval and registering the trial, we randomly allocated 105 adult patients undergoing LC to three groups: Group I (n = 35), received multimodal analgesia; Group II (n = 35), received pre-incisional port site infiltration with 20 ml of 0.375% bupivacaine; and Group III (n = 35), preoperative bilateral ESP block with 20 ml of 0.375% bupivacaine bilaterally was administered. Pain severity, fentanyl consumption, and time to first rescue analgesia were recorded over 24 h. Quality of recovery (QoR-15) was assessed at baseline and 24 h postoperatively. Results: Pain in the first 6 h was lowest in the ESP group (P < 0.001). Although static pain in the infiltration group was comparable with that in the ESP group after 6 h (P > 0.05), dynamic pain was better in the ESP group till 20 h postoperatively (P < 0.05). Fentanyl consumption was significantly lower in the ESP group (P < 0.001). Global and sub-dimensional QoR-15 scores were significantly higher only in the ESP group at 24 h compared to the other two groups (P < 0.001). The infiltration group did better than the control group in terms of total opioid requirement (P < 0.001) and Visual Analogue Scale (VAS) score after 6 h (P < 0.001). Conclusion: ESP block provided lower postoperative pain scores with opioid-sparing and better quality of recovery in patients undergoing LC.

Update on preoperative evaluation and optimisation.

The patients presenting for surgery today often belong to the extremes of age, have multiple co-morbidities, and undergo complex surgeries. This makes them more prone to morbidity and mortality. A detailed preoperative evaluation of the patient can contribute to reducing this mortality and morbidity. There are various risk indices and validated scoring systems and many of them need to be calculated using preoperative parameters. Their key objective is to identify patients vulnerable to complications and to return them to desirable functional activity as soon as possible. Any individual undergoing surgery should be optimised preoperatively, but special considerations should be given to patients with comorbidity, on multiple drugs, and undergoing high-risk surgery. The objective of this review is to put forth the latest trends in the preoperative evaluation and optimisation of patients undergoing noncardiac surgery and emphasise the importance of risk stratification in these patients.

Postoperative pain relief and functional outcomes after pre-emptive ultrasound-guided caudal analgesia in patients undergoing spinal laminectomy under general anaesthesia: Comparison between bupivacaine versus bupivacaine with morphine.

Background and Aims: Prevention of the start of the neural cascade may result in long-term advantages by the elimination of hypersensitivity produced by noxious stimulus. This study was designed to evaluate postoperative pain and long-term functional outcomes after pre-emptive ultrasound (US)-guided caudal analgesia in patients undergoing spinal laminectomy. Methods: A total of 90 consecutive patients, aged 20 to 60 years, of either sex, scheduled for elective spinal laminectomy under general anaesthesia were randomly allocated to two groups. Group M (n = 45) received 3 mg morphine + 0.25% bupivacaine (25 ml), whereas group B (n = 45) was administered 0.25% bupivacaine (25 ml) in caudal block. The primary outcome was to observe postoperative static and dynamic pain using the Verbal Numerical Rating Score (VNRS) for 24 h. The secondary outcome was to record functional outcomes using two questionnaires-Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) during the preoperative period, at 1 month and 3 months postoperatively. Results: The static and dynamic VNRS scores were significantly less in group M (P < 0.05). There was a statistically significant clinical improvement in RMDQ and ODI scores at all-time intervals between both groups (P < 0.05). A four-point difference in ODI during subsequent months represents a true change and the results of our study showed an outstanding improvement of 9-11 points at 1 and 3 months from the baseline. Conclusion: The use of caudal block with the US guidance in adults undergoing spine surgeries can bring new horizons in improving pain relief and long-term functional outcomes.

Evaluation of Gastric Emptying by Ultrasonography after Recommended Fasting Period and Administration of Prokinetic in End-stage Renal Disease Patients.

