European Journal of Molecular & Clinical Medicine

Preservative free Chloroprocaine (CP) seems like a promising alternative, being a short acting agent of increasing popularity in recent years. While Chloroprocaine was withdrawn from the market in the 1980s because of concerns about neurotoxicity a new formulation without preservatives that has no longer been associated with neurotoxicity was introduced in clinical routine. After taking informed and written consent, 40 patients of either sex, aged between 18-60years, belonging to American Society of Anaesthesiologists Physical status I to III, undergoing elective perianal surgeries under spinal anaesthesia enrolled in this observational study. Our study showed mean time of onset of motor block was 8.38±1.25 minutes, mean time to achieve maximum motor block 9.45±0.71 minutes and mean time for motor regression to bromage scale 0 was 65.68±15.19 minutes. The time to void was 98.32±15.80 min and time to ambulation was 89±15.30 min the time of first postoperative analgesic requirements was 96.32±12.83 min.

Spinal anaesthesia requires a small volume of drug to produce profound sensory and motor blockade but has limited duration of action. An adjunct to local anaesthetic produces a better-quality regional block.The present study was aimed to evaluate the study and tolerability of combined use of intrathecal neostigmine and fentanyl as an adjunct to bupivacaine for postoperative analgesia in patients posted for abdominal surgeries under spinal anaesthesia. Material and Methods: Present study was single-center, prospective, comparative, observational study, conducted in patients of age group of 20-60 years, of either gender, ASA grade I/II, Elective patients undergoing Lower Abdominal Surgeries. 60 patients were divided by computer assisted randomization table into 2 groups of 30 subjects each as GROUP B (BUPIVACAINE Group) & GROUP C (COMBINED Fentanyl Neostigmine Group). Results: There was no significant difference in age distribution, gender distribution & ASA grade in two groups. (p>0.05). The mean duration of sensory block was found to be 194.16 ±21.43 minutes in group C while 153.03 ±19.19 minutes in group B, difference was statistically highly significant. (P <0.0001). The mean duration of motor block was found to be 197.18 ±21.78 minutes in group C while 169.26 ± 19.38 minutes in group B, difference was statistically highly significant. (P <0.0001) There was no difference when two groups were compared statistically for complications. (p>0.05) post-operative analgesia remained for longer duration in Group C, 7.40 ± 1.21 hours as compared to 5.32 ± 1.21hours in Group B, difference was statistically significant (P <0.05). Conclusion: Spinal neostigmine added to bupivacaine and fentanyl provided a significantly longer surgical analgesia and insignificant adverse effects who had lower abdominal surgery under spinal anaesthesia.

Spinal anaesthesia is the most preferred technique for infraumbilical surgeries.Hyperbaric Ropivacaine has been shown to produce reliable and predictable anaesthesia for surgery. Fentanyl, a synthetic lipophilic opioid and Dexmedetomidine, a new highly selective α2-agonist, have been used as neuraxial adjuvants in spinal anaesthesia to prolong intraoperative and postoperative analgesia. The present prospective randomized study is undertaken to investigate and compare the clinical effects of 0.75% hyperbaric ropivacaine with additives such as fentanyl and dexmedetomidine on spinal anaesthesia for infraumbilical surgeries.
Aim: To compare the clinical effects of intrathecal 2ml of 0.75% hyperbaric ropivacaine with fentanyl 25μg and dexmedetomidine 10μg as additives in patients undergoing elective infraumbilical surgeries.
Materials & Methods: The study was conducted on 90 patients of both sexes, aged 18-60 years, of class I or II of the American Society of Anesthesiologists classification, who underwent elective infraumbilical surgery. Patients were randomly assigned to three groups (30 patients each): group RC (control group) received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of normal saline (0.9%) at a total volume of 2.5ml intrathecally, whereas group RF received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of 25μg fentanyl (50 μg/ml) at a total volume of 2.5ml intrathecally and group RD received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of 10μg dexmedetomidine (50μg dexmedetomidine diluted in 2.5ml of normal saline) at a total volume of 2.5ml intrathecally. The onset, extent, duration of sensory and motor blockade, time to first rescue analgesia request, hemodynamic parameters, and side effects such as nausea, vomiting, pruritis, respiratory depression and shivering were recorded.

Introduction: Hysterectomy is routinely performed laparoscopically. It has many advantages as compared to open abdominal hysterectomy such as less post operative pain, better cosmetic results, shorter hospital stay, lower complication rate. However Laparoscopic surgeries are routinely performed under general anaesthesia with endotracheal intubation to prevent aspirations of gastric contents and respiratory embarrassment secondary to pneumoperitoneum.But it has several disadvantages like hemodynamic instability, postoperative nausea and vomiting, increased postoperative analgesic requirement, complications related to intubation or extubation and postoperative sore throat.
Material and Methods: After the approval of institutional ethics committee and written informed consent 24 ASA grade 1 and 2 patients in the age group of 35 to 55 years underwent total laparoscopic hysterectomy under spinal anaesthesia with intrathecal bupivacaine and fentanyl. Exclusion criteria included those with presence of any condition contraindicating elective surgery or spinal anaesthesia. The patients were explained during pre-operative visit about the procedure and also told that any anxiety, pain, or discomfort during the surgery would be dealt with intravenous medications or if required conversion to general anaesthesia.

