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Context: Ultrasound is an excellent modality for the evaluation of the soft tissue structures as well as articular pathologies of the elbow joint. Higher resolution transducers along with the superficial location of the elbow structures make them amenable for easy visualisation However, the long learning curve and the operator dependency can limit its use. Aims: The aim of this article is to describe and demonstrate novel techniques to image distal biceps tendon, lateral ulnar collateral ligament and radial nerve at elbow joint with ease. Design: Technical advancement. Methods: The elbow joint ultrasound examination was performed on ten asymptomatic volunteers, 20–40 years old, using a linear probe of 3–13 MHz frequency. The scanning was started from the anterior elbow, the distal biceps tendon was visualised first with anterior to the medial approach followed by the lateral ulnar collateral ligament with one finger technique and radial nerve with first bone technique respectively. Conclusion: We consider our techniques as an easy approach to identify the distal biceps tendon, lateral ulnar collateral ligament and radial nerve.

Background: Anaesthesiologists most commonly perform the procedure of internal jugular vein cannulation(IJV) in emergency and also in elective cases. With the use of ultrasound guidance placement of guide wire and catheter into the internal jugular vein has been made easy, safe and with less complications. Aims: The aim of the study was to compare IJ vein cannulation under ultrasound guidance with respect to Short and Long axis (SA and LA) view approaches. Methods: Patients who may require central venous cannulation for undergoing surgery and will be in intensive care unit were randomized using computer generated randomization for ultrasound guided cannulation into one of short axis and long axis (SA and LA) approaches group. Success rate of first pass, number of needle attempts made, guide wire insertion time, catheter placement time and complications were noted for each procedure. Results: Successful cannulation of IJV was achieved in all the patients. Significant results were not noted among the two groups with respect to demographic profile of the patient, catheter placement time, rate of carotid artery puncture. Whereas a significant result was noted in terms of success rate of first pass (97% in SA v/s 53% in LA, P-0.0001), number of needle attempts (mean of 1.05±0.18 in SA v/s 1.55±0.68 in LA, P-0.0001), guide wire insertion time (mean of 43.20±5.64 in SA v/s 74.83±39.36 in LA). Conclusion: We conclude from the above study that short axis view approach is better with respect to success rate of first pass, number of needle attempts and guide wire insertion time than long axis view approach for internal jugular vein cannulation under ultrasound guidance.

Background: Transverse abdominus plane (TAP) block is a regional anesthetic technique which provides an excellent analgesia without major adverse effects. The primary aim of this study was to evaluate the efficacy of dexmedetomidine in comparison to tramadol when added as adjuvant to levobupivacaine in TAP block on duration of post operative analgesia following laproscopic orchidopexy. Methods: Sixty American Society of Anaesthesiologists (ASA) grade 1 pediatric patients undergoing laproscopic orchidopexy under general anaesthesia were randomized into two groups (GroupLD and Group LT). Group LD recieved ultrasound guided bilateral TAP block with 0.3 ml/kg 0.25% levobupivacaine with 1µg/ kg of dexmedetomidine on both sides and Group LT recieved TAP block with 0.3 ml/kg 0.25% levobupivacaine with 1mg/ kg of tramadol. During the first 24 h postoperatively, we assessed hemodynamic stability, respiratory depression, and postoperative pain using face, legs, activity, cry, consolability (FLACC) pain scale. Results: Total duration of analgesia (986.67 ± 47.29 min vs. 690 ± 53.49 min, P value- 0.000), and the total consumption of paracetamol in the first 24 hours postoperatively (324.28 ± 35.5 mg vs. 580.14 ± 38.23, P value – 0.000) were statistically highly significant in group LD in comparison to group LT. The FLACC score were lower in Group LD as compared to group LT and side effects profile were similar in both the groups. Conclusion: Dexmedetomidine in a dose of 1 μg.kg-1 when added to levobupivacaine in ultrasound guided transverse abdominus plane block significantly prolongs the duration of postoperative analgesia as compared to tramadol with levobupivacaine without major side effects.