BACKGROUND: Delayed gastric emptying is observed in end-stage renal disease (ESRD). AIMS: Evaluation of gastric emptying after recommended fasting period and on oral administration of prokinetic in ESRD patients using ultrasonography (USG). SETTINGS AND DESIGN: Randomized, double-blind, prospective, controlled study. MATERIALS AND METHODS: After institutional ethics committee approval, 200 patients were divided randomly into two equal groups. Three sessions of USG evaluation of gastric antrum were done in supine and right lateral position for assessing gastric emptying, first at 8 am, second after the light meal at 8.30 am, and third after 6 h of light meal. Group A received placebo (sugar-coated pill) and Group B received tablet metoclopramide hydrochloride 10 mg after second session of USG. In each session, measurement of anteroposterior and craniocaudal diameters of gastric antrum was done, and then cross-sectional area was estimated. Three-point grading system (Perlas) was used to perform qualitative evaluation. STATISTICAL ANALYSIS: Comparison of normally distributed continuous variables was performed using Student's t-test. Nominal categorical data were compared using Chi-squared test. Nonnormal distribution continuous variables were compared using Mann-Whitney U-test. RESULTS: 6 h of fasting after light meal showed that Group A only had 14% incidence of complete gastric emptying, whereas Group B had 71% as compared by Perlas grading. Gastric antral cross-sectional area measured both in supine (480.89 ± 84.92) and right lateral (575.40 ± 92.62) position of Group A was more than Group B supine (394.15 ± 62.80) and right lateral (470.25 ± 73.63) position (P < 0.05). CONCLUSION: USG of ESRD patients preoperatively can evaluate gastric contents to assess risk of pulmonary aspiration and guide anesthetic management. Metoclopramide is a good drug to enhance gastric emptying in ESRD patients within the recommended fasting period.

Role of pre-emptive Huff's manoeuvre and acupressure in reducing the incidence of fentanyl induced cough; a risk factor for postoperative nausea vomiting in female patients: A prospective randomised controlled study.

BACKGROUND AND AIMS: Fentanyl-induced cough is found to occur more often in females and it has been observed to be a risk factor for post-operative nausea and vomiting (PONV). We studied the effect of pre-emptive Huff's manoeuvre and acupressure in reducing incidence of PONV in patients who had fentanyl-induced cough (FIC). METHODS: This prospective, experimental and randomised study was conducted on 336 patients who were randomly divided into three groups. Group A (n = 112): acupressure was applied, Group B (n = 112): Huff's manoeuvre was performed and Group C (n = 112) was the control group. Thereafter the patients were given a rapid bolus of injection fentanyl at a dose of 2 µ/kg before induction of anaesthesia. Any episode of cough within 60 seconds of fentanyl administration was classified as FIC, and the severity was graded based on the number of coughs (mild 1 - 2, moderate 3 - 4, and severe 5 or more). The occurrence of PONV was recorded. Statistical analysis done using ANOVA test, Kruskal Wallis. RESULTS: Incidence of FIC was 8%, 7.1%, and 25.9% in Acupressure, Huff's and control group respectively. The incidence of PONV was found to be higher in patients who had FIC rather than the patients who did not have FIC. CONCLUSION: We conclude that use of Acupressure and Huff's manoeuvre have been demonstrated to be efficacious in reducing FIC and also have an impact in reducing PONV.

Prediction of endotracheal tube size in children by predicting subglottic diameter using ultrasonographic measurement versus traditional formulas.

BACKGROUND: Paediatric airway assessment remains the most challenging task before the anaesthesiologists. Recent advancement in ultrasonography techniques should now allow for accurate and descriptive evaluation of paediatric airway. To compare calculated external diameters of the endotracheal tube from physical indices of traditional formulas and predetermined by ultrasound. MATERIALS AND METHODS: 100 subjects of either sex between 12-60 months of age, undergoing various elective surgeries under general anaesthesia requiring endotracheal intubation were enrolled in the study. The transverse diameter was measured at the level of cricoids cartilage by ultrasonography. The tracheal tube was considered best fit if air leak was satisfactory at 15-20 cm H2O of airway pressure. The obtained values were compared with the values of endotracheal tube size calculated by various age, height, weight based formulas and diameter of right and left little finger. The correlation of size of Endotracheal tube by different modalities was done and Pearson's correlation coefficient was obtained. RESULTS: According to Pearson's correlation there was a moderate correlation of best fit Endotracheal tube with endotracheal tube size by age based formula (r = 0.743), body length based formula (r = 0.683), right little finger based formula (r = 0.587), left little finger based formula (r = 0.587) and multivariate formula (r = 0.741). There was a strong correlation with ultrasonography (r = 0.943). CONCLUSION: Ultrasonography is a reliable method of estimation of subglottic diameter and for prediction of endotracheal tube size in children.