Spinal anaesthesia is a safe and reliable technique for surgery of the lower abdo­men and lower limbs. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The choice of the correct local anaesthetic for spinal anaesthesia is therefore crucial in the ambulatory setting: the ideal anaesthetic should allow rapid onset and offset of its own effect for fast patient discharge with minimal side effects.
Aims: To compare the duration of sensory and motor blocks with use of chloroprocaine, and levobupivacaine as local anaesthetics in spinal anaesthesia.
Materials and method: The present study was a Prospective randomized open label double blind study. This Study was conducted From 18 months, from February 2018 to July 2019 at Department of Anaesthesia, Bankura Sammilani Medical College and Hospital. Total 72 patients were included in this study.
Result: We found that, In group-C, the mean duration of surgery (mean ±s.d.) of the patients was 43.7500 ± 5.6537 mins. In group-L, the mean duration of surgery (mean ±s.d.) of the patients was 44.5833 ± 4.3712 mins. There was no statistically significant difference in ASA gradings in between two groups (p=0.4865). There was no statistically significant difference in mean time to reach peak block height in between two groups (p=0.6142). In group-C, the mean two segment regression time (mean ±s.d.) of the patients was 57.0833 ± 8.5670. In group-L, the mean two segment regression time (mean ±s.d.) of the patients was 80.5833 ± 7.4234. There was statistically significant difference in mean two segment regression time in between two groups (p<0.001). There was statistically significant difference in mean time for regression to L1 in between two groups (p<0.001). There was   no statistically significant difference in PEAK BLOCK HEIGHT in between two groups. (p=0.4004).
Conclusion: we conclude that in patients undergoing unilateral knee arthroscopy, the use of chloroprocaine was associated with decreased time of duration of sensory and motor block and early recovery, early ambulation and early void. There were no statistically significant difference is noted in haemodynamic changes in between two groups. No adverse effects regarding allergic reactions, hypotension, shivering, bradycardia  and nausea and vomiting were  found during intraoperative and postoperative period.

INTRODUCTION: When the intrathecal opioid drug was administered with the local anaesthetic in Spinal anaesthesia they develop the superior quality of analgesia. Fentanyl was found to provide safe potentiate of local anaesthetic effects by its increased lipophilic quality and decreased rostral spread. The present study was conducted to compare block characteristics of equal doses of isobaric levobupivacaine 0.5% (10 mg) with normal saline and isobaric levobupivacaine 0.5% (10 mg) plus fentanyl (25 μg), in infraumbilical surgeries under spinal anaesthesia.
MATERIALS AND METHODS: The present prospective observational study was conducted in tertiary health centre from January 2020 to June 2021 amongst 120 patients belong to ASA physical status I and II aged between 20 to 65years who underwent infraumbilical surgeries. Study population were divided into Group L: Group of 60 patients received 2 ml of 0.5% isobaric levobupivacaine (10 mg) plus 0.5 ml normal saline and Group LF: Group of 60 patients received 2 ml of 0.5% isobaric levobupivacaine (10mg) + 0.5 ml fentanyl (25 μg).
RESULTS: The mean time for onset of sensory blockade at T10 dermatome in group L (7.1±1.4 min) was late than in group LF (5±1.6 min). Higher dermatomal level of sensory blockade was achieved by addition of fentanyl. The mean time for maximum sensory blockade was earlier in group LF (8.1±1.7min) than in group L (15.6±2.1min.). Maximum motor blockade was achieved significantly earlier in group LF than group L. The total duration of sensory blockade was significantly prolonged in group LF than in group L.Total duration of analgesia in group L was 199.2 ± 10.7 min and in group LF was 263.2 ± 14.7 min.
CONCLUSION: It was concluded that addition of fentanyl to levobupivacaine leads to early onset of sensory blockade and prolonged duration of sensory blockade, motor blockade, stable hemodynamics and prolonged postoperative analgesia thus decreasing the doses of rescue analgesics.

Pregnancy-induced hypertension constitutes a significant cause of morbidity and mortality in developing nations and complicates about 6-8% of pregnancies. Severe preeclampsia poses a serious dilemma for the anaesthesiologist, especially in emergencies, with respect to difficulty in endotracheal intubation and exaggerated haemodynamic responses due to anaesthetic procedures.
Objective: This study aimed to observe intra-operative haemodynamic, anaesthesia parameters, maternal and foetal complications and indications of the need for postoperative critical care. Methods: This study included 145 patients with severe pre-eclampsia who underwent emergency caesarean section. Out of 145 patients, 103 patients were administered spinal anaesthesia (SA), and 42 patients received general anaesthesia (GA) based on the consent of the patient, fasting status of the patient, maternal and foetal distress and active respiratory tract infection (RTI). Patients were categorised into two groups: those who received SA as Group S and those who received GA as Group G.
Results: The Mean intra-operative SBP in group S and group G was 129.8±14.23 mmHg and 136.5±17.25 mmHg respectively, with statistically significant differences (p-value of 0.017). Mean intra-operative DBP group S and group G were 79.1±12.64mmHg and 85.4±15.38mmHg, respectively, with statistically significant differences (p-value of 0.012). The most common maternal complication among group S was headache (6.8%), and among the group G was pulmonary oedema (8.3%) (p<0.001). 74.8% of patients in group S and 31% in group G were complications-free (p<0.001). Out of 103 patients in group S, nine (8.7%) were admitted to ICU and 19 (45.2%) out of 42 patients in group G. The difference was statistically significant (p-value< 0.001).
Conclusion: Spinal anaesthesia is a safer alternative to general anaesthesia in severe preeclampsia, with less postoperative morbidity and mortality for mothers and babies. These findings agreed with many previous studies worldwide.

