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Introduction: The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. Aim: To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. Materials and Methods: This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean±Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. Results: The mean age in group A was 42.9±13.5 years and in group B was 46.3±13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4±3.2 kg/m2 and 26.3±3.1 kg/m2, respectively. The mean duration of sensory block was longer in group A (12.3±4.6 hours) compared to group B (4.7±0.7 hours). The mean VAS scores (1.351±0.659 vs 3.240±0.590) were significantly lower in group A. The total opioid requirement was 42.9±73.6 mg vs 205.9±26.0 mg between the two groups, which was significantly lower in group A. Conclusion: In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries. [ABSTRACT FROM AUTHOR]

Introduction: To provide equitable distribution of healthcare there is a need for increased number of healthcare professionals willing to provide rural health services. As the interns are the future workforce of India, this study was taken up among them. Aim: To assess the attitude and perception of medical interns towards rural healthcare services and to find out associations between socio-demographic characteristics and their attitude towards rural healthcare. Materials and methods: A cross-sectional study was carried out among 97 interns in a medical college of Odisha, during February to April 2020. A pre-deigned, pretested semi-structured questionnaire was used with questions on attitudes towards rural healthcare services were used to calculate scores and categorize the attitude of the interns into positive and negative. Data was analyzed using SPSS version 20 and results were presented in terms of means, standard deviation and proportions. Chi-square test was applied and p value of <0.05 was considered significant. Results: The mean±S.D. age of the study participants was (23.7±0.96) years. Majority (52%) of them were males. The mean±SD of the total score of respondents' attitudes towards working in rural areas was 43.7±7.76, indicating a negative attitude. Males had a higher mean score. A significant association was found between gender, place of residence, parents' education and the attitude towards rural healthcare services. Conclusions: Even though the interns realized the importance of working in rural areas, their attitude was somewhat negative. Improved residential facilities, opportunities for post-graduation, professional growth and additional allowances for rural service can help in conditioning a more favorable attitude. [ABSTRACT FROM AUTHOR]

Background: Anesthesia accounts for the initial step of any surgery; with different means of establishing a secured airway. Amongst the various devices used for endotracheal intubation (EI), the McCoy (MC) laryngoscope which was used more commonly, was compared with the Airtraq (AT) laryngoscope, which has been developed for use in patients with normal or difficult airways for Comparing the POGO scoring in two groups using McCoy and Airtraq laryngoscope and comparison of hemodynamic changes observed by using both the laryngoscopes. Materials and methods: This cross-sectional study was carried out in a teaching hospital, in Aligarh from January to March 2012; on a sample of 50 patients, randomly divided into two groups of 25 patients each using chit-in-a-box technique. Observations: The male: female ratio was 0.8:1. The mean ± SD age in the AT group was 36.76 ± 9.09 years and in the MC group was 38.48+15.19 years. The POGO scoring of the patients using Airtraq laryngoscope was better than that of McCoy laryngoscope. The fluctuations in heart rate were more evident in the McCoy group as compared to the Airtraq within the first few seconds and this was found to be highly statistically significant (p<0.001). The fluctuations in mean arterial blood pressure (MABP) was more pronounced in the MC group as compared to the AT group in the first (1sec) and third second (3secs) readings which was also found to statistically highly significant (p<0.001). Conclusion: Airtraq might be a better device for EI. [ABSTRACT FROM AUTHOR]

Introduction: Spinal Anaesthesia (SA) is frequently associated with hypotension, which is due to sympathectomy causing vasodilation, leading to relative hypovolemia. This decrease in venous return to the heart causes a decrease in left ventricular filling pressure, leading to the activation of the Bezold-Jarisch Reflex (BJR), which causes bradycardia. This response is mediated by mechanoreceptors and chemoreceptors present on the heart walls. These chemoreceptors are mediated through serotonin (5-HT). Therefore, the activation of 5-HT3 receptors at sensory vagal nerve endings in the heart causes hypotension and bradycardia. Aim: To assess the efficacy of Palonosetron in attenuating spinal anaesthesia-induced hypotension and bradycardia. Materials and Methods: The trial was a parallel-design, randomised, double-blind controlled trial conducted over two years, from February 2021 to August 2022 in the Department of Anaesthesiology, Kalinga Institution of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, among patients undergoing spinal anaesthesia for various surgeries. The patients were divided into two groups based on the type of medication received: Group A-Palonosetron group and Group B- the saline group. Computer-generated random number generator software was used for randomisation. At a 1:1 ratio, 150 patients were chosen (75 in each group). Baseline assessment of haemodynamic parameters was performed, followed by continuous monitoring. The drug was administered 10 minutes prior to spinal anaesthesia, and the haemodynamic parameters (Heart Rate [HR], Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP], and Mean Arterial Pressure [MAP]) were monitored. Continuous variables are expressed as mean±Standard Deviation (SD). The Student's t-test was used to compare the difference between the two groups, and categorical variables are expressed as frequency and percentage, with comparisons done using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The mean age of Group A and Group B was 40.88 and 42.14, respectively. Significant haemodynamic changes (hypotension) were observed following induction in Group B (28 [37.3%]) compared to Group A (9 [12%]). Consumption of vasopressors and intravenous (i.v.) fluids was significantly higher in Group B compared to Group A. The incidence of bradycardia in Group A and Group B was 15 (20%) and 18 (24%), respectively. Postoperative Nausea and Vomiting (PONV) in Group A and Group B were 3 (4%) and 8 (10.7%), respectively. Conclusion: Based on the present study, the prophylactic administration of 0.075 mg Palonosetron 10 minutes before subarachnoid block is effective in attenuating the incidence of spinal anaesthesia-induced hypotension and bradycardia. There is also decreased consumption of vasopressors and a lower incidence of PONV. [ABSTRACT FROM AUTHOR]

Introduction: Sacral nerves emerge through sacral foramina and traverse below the multifidus muscle. Hence, blocking this myofascial plane can provide postoperative analgesia in the perianal region by blocking the sacral nerves supplying it. Aim: To study the effect of Sacral Erector Spinae Plane Block (SESPB) on postoperative pain and postoperative analgesic requirement in perianal surgeries. Materials and Methods: A randomised controlled trial was done with 60 patients who were randomly allocated into two groups (30 in each group). Group 1 patients received no intervention, whereas Group 2 received bilateral SESPB. The Visual Analogue Scale (VAS), opioid requirement, first analgesic demand, and additional analgesic requirement were compared between the two groups. The qualitative data was analysed by Student's t-test, whereas the quantitative data was analysed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Around 18 (60%) of the participants in group 1 were males, whereas group 2 consisted of 15 (50%) males. The mean age in group 1 was 40.7±11.5 years, whereas it was 43.6±12.7 years in group 2. The means of BMI were similar in both groups. The mean VAS score of group 1 was 3.19±0.23, whereas it was 2.37±0.25 in group 2. The first analgesic requirement was significantly delayed, and total tramadol requirement was lower in group 2 compared to group 1. Four patients from group 1 (control group) required inj. diclofenac sodium additionally. Conclusion: Bilateral SESPB provided good postoperative analgesia in patients who underwent perianal surgery. The total analgesic requirement was also found to be lower with this block. Hence, it can be considered a modality for perianal surgeries. [ABSTRACT FROM AUTHOR]