Are Female Children More Likely to be Born to Indian Anesthesiologists? - A Nationwide Survey.

CONTEXT: Exposure to medications (prescribed or over-the-counter) or exposure to chemicals (unintentional or occupational) during pregnancy have always been of great scientific concerns. AIMS: This study aims to ascertain whether the recently documented offspring sex ratio (OSR) skew in medical literature is reproducible among our respondent population and how our respondents' characteristics relate to the OSR skew (if any) in our respondent population. SETTINGS AND DESIGN: A survey questionnaire uploaded on the SurveyMonkey® Online Portal. SUBJECTS AND METHODS: The survey was completed by the Indian anesthesiologists about themselves and their spouses during the periconceptional periods of their offspring. STATISTICAL ANALYSIS USED: Analysis of variance for means and Chi-square test for proportions with P < 0.05 as statistically significant. RESULTS: Respondents (irrespective of gender) who sired first-born or second-born male children were anyway more likely to sire male children as reflected in the personal sex ratios among all offspring sired by them, and similarly respondents (irrespective of gender) who sired first-born or second-born female children were anyway more likely to sire female children. Male parents were significantly more common to have worked in operating rooms around the time of conception of first-born or second-born children. As compared to female anesthesiologists, male anesthesiologists significantly reported that they were practicing inhalational induction of anesthesia more often around the conception of their second-born female children as compared to around the conception of their second-born male children. CONCLUSIONS: Practice of inhalational induction of anesthesia was reportedly more common among Indian male anesthesiologists during periconceptional period of their second-born female children.

Post-operative effectiveness of continuous wound infiltration, continuous epidural infusion and intravenous patient-controlled analgesia on post-operative pain management in patients undergoing spinal surgery.

BACKGROUND AND AIMS: Very few studies have compared continuous wound infiltration (CWI), continuous epidural infusion (CEI) and intravenous Patient Controlled Analgesia (PCA) with morphine in spine surgery. This study compared these modalities in patients undergoing microdissectomy. METHODS: This prospective, randomized control trial was conducted on 75 patients of American Society of Anesthesiologists' physical status I or II undergoing microdiscectomy. Patients in all the three groups received morphine 1 mg IV, with a lockout period of 10 min after each bolus, and the maximum allowed dose was 15 mg/5 h postoperatively. Patients in Group A received CWI with 0.25% levobupivacaine 20 mL as bolus after extubation followed by infusion at 5 mL/h. Group B received CEI with 0.25% levobupivacaine at 5 mL/h. Patients in Group C received intravenous (IV) morphine by PCA pump only. The primary end points were static and dynamic visual analogue scores (VAS) and postoperative pain scores. Secondary observations were postoperative morphine consumption at 8 h, 24 h and 48 h, and patient satisfaction. RESULTS: Group A showed greater analgesic effects at 12 h (P < 0.02), 24 h (P < 0.03), 36 h (P < 0.008) and 48 h (P < 0.007) when compared to the other two techniques, as pain scores were less in group A as compared to group B and C. The requirement of postoperative intravenous morphine (mg) was 18 ± 12.82, 22.92 ± 9.88, 41.56 ± 8.83 for groups A, B and C after 48 h (P < 0.001). CONCLUSION: Continuous wound infiltration is an effective postoperative pain control technique with minimal side effects, after spinal surgery.

The opinion of post graduate students on objective structured clinical examination in Anaesthesiology: A preliminary report.