Background: Femur fracture is a common orthopaedic injury that causes a lot of pain and distress to the patients as the periosteum is more sensitive to pain. Proper positioning while giving neuraxial block is important but pain due to overriding of fractured bone ends makes it difficult. Over the years various techniques, drugs and blocks have been studied to reduce this discomfort and make patients more comfortable during positioning. Our study compares efficacy of Fascia Iliaca Compartment Block & intravenous Ketorolac during positioning for subarachnoid block in femur fracture patients.
Method: Prospective double blinded randomized control trial, n=60 patients; computer-based allocation into Group FICB (n=30)- Fascia Iliaca Compartment Block, landmark technique with 20 ml of 0.25% bupivacaine; Group KETO (n=30)- 0.5 mg/kg Inj Ketorolac (max 30mg) in 100 ml normal saline; 15 minutes prior to subarachnoid block; aged between 18-65 years, ASA class I and II, for elective femur fracture surgeries. VAS was studied till positioning for subarachnoid block and patient positioning, patient satisfaction & time to give subarachnoid block were also noted. The comparison was studied using the Chi-square test or Fisher's exact
test as appropriate, with the P value reported at the 80% confidence interval. P<0.05 was
considered statistically significant.

Background: 
Spinal anaesthesia remains one of the basic techniques despite the waxing and waning of its popularity over last 100 years since its introduction various agents have been used with local anaesthetics in spinal anaesthesia to improve the quality of block and to provide prolonged postoperative analgesia.
AIM: In the present study, we tried to study effectiveness of intrathecal 0.5% bupivacaine (heavy) alone and with Dexmedetomidine as an adjuvant for lower limb and lower abdominal surgeries.
Material and Methods: The study was conducted in the department of anaesthesiology, KIMS, Narketpally during Oct 2021 to Sep2022.This study was a prospective, randomised controlled, single blind, study conducted in 60 patients of ASA grade I and II undergoing elective surgeries. The patients were divided by random number table into two groups, containing 30 patients in each group. Dosages of drugs selected are divided as Group B: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) and Group BD: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) plus 5 µg Dexmedetomidine. Spinal block characteristics, haemodynamics and side effects were observed.
Results: It was found that in Dexmedetomidine group time to reach T10 sensory blockade and complete motor blockade and was earlier and a higher and prolonged when compared to the control group. Haemodynamic parameters were preserved both intra-operatively and postoperatively. There were a small percentage of patients who had minor side effects.
Conclusion: Intrathecal low dose Dexmedetomidine in a dose of 5µg along with 0.5% hyperbaric bupivacaine given intrathecally prolongs significantly the duration of sensory and motor blockade

Spinal anaesthesia using only local anaesthetics is associated with relatively short duration of action. Postoperative pain control is a major problem with spinal anaesthesia using only local anaesthetics alone, and thus early analgesic intervention is needed in postoperative period. Various adjuvants such as morphine, Opioids, Dexamethasone, Magnesium sulphate etc., have been studied to prolong the effect of spinal anaesthesia. This study is designed to compare the effect of adding Dexamethasone and magnesium sulphate to hyperbaric Bupivacaine in lower abdominal surgeries. Total of 80 adult patients aged between 18-50 years undergoing lower abdominal and lower limb surgeries. After institutional ethical committee approval, 80 patients aged between 18-50 years undergoing lower abdominal and lower limb surgeries are selected. Patient pain was assessed with VAS at 30 min post operatively and following results were observed. Mean VAS for D group was 4.5 and mean VAS for M group was 5.2. Hence it is observed that addition of Dexamethasone to bupivacaine had a better analgesic effect than Magnesium sulphate.

Background: Outpatient operations are increasingly becoming popular due to a reduction in costs through occupation of fewer hospital beds, minimizing the possibility of hospital-acquired infections; and for the positive effects on patient psychology. Therefore, spinal anesthesia is an acceptable option in surgery for outpatients, as it has a short anesthesia start time, provides an adjustable anesthesia level, postoperative analgesia and early recovery.
Aim & Objective: The aim of this study is to examine the effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy.
Methods: Study design: Experimental study.  Study setting:  tertiary care centre.
Study duration: Two years …….
Sample size: 62
Results: There were no statistically significant differences observed between the groups in terms of demographic data, hemodynamic parameters, maximum sensorial, sympathetic and motor block levels, time to motor block resolution, and time of discharge (p>0.05). When assessing side effects, three patients in Group BS and one patient in Group B were inserted a foley catheter due to urinary retention (p>0.05)
Conclusions: All patients were successfully given unilateral spinal anaesthesia with sufentanil added to low-dose hyperbaric bupivacaine for an outpatient knee arthroscopy, without affecting the time of discharge. However, for one-day interventions such as arthroscopy, it was concluded that administration of only low-dose hyperbaric bupivacaine was sufficient