BACKGROUND AND AIMS: The scenario in medical education is changing with objective structured clinical examination (OSCE) being introduced as an assessment tool. Its successful implementation in anaesthesiology postgraduate evaluation process is still limited. We decided to to evaluate the effectiveness of OSCE and compare it to conventional examinations as formative assessment tools in anaesthesiology. METHODS: We conducted a cross-sectional comparative study in defined population of anaesthesiology postgraduate students to evaluate the effectiveness of OSCE as compared to conventional examination as formative assessment tool in anaesthesiology. Thirty-five students appeared for the conventional examination on the 1(st) day and viva voce on the 2(nd) day and OSCE on the last day. At the conclusion of the assessment, all the students were asked to respond to the perception evaluation questionnaire. We analysed the perception of OSCE among the students. RESULTS: Results showed a positive perception of the objective structured physical examination (OSCE) as well as structured 9 (25.7%), fair 19 (54.2%) and unbiased 13 (37.1%) with more standardised scoring 9 (25.7%). The students perceived OSCE to be less stressful than other examination. Thirty-one (88.5%) students agreed that OSCE is easier to pass than conventional method and 29 (82.5%) commented that the degree of emotional stress is less in OSCE than traditional methods. CONCLUSION: OSCE is better evaluation tool when compared to conventional examination.

Cervical Spine Movement and Ease of Intubation Using Truview or McCoy Laryngoscope in Difficult Intubation.

STUDY DESIGN: Prospective, observational, analytical, randomized control trial. OBJECTIVE: To compare cervical spine movement for best laryngoscopic view and ease of intubation using Truview or McCoy laryngoscope in anticipated difficult intubation. SUMMARY OF BACKGROUND DATA: The addition of modified laryngoscope blade to the anesthesiologist's armamentarium adds flexibility and improves the skill of the anesthetist, which benefits the patients. METHODS: One hundred patients of American Society of Anesthesiologists status I and II with predicted difficult intubation score ≥5 were divided into two groups: Group A (n = 50): intubation done with McCoy laryngoscope and Group B (n = 50): intubation done with Truview laryngoscope and compared for the ease of intubation using intubation difficulty scale (IDS), cervical spine movement, and hemodynamic alterations. RESULTS: The total IDS determining the ease of tracheal intubation was better in Group B than Group A. On comparing the variables of IDS score, there was no difference between the two groups except 14 (28%) patients in Group A required application of external laryngeal pressure, whereas only five (10%) patients had this difficulty in Group B. It was seen that craniocervical extension was significantly less (2.5 times) in Group B as compared to Group A. CONCLUSION: In anticipated difficult intubation, Truview improves the laryngeal view, causes less movement at cervical spine, which could be more helpful in patients with restricted neck mobility, and has lesser complications. LEVEL OF EVIDENCE: 2.

A comparison of granisetron and nitroglycerine for attenuating rocuronium pain: A double-blinded randomized, placebo controlled trial.

BACKGROUND: The incidence of pain reported in literature after IV administration of rocuronium is 50-80%. The aim of our study was to determine whether pre-treatment with intravenous granisetron and nitroglycerine would reduce rocuronium-induced pain. METHODS: One hundred fifty patients of either sex, aged 18-65 years, American society of Anaesthesiologist grading (ASA) I-II, scheduled for various surgeries under general anesthesia were randomly assigned to one of the groups. Group G: received 2 granisetron (1mg/ml) diluted with 3 ml of 0.9% normal saline) while the Group C: received 5 ml of 0.9% normal saline. Group N: received 200΅g of nitroglycerine diluted to a total of 5 ml(with 0.9% normal saline). It was accompanied by manual venous occlusion for 20 seconds. Then 0.06mg/kg of rocuronium was injected through same cannula over 10-15 sec. Patients were asked by a blinded investigator to score the pain on injection of rocuronium using visual analogue scale (0-10) with 0-no pain,1-3 mild pain, 4-6 moderate and >=7 severe pain. At the same time discomfort in the form of patient's movement, such as no movement (grade 0), movement only wrist (grade 1), movement to the upper arm and shoulder of injected arm (grade 2) or generalized movements (grade3) was observed. Statistical analysis using independent t test, Mann-Whitney test and reverse ANOVA was done. RESULTS: 1. At 0 seconds, in group G number of patients who experienced withdrawl score of 0-1 were 92%,group N were 82% while only 26% of patients in group C had favourable withdrawl score.74% of patients in group C had score of 2-3 at same time. 2. At 0 sec, in group G number of patients who experienced VAS score of 0-3 were 96%, group N 72%. At same time Group C 48 % of patients had VAS score of 2-3. CONCLUSION: We conclude that pre-treatment with granisetron or nitroglycerine both are highly effective in attenuation of rocuronium induced pain.

Postoperative pain and long-term functional outcome after administration of gabapentin and pregabalin in patients undergoing spinal surgery.