Background: Outpatient operations are increasingly becoming popular due to a reduction in costs through occupation of fewer hospital beds, minimizing the possibility of hospital-acquired infections; and for the positive effects on patient psychology. Therefore, spinal anesthesia is an acceptable option in surgery for outpatients, as it has a short anesthesia start time, provides an adjustable anesthesia level, postoperative analgesia and early recovery.
Aim & Objective: The aim of this study is to examine the effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy.
Methods: Study design: Experimental study.  Study setting:  tertiary care centre.
Study duration: Two years …….
Sample size: 62
Results: There were no statistically significant differences observed between the groups in terms of demographic data, hemodynamic parameters, maximum sensorial, sympathetic and motor block levels, time to motor block resolution, and time of discharge (p>0.05). When assessing side effects, three patients in Group BS and one patient in Group B were inserted a foley catheter due to urinary retention (p>0.05)
Conclusions: All patients were successfully given unilateral spinal anaesthesia with sufentanil added to low-dose hyperbaric bupivacaine for an outpatient knee arthroscopy, without affecting the time of discharge. However, for one-day interventions such as arthroscopy, it was concluded that administration of only low-dose hyperbaric bupivacaine was sufficient

Background and objectives: One of the most important determinants affecting the level of anaesthesia after subarachnoid block is the baricity of local anaesthetic. Hyperbaric local anaesthetic solutions are more predictable with greater intrathecal spread and less interpatient variability. This study was designed to compare these two drugs in hyperbaric forms in patients undergoing elective infraumbilical surgeries under spinal anaesthesia.
            Materials and methods:  100 patients of either sex, aged between 18 to 60 years and belonging to American society of Anaesthesiologists (ASA) physical status class I and II who were posted for various elective infraumbilical surgeries under spinal anaesthesia were randomly allocated to two groups of 50 each, to receive either 2.5 ml of 0.42% hyperbaric Levobupivacaine (group HL) or 2.5 ml of 0.42% hyperbaric Ropivacaine (group HR) intrathecally. Sensory and motor characteristics, haemodynamic parameters and adverse effects if any were recorded and data analysed with appropriate tests.
            Results: There was no statistically significant difference observed between the two groups with regards to mean time for onset of sensory and motor block (4.16±1.06 and 3.56±1.18mins in group HL vs 3.89±1.61 and 7.06± 0.99 mins in group HR). Mean time taken to achieve maximum level of sensory block and motor block were significantly shorter in group HL (7.06±1.33 and 8.81±9.0 mins) compared to group HR (10.13±2.53 and 12.91±1.48 mins). Mean time for two segment sensory regression, sensory level regression to S1, total duration of analgesia and motor block were significantly prolonged in group HL compared to group HR (109.56±12.63 vs 74.80±7.45 mins, 234.88±27.95 vs 163.16± 15.38 mins, 215.22±26.26 vs 148.34±15.73 mins and 158.16±22.7 vs 95.98±14.06 mins respectively).
            Interpretation and conclusion: Both hyperbaric Levobupivacaine and hyperbaric Ropivacaine produced reliable and adequate spinal blockade for infraumbilical surgeries without significant hemodynamic changes, however hyperbaric Levobupivacaine produced prolonged sensory and motor blockade compared to hyperbaric Ropivacaine

Introduction: Cholecystectomy is performed either as an open or a laparoscopic route. Despite of a number of peri-operative and post-operative benefits of laparoscopic cholecystectomy, the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Therefore, this study was conducted to compare the effectiveness of SA for open cholecystectomy versus GA with respect to reducing post operative pain, analgesia requirement, respiratory complications and length of hospital stay.
Materials and Methodology: One hundred and forty patients were allocated randomly into two groups—SA group (spinal anaesthesia group, n = 70) and GA group (general anaesthesia group, n =70). And the two groups were divided as SA group underwent open cholecystectomy under spinal anaesthesia whereas GA group had undergone it under general anaesthesia.
Results: Out of all the 140 patients, 70 patients were allotted in each group, there were 120 females (85.85%) and 20 males (14.17%). Their age mostly ranged between 18 – 70 years, with a mean of 42.35 ± 12.66 years. There was no statistically significant difference between both the study groups with respect to age, sex distribution, body mass index (BMI) and ASA physical status. Intra-operatively, bradycardia and hypotension were more common in the SA group. Bradycardia less than 50/ min in 12 patients (16.66%) were treated by atropine 0.6mg IV. Bradycardia was the only side effect noted in both groups.
Conclusion: Since the conventional use of general anaesthesia in open cholecystectomy, this study displays that spinal anaesthesia is also a recommended alternative. It is therefore safe and more effective than general anaesthesia in providing prolonged post-operative pain-free interval, less analgesic/ opioid requirement and no reported respiratory problems.

Introduction: Spinal anaesthesia is a safe, reliable, inexpensive anaesthetic technique for regional anaesthesia. It also allows early ambulation and early rates of hospital discharges.
Material and methods: Present study was carried at tertiary care Hospital. After receiving ethical approval from the college ethical committee and CTRI registration, 64 patients aged 19 to 65 years old with ASA grade I and II physical status who were undergoing elective infra-umbilical surgeries were included in the study. Patients were randomly allocated in two groups of 32 patients each. Group C: Received 1% Isobaric Chloroprocaine 3 ml (30mg) + clonidine (30 mcg). Group F: Received 1% chloroprocaine 3ml (30 mg) + fentanyl (25 mcg). Total volume = 3.5ml. Sensory block was examined using pin prick method. Quality of motor block was examined and graded using Modified Bromage Scoring. Hemodynamic was monitored and side effects were noted.
Result: Total 64 patients were divided into two groups of 32 each. There were 17 males and 15 females in Group F. While in Group C, male and female participants were 16 each. In group F, mean onset time of sensory blockade was (3.69 ± 0.41min) and mean onset of motor blockade was (5.14 ± 0.65min). In group C, mean onset time of sensory blockade was (3.86 ± 0.28min) and mean onset of motor blockade was (5.31 ± 0.63min). In group F, mean duration of sensory blockade was (74.19 ± 3.14min) and mean duration of motor blockade was (60.24 ± 2.97min). In group C, mean duration of sensory blockade was (110.34 ± 8.45min) and mean duration of motor blockade was (94.88 ± 4.39min). In group F, 1 patient had hypotension and bradycardia while in group C,4 patients had hypotension and 3 had bradycardia. Transient neurological symptoms, respiratory depression and pruritis were not seen in any of the groups.
Conclusion: From our study we conclude that, clonidine as an adjuvant to intrathecal chloroprocaine can be used for infra-umbilical ambulatory surgeries with good sub-arachnoid block quality and lesser side effects.

Introduction: Stress factors in the operation room and block level mismatch with
surgical area may contribute to discomfort, anxiety and restlessness in patients under
spinal anaesthesia. Sedation is a valuable tool to provide general comfort for the patient.
It usually provides freedom from specific discomfort and can impose some amount of
amnesia for the block procedure and surgical procedure. Thus, legal use of sedation can
make these surgeries under spinal anaesthesia more comfortable for the patient, the
surgeon and the anaesthetist. Therefore, it can enhance the patient's acceptance of
regional anaesthetic technique. Spinal anaesthesia itself can impart some sedative
effects.Spinal subarachnoid block is one of the most versatile regional anaesthetic
techniques available these days. Regional anaesthesia usually offers several advantages
over general anaesthesia—blunts stress response to surgery, decreases intraoperative
blood loss, lowers the incidence of postoperative thromboembolic events and provides
analgesia in early postoperative period. Subarachnoid block provides profound
anaesthesia for patients undergoing infraumbilical surgery.

Background: Spinal anaesthesia is popular and safe anaesthesia technique for various surgeries. Shivering that develops following spinal anaesthesia is common problem due to impairment of thermoregulatory control. Present study was aimed to compare the efficacy and safety of intravenous Tramadol with intravenous Clonidine in controlling shivering in obstetric patients under regional anaesthesia for caesarean section.
Material and Methods: Present study was single-center, prospective, comparative study, conducted in pregnant women, 18-40 years age, ASA grade I & II, developing shivering intra operative or postoperative in emergency or elective section. Drug therapy started as per patient group after delivery of baby
as Group C received Clonidine 0.5mcg per kg i.v while group T- received tramadol 0.5mg per kg i.v. Results: There was no significant difference in pre operative temperature, HR, SBP, DBP and SpO2 in both groups and even after the control of shivering. Mean time required to control the shivering in Tramadol group is 2.77 minutes is significantly less as compared to the Clonidine group which is 5.47 minutes (p< 0.001). Response rate that is the percentage of patients in which shivering controlled in 15 minutes after the treatment is 95% in Tramadol group and 82.5% in Clonidine group. The difference was not significant statistically (P-value 0.155). No side effects were noted in tramadol group, while 3 patients had side effects in clonidine group (3 cases had sedation), difference was not significant statistically.
Conclusion: Tramadol as compared to Clonidine is safe and effective in controlling the shivering in obstetric patients receiving spinal anaesthesia. Side effects were nil with tramadol, while patients received Clonidine were more sedated. Tramadol should be used for management of intra-operative shivering in regional anaesthesia for caesarean section.

Background: The present aim of the study is to compare the clinical efficacy of
dexmedetomidine versus fentanyl added to intrathecal levobupivacaine for orthopedic
surgeries on the lower limb.
Materials and Methods: The current study was a prospective randomized double-blind
comparative study. This study was done in 90 ASA grade I & II patients. The patients
were aged between 18 to 60 years scheduled for elective orthopedic surgeries under
spinal anaesthesia at Government General Hospital, Kurnool District, Andhra Pradesh.
The patients were distributed into three groups (30 patients each). Namely., Group-C
[Study group LN:15mg of 0.5% of Levobupivacaine + 0.5 ml of normal saline]-Total-
3.5ml, Group-D [Study group LD:15mg of 0.5% of Levobupivacaine + 5 mcg (0.05ml=2
units from insulin syringe) of dexmedetomidine+0.45 ml of normal saline]-Total-3.5ml
and, Group-F [Study group LF: 15 mg of 0.5% of Levobupivacaine + 25 mcg of
fentanyl]- Total =3.5 ml.

Introduction: Spinal anaesthesia is simple, rapid and most reliable anaesthetic technique. It is the most common regional anaesthesia technique, practiced worldwide. It is an efficient technique, which is easy to perform. However, associated with side effects like hypotension, bradycardia and also post-operative nausea, vomiting and chills. Decrease in vascular resistance caused by sympathetic blockade leads to drop in arterial pressure. Bradycardia is caused due to parasympathetic over activity, increase in baroreceptor activity and Bezold Jarish reflex (BJR). Ondansetron is a well-tolerated drug with 5HT3 antagonising effects which is used most commonly for peri-operative nausea and vomiting with minor side effects. Ondansetron poorly penetrates the blood brain barrier with minimal influence on central serotogenic mechanisms. Hence has less chances of causing cognitive side effects like headache, agitation and confusion. The objectives of this study is to assess the effect of intravenous ondansetron on spinal anaesthesia induced hypotension and bradycardia and the effect of ondansetron on Peri-operative nausea, vomiting and chills.