STUDY DESIGN: Prospective, double-blind study, randomized control trial. OBJECTIVE: To evaluate and compare the analgesic efficacy, adverse effects, and clinical utility of gabapentin and pregabalin in postoperative pain management, long-term functional outcome, and quality of life in patients undergoing spinal surgery. SUMMARY OF BACKGROUND DATA: Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. The most common persistent symptoms are pain, motor deficit, and decreased functional status. METHODS: This study was conducted in 90 patients belonging to the 18 to 75 age group of either sex undergoing spinal surgery under general anesthesia. Group A received 300 mg of gabapentin, group B received 75 mg of pregabalin, whereas group C received placebo 1 dose 1 hour before surgery and 8 hourly for 7 days, thereafter. The outcome of postoperative static and dynamic pain and functional outcome was recorded using 3 questionnaires-visual analogue scale, Prolo functional and economic score, Oswestry Disability Index score from preoperative period to 3 months postoperatively. RESULTS: Among the 3 groups, subjects receiving pregabalin showed consistently reduced static and dynamic pain intensity and also required lesser amount of rescue drug throughout the postoperative period. There was statistically significant difference (P < 0.05) in the Prolo score and Oswestry Disability Index score at all time intervals between group B and group C. Although, significant difference in the functional outcome between group A and group B was seen at 3 months. CONCLUSION: Preoperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy followed by gabapentin and then placebo. LEVEL OF EVIDENCE: 2.

Anesthesia for opioid addict: Challenges for perioperative physician.

Opioid addiction is on a rise globally. Such a patient presents to an anesthesiologist as well as to the surgeon with an array of challenges. We present the case of an opioid addict (pentazocine) who presented for debridement and grafting of eschars and old healed scars. Initially he was medically managed for opioid addiction followed by a planned anesthesia. We hereby discuss the challenges faced during perioperative period.

Current understanding of the literate versus illiterate patient's knowledge about anesthesiologists: A comparative study.

CONTEXT: There is a widespread ignorance among the public about the role of anesthesiologists and their responsibilities inside or outside the operating room both in developed and developing countries. AIMS: The present study was conducted to assess the knowledge of literate and illiterate patient about the role of anesthesiologists and their concerns regarding anesthesiology. SETTING AND DESIGN: This is a prospective study conducted in a preoperative anesthetic clinic of a large tertiary care hospital. The study consisted of a standard preanesthetic interview and questionnaire. MATERIALS AND METHODS: After obtaining permission from the Ethics committee, patients in the age group 18-75 years of either sex undergoing elective surgery were included. The patients were divided into two groups on the basis of their education: Group A: included patient who are illiterate; Group B: included patients who are literate, completed a questionnaire, which was later evaluated. STATISTICAL ANALYSIS USED: Unpaired t test and correlation r test were used. RESULTS: There was limited knowledge among both literates and illiterates regarding the perioperative role of anesthesiologists. They wanted to be fully explained about the anesthesiology technique and were keen to meet their anesthesiologist both before and after the surgery. CONCLUSION: To eliminate the ignorance among general public regarding the role of anesthesiologists, efforts must be made to educate and generate awareness among the population.

A retrospective analysis of anesthetic experience in 2917 patients posted for cleft lip and palate repair.

CONTEXT: Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children. AIM: to study the perioperative anesthetic complications in poor children with cleft abnormalities. SETTINGS AND DESIGN: Retrospective analysis. MATERIALS AND METHODS: This retrospective audit was conducted on 2917 patients of smile train project under going general anesthesia for cleft lip and palate from January 2007 to December 2010. Demographic, pre-anesthetic status, anesthetic management and anesthesia complications were recorded. Chi-square test was used to assess the relation between patient factors and occurrence of complications. RESULTS: Of the 3044, we were able to procure complete data of 2917 patients. Most of children presented with anemia 251 (35%), 202 (29%) had eosinophilia while 184 (26%) had upper respiratory tract infection. The incidence of perioperative complications was 8.19% of which 33.7% critical incidents occurred during the induction time. The most common complication was laryngospasm 77 (40.9%) followed by difficult intubation 64 (30.9%). There was no mortality. CONCLUSION: Since these procedures do not characterize an emergency, most of the perioperative complications can be prevented by following the routine installed by the institute and smile train protocols.