Background: Various adjuvants have been used with local anaesthetics in spinal
anaesthesia to prolong postoperative analgesia. Dexmedetomidine, the new highly
selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this
study was to evaluate the onset and duration of sensory and motor block, hemodynamic
effect, postoperative analgesia, and adverse effects of dexmedetomidine, or fentanyl
when given intrathecally with hyperbaric 0.5% bupivacaine.
Materials and Methods: Ninety patients classified in American Society of
Anaesthesiologists classes I and II scheduled for lower abdominal surgeries requiring
spinal anaesthesia were studied. Patients were randomly allocated to receive either 12.5
mg hyperbaric bupivacaine plus 10 μg dexmedetomidine (group D, n=30) or 12.5 mg
hyperbaric bupivacaine plus 25 μg fentanyl (group F, n=30) intrathecal. The control
group received 12.5 mg hyperbaric bupivacaine intrathecally (n=30).
Results: Patients in the dexmedetomidine group (D) had a significantly longer sensory
and motor block time than patients in the fentanyl group (F) and control group (B).
VAS score at rescue analgesia was significantly higher in the control group. Duration of
analgesia was significantly more in the dexmedetomidine, and fentanyl group as
compared to control. The total duration of analgesia was longer with dexmedetomidine
than fentanyl. Sedation scores were significantly higher in the Dexmedetomidine group.
No hemodynamic changes were noted in any group.
Conclusion: Intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric
bupivacaine prolong sensory and motor block with minimal hemodynamic instability
and reduced demand for rescue analgesia. Intrathecal dexmedetomidine has a longer
duration of analgesia than fentanyl.

Background:Aim: To evaluate and compare the following factors in two groups –
intrathecal dexmedetomidine and intrathecal buprenorphine as an adjuvant to 0.5%
hyperbaric bupivacaine for lower abdominal surgeries and lower limb surgeries.
Materials and Methods: A clinical study was undertaken to compare the effects of
intrathecal Buprenorphine and dexmedetomidine as additives to 0.5 % hyperbaric
bupivacaine for spinal anaesthesia. This prospective, randomized, Double blind study
was conducted on 60 adult patients of ASA physical status 1 and 2 in the age group of
18 to 60 years, posted for elective lower abdominal surgeries at Osmania Medical
college Hospital, Hyderabad from the period 2017 – 2020. Patients were randomly
allocated into two groups namely, Group BB and Group BD of 30 each. Patients in
Group BB received 60mcg of Buprenorphine with 0.5% bupivacaine 15mg
intrathecally. Patients in Group BD received 5mcg of Dexmedetomidine with 0.5%
bupivacaine 15mg intrathecally. After connecting monitors, the required preloading
done to all patients. Subarachnoid block was carried out under aseptic precautions.
Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation were
recorded at 0, 2, 5 minutes and thereafter every 10 minutes up to 90 minutes
intraoperatively.
Results: The following parameters were observed - onset and duration of sensory block
and motor block, time for sensory regression to S1, degree of sedation, hemodynamic
stability and any side effects associated with these drugs. Collected data were analysed
using appropriate statistics. Demographic datas were not statistically significant. The
onsets of sensory and motor blockades were not statistically significant. The duration of
sensory blockade was prolonged in dexmedetomidine group (51%) compared to
buprenorphine group. The Motor blockade, sensory regression to S1 were also got
prolonged in Dexmedetomidine group Hemodynamic parameters were comparable
between the groups. In our study The onsets of sensory and motor blockades were not
statistically significance between the groups. The duration of both sensory and motor
blockades were prolonged in dexmedetomidine group compared to buprenorphine
group with the best statistical significance. Both groups had stable and comparable
hemo dynamics during the study. Compared to buprenorphine, intrathecal
administration of dexmedetomidine as additive to hyperbaric bupivacaine was
associated with fewer side effects.
Conclusion: Our study concludes that dexmedetomidine as an adjuvant to intrathecal
bupivacaine prolongs both sensory and motor block duration with fewer side effects
compared to buprenophine.

Introduction: Spinal anaesthesia using hyperbaric bupivacaine with adjuvants such as
clonidine is now the routine and preferred technique for majority of the surgical cases.
Aim: to compare various block characteristics alongwith materno-fetal outcome in
patients scheduled for caesarean section under subarachnoid block (SAB), following
administration of hyperbaric bupivacaine alone and in combination with clonidine
intrathecally.
Methods: In this randomized clinical trial, 90 patients undergoing elective cesarean
section were randomly allocated to two groups. The patients of Group A received
intrathecal 0.5% hyperbaric Bupivacaine (10 mg) + 0.2 mL of normal saline and Group
B received intrathecal 0.5% hyperbaric Bupivacaine (10 mg) + 0.2 mL of clonidine (30
μg). Various block characteristics and materno-fetal outcome were compared between
the groups.
Results: Group B had quicker sensory onset (3.17 ± 1.05 min vs. 3.50 ± 0.94 min), longer
duration of sensory and motor block (209.73 ± 30.70 min and 147.50 ± 23.00 min),
longer time for rescue analgesia demand (298.83 ± 44.68 min) in comparison to Group
A.
Conclusion: Intrathecal clonidine provided better block characteristics and outcome
measures in terms of prolonged sensory as well as motor blockade, longer duration of
analgesia, greater intraoperative relaxation and minimal or no adverse incidences.

Background: Midazolam and propofol by virtue of their antiemetic effect were found
individually to reduce the incidence of intraoperative nausea and vomiting. This study
compares the effects of midazolam and propofol in decreasing the incidence of nausea and
vomiting in pregnant women undergoing lower segment caesarean section (LSCS) under
spinal anaesthesia. It also assesses maternal sedation, neonatal outcome and other side effects.
Aim: To compare the effects of subhypnotic dose of midazolam and propofol in prevention
of intraoperative nausea and vomiting in lower segment caesarean section under subarachnoid
block.
Methods: With ethical committee permission the 60 pregnant women were randomly
allocated into 2 groups after taking informed consent. Group M received 0.03mg/kg
midazolam immediately after cord is clamped, Group P received 10 mg propofol immediately
after cord is clamped. Incidence of nausea and vomiting was not according to Bellville
scoring system (0-novomiting, 1-Nausea, 2-Retching, 3_vomiting). The degree of sedation,
hemodynamic changes were noted baseline, after induction, after drug administration, 30
mins after drug administration, 60 mins after drug administration, neonatal out come and side
effects were recorded.
Results: Statistically significant decrease in intraoperative nausea and vomiting in patients
undergoing LSCS under spinal anaesthesia with 10 mg propofol compared to 0.03 mg
midazolam is observed. Degree of sedation, respiratory rate, mean mephentermine
consumption were comparable between two groups and no difference found.
Conclusion: Propofol significantly decreases incidence of intraoperative nausea and
vomiting inches are in section under spinal anaesthesia as compared to midazolam.

Introduction: Pain is the fifth vital sign and a critical focus of the anaesthesiologist. Pain
is perhaps elaborated as an unpleasant sensory and emotional experience associated
with actual or potential tissue damage. Acute post operative pain is a complex
physiological reaction to tissue-injury, visceral distension or disease. It is manifested by
autonomic, psychological and behavioural responses that result in patient specific
unpleasant, unwanted sensory and subjective emotional experience. Postoperative pain
leads to delayed mobilization and its associated complications. With the development of
an expanding awareness of the epidemiology and pathophysiology of pain, more
attention is focused on the multimodal management of pain to improve the quality of
pain relief, augment functionality, leading to early mobilization, and reduce
physiological and emotional morbidity. Hence the present study was done at our
tertiary care centre to compare the effectiveness of intrathecal neostigmine (50 mcg)
combined with 0.5 % bupivacaine (Hyperbaric) with 0.5 % bupivacaine (Hyperbaric)
alone in spinal anaesthesia for infra umbilical surgeries.

Introduction: Spinal anesthesia is most commonly used for lower abdominal surgeries due to its low cost and ease of administration as well as rapid onset of anaesthesia. Adjuvants like Fentanyl and dexmedetomidine are used to accelerate and prolong the anaesthetic effect depending on the purpose. This study was done to compare the effects of intrathecal hyperbaric bupivacaine with fentanyl and bupivacaine with dexmedetomidine for lower abdominal surgeries.

Introduction: Spinal anaesthesia (or spinal anesthesia), also called spinal
block, subarachnoid block, intradural block and intrathecal block is a form of
neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid
into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long.
Epidural anesthesia is a technique that may be used as a primary surgical anesthetic or
as a resource for postoperative pain management. It is safe and relatively easy to learn
and perform.A hernia is reducible if it occurs intermittently (such as on straining or
standing) and can be pushed back into the.
Material and methods: This is a prospective, comparative and randomized study was
conducted in the anaesthesia department of a tertiary medical Hospital. All patients
were male, age between 18 to 70 years. The present study included male patients of
uncomplicated inguinal hernia with American society of anaesthesiologist (ASA) grade
1 and 2. All patients were admitted for planned surgery; they were examined and
preanesthetic check-up done. All patients were explained about the techniques of
anaesthesia for hernioplasty and where randomized into two groups. They were
operated for inguinal hernioplasty according to recognised surgical guidelines.
Results: Total time taken for performing the procedure was significantly longer with
Epidural Anaesthesia than that of Spinal Anaesthesia (8.03±0.84 Vs 3.65±0.23 minutes,
p<0.001) but onset of action was comparable in both the groups (6.84±1.08 in Spinal Vs
11.23±1.21min in Epidural p<0.001 Significant). Intraoperative fluid requirement was
statistically higher in Spinal than Epidural (1612.43±163.3 ml vs 1102.54±94.53 ml)
(p<0.0001). Duration of Surgery was significantly shorter in Spinal as compared to
Epidural (91.43±8.64 vs 114.53±11.64 mins.) (p=0.021).
Conclusion: The spinal block induces a faster and more effective analgesia as well as a
more severe motor blockage than epidural block. In Spinal Anaesthesia, the
haemodynamic fluctuations and adverse effects are larger than in Epidural
Anaesthesia. As a result, both spinal and epidural anaesthesia may be utilised safely
during day surgery.

Aims: The aim of the study is to compare the anaesthetic efficacy of intrathecal
hyperbaric 0.5% Bupivacaine with 25mcg Fentanyl and intrathecal hyperbaric 0.5%
Bupivacaine with 60mcg Buprenorphine for lower abdominal and lower limb surgeries
Materials and methods: The present study was undertaken in Sixty patients (of either
sex belonging to ASA I and II physical status) posted for elective lower abdominal and
lower limb surgeries (under Spinal Anesthesia) were selected and were randomly
allocated into two groups; Buprenorphine (Group B), and Fentanyl (Group F).
Results: The demographic profile with regard to age ,gender, ASA grading, average
duration of surgery were comparable in all the groups. The onset of block , mean time
for onset of motor blockade,mean time for sensory regression, mean time for regression
to bromage ‘1’ , mean duration of analgesia was the difference between the groups was
statistically significant.Intraoperative heart rates were comparable among the two
groups (p<0.005). isolated incidents of Bradycardia were noticed – but were neither
statistically significant nor clinically significant. There was gradual fall in the SBP and
DBP towards 30 minutes into surgery followed by a stable state .Both the groups were
comparable (p>0.05) with regard to their MAP, although hypotension was noticed in
both the categories of patients.All the adverse events were mild in nature which
required no intervention. No episodes of respiratory depression, dry mouth, PDPH were
noted in any of the subject in both the groups.
Conclusions: Intrathecal Buprenorphine (60mcg) is superior over intrathecal Fentanyl
(25mcg) as an adjuvant to Intrathecal hyperbaric 0.5% Bupivacaine when prolongation
of spinal anaesthesia is desired.