Recovery profile and emergence delirium following sevoflurane and isoflurane anesthesia in children posted for cleft lip surgery.

UNLABELLED: This prospective, randomized, double control study was carried out in 84 children aged 2-24 months posted for elective cleft lip surgery. METHODS: Patients were randomally divided into 2 groups of 42 patients each. In Group A patients were induced and maintained on sevoflurane while in Group B patients were induced with sevoflurane and maintained on isoflurane. Standardized anesthesia technique was used. Recovery milestones and post operative complications were recorded. RESULTS: Incidence of emergence delirium in sevoflurane group was 11.9% while in isoflurane group is 2.38%. The overall incidence of emergence delirium in the study was 7.14%. There was no significant difference (p > 0.05) in the incidence of emergence delirium between the two groups. There was no effect of duration of exposure of sevoflurane and time taken for achievement of recovery milestones while we observed a positive correlation with isoflurane. In sevoflurane the recovery endpoint first reached was limb movement > spontaneous respiration > spontaneous eye opening. In isoflurane group the recovery end point first reached was spontaneous respiration > limb movement = spontaneous eye opening. CONCLUSION: Our study confirms that the recovery profile of sevoflurane in children less the two years is superior compared to isoflurane.

An observational study on the epidemiological and mycological profile of Candidemia in ICU patients.

BACKGROUND: This study aimed to analyze the epidemiological and mycological profile of candidemia in intensive care unit (ICU) patients attending a tertiary care teaching hospital in the Himalayan region of northern India. MATERIAL/METHODS: A 15-bed medico-surgical ICU and a 5-bed pediatric ICU. Ninety-one consecutively admitted ICU patients were screened for the presence of candidemia by performing blood cultures at periodic intervals. RESULTS: The recovered Candida isolates were speciated and subjected to antifungal susceptibility testing using standard procedures. Forty-one of the recruited patients (45%) were found to be candidemic, with the majority of patients being in the extremes of age (13 neonates and 15 >65 years of age). Four risk factors were found to be significantly associated with the occurrence of candidemia in our patients - a period of hospitalization exceeding 7 days (p=0.0008), previous use of antibiotics (p=0.001), presence of chronic renal failure (p=0.003), and ongoing cancer chemotherapy (p= 0.041). Ninety-six Candida isolates were recovered from the 41 culture-positive patients, with Candida albicans being the commonest isolate recovered (n=75, 78.1%), followed by Candida tropicalis (n=15, 16%), and Candida glabrata (n=6, 6.5%). Fluconazole resistance was observed among 26% of all Candida isolates and 17.3% of C. albicans isolates. CONCLUSIONS: Contrary to the majority of recent reports, species shift towards non-albicans candidemia has not been observed in our center, though the prevalence of azole resistance is alarmingly high even among the C. albicans isolates.

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery.

UNLABELLED: AIMS AND CONTEXT: To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively SETTING AND DESIGN: Prospective, randomized, double-blind study. METHODS: Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine (1 µg/kg) and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. STATISTICAL ANALYSIS: Two sample unpaired t-test and the correlation r test. RESULTS: The duration of analgesia from the time of administration of block in group A was 667.72 ± 210.74 min compared to 558.48 ± 150.28 min in group B (P<0.05). CONCLUSION: Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects.

Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine.

BACKGROUND: Propofol has the disadvantage of causing pain or discomfort on injection. The aim of the study was to assess the efficacy of pretreatment with various drugs to alleviate the propofol injection pain. METHODS: One hundred American Society of Anesthesiology (ASA) I and II adults, scheduled for various elective surgical procedures under general anesthesia (GA), were included in the study. They were randomly divided into four groups having 25 patients in each group. Group A received pretreatment with intravenous (i.v.) magnesium sulfate, group B received i.v. granisetron, group C received i.v. nitroglycerine and group D was the control group. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 seconds. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal response. A score of 0-3 which corresponds to no, mild, moderate and severe pain was recorded. RESULTS: All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was granisetron > nitroglycerine > magnesium sulfate > control. CONCLUSION: Granisetron was the most effective followed by nitroglycerine and magnesium sulfate in attenuating pain on propofol intravenous injection.