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

Introduction - The emergence of ultrasound imaging in regional anaesthesiahas
revolutionizedthepopularityofPNBs.Itprovidesveryhigh-resolutionimages,direct
visualization of structures, avoid accidental vessel or nerve injuries and hence providehigh
safetyprofileascomparedtoblindprocedures.Thisleadstoincreasedsuccessrateduetoreal
timeimagingwhilethedrugisbeinginjected,decreaseddoseneededforlocalanaestheticsand
hence reduced the risk of local anaesthetictoxicity.
Methodology-ThestudywasdoneastheRandomizedSingleBlindedComparativeStudy.
Patientsundergoingunilateralinguinalherniarepairwerechosen.Thepatientswererandomly
allocated into two groups such as group S (Unilateral Spinal Anaesthesia) and groupP
(Paravertebralblock),of25patientseach,usingblockrandomizationwithsealedenvelope
system.
 
Results-Wefoundthatthemeanarterialpressurewasbetterpreservedinthepatientsreceiving
PVBascomparedtounilateralspinalanaesthesia.However,heartratewascomparableinboth
techniques. PVB provides better postoperative analgesia as time to first rescue analgesiawas
significantly higher and total rescue analgesia consumption was significantly less in groupP.
No significant difference was found in adverse effects in bothtechniques

Introduction: Obstetric anaesthesia and analgesia are associated with many unique and different problems for the anaesthesiologists.Arterial hypotension in pregnant women following  spinal anaesthesia continue to be a matter of concern to the anaesthetist.
Objective: The study was carried out to compare the efficacy ofIVbolusPhenylephrine, Ephedrine and Mephentermine for maintenance of arterial pressure during spinal anaesthesia in caesarean section. To monitor and record side effects, if any.
Subjects and methods: The present study was undertaken on 90 subjects with American society of anaesthesiologist (ASA) type I and II who underwent lower segment caesarean sections under spinal anaesthesia and developedhypotension were selected. Cases were drawn from  obstetrics and gynaecology department of NSCB Medicalcollege and Hospital, in whom the decision was taken to perform caesarean section.The subjects are divided into 3 groups of 30 each to receive Group I -Phenylephrine 100ug, Group II - Ephedrine 6mg and GroupIII-Mephentermine  6mg IV bolus.
Results: The ANOVA test was used to compare the group among the study groups.In group I (Phenylephrine) it was observed that the peak effect was seen between 1-2 minutes,in group II (Ephedrine) between 3-5 minutes.and in group III(Mephentermine) it was seen between 5-6 minutes 
Conclusion- It was concluded that Phenylephrine,Ephedrine and Mephentermine all could be used for maintenance of arterial pressure during spinal anaesthesia for caesarean section.Phenylephrine had an immediate peak,so it may be beneficial for initial control of hypotension. It also shows some advantage over others with regard to reduction in heart rate.

Background: Sympathetic nervous system and hypothalamic-pituitary adrenal axis constitute the efferent pathway of the perioperative stress response. Surgical tissue trauma and stress results in activation of hypothalamic-pituitary adrenal axis, thereby causing release of corticotrophin releasing hormone (CRH) by hypothalamus. Surgery evokes stress response resulting in increased secretion of counter-regulatory hormones (catecholamines, cortisol, glucagon, and growth hormone) and excessive release of inflammatory cytokines, a state of functional insulin deficiency occurs. Hence, diabetic patients undergoing surgery further develop hyperglycemia in the intra-operative and postoperative period. Aims and Objectives: To evaluate the spectrums of spinal anaesthesia on perioperative hyperglycemia in diabetic patients undergoing lower limb surgeries. Materialand Methods: In this study, 62 diabetic (D) patients having preoperative blood glucose between 80 to 120mg/dl, undergoing lower limb orthopaedic surgery, under spinal anesthesia were included. During surgery, blood sugar was measured in capillary blood, using glucometer 10 minutes before initiation of anaesthesia, at time of surgical incision (SI), 30 min after incision and thereafter 1hourly till 4th hour after surgical incision. Statistical analysis was done using SPSS 17.0 software. Results and Observations: In our study Blood glucose (BG) value decreases till 1hr after surgical incision (SI), and then increases till 4th hour after SI. This change in blood glucose values is statistically significant at SI, 2nd hour after SI, 3rd hour after SI and 4thhour after SI. Conclusion: Therefore, hyperglycaemia is very common in surgical patients. Our study demonstrates a linkage between elevated BG and a risk of perioperative complications in diabetic and non-diabetic patients. Spinal anaesthesia blunts surgical stress response and hence, at SI, BG values decrease. But, BG values increase at other times in perioperative period owing to the regression of sensory analgesia.