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Introduction: The sitting position is often used for patients undergoing spinal anesthesia especially when lower lumbar and sacral levels of sensory anesthesia are required. An advantage of this position is that the complications associated with it can be reduced. The present study assess the relation between saddle block anesthesia and the duration spent in sitting posture. Materials and Methods: Sixty ASA I and II patients were included in this study. In this randomized controlled study, patients planned to undergo perineal procedures were selected. Spinal anesthesia was given with 2.2 ml of 0.5 % hyperbaric bupivacaine and the patients were made to sit for one, six, twelve and twenty minutes before making them supine for the procedure. The data were analyzed using students ‘t’ test and .Chi - Square test . Results: Better hemodynamic stability was achieved by increasing the duration of sitting posture after spinal anesthesia. Also duration of motor /sensory blockade was decreased by increasing the duration of sitting position. Conclusion: The study shows that the duration of sitting position is inversely related to the duration and extent of sensory and motor blockade. .Also better hemodynamic stability can be achieved with saddle block anesthesia. Keywords: Spinal anesthesia, Sympathetic blockade, Hyperbaric bupivacaine, Cerebrospinal fluid.

Background: Severe pain associated with proximal femur fractures makes the positioning for regional anesthesia a challenge. Systemic administration of analgesics can have adverse effects. Individually, both the fascia iliaca block (FIB) and femoral nerve blocks (FNB) have been studied. However, there is little evidence comparing the two. The aim of this study was to compare the overall efficacy of the two blocks in patients with proximal femur fracture before positioning for spinal anesthesia. Methods: ASA (American Society of Anesthesiologists) class I, II, and III patients scheduled for elective and emergency surgery with the diagnosis of proximal femur fracture between October 2018 and June 2019 were included in the study. The patients were assigned to two groups by convenience nonprobability sampling of 35 each. Results: Our study showed a reduction in visual analogue scale scores at 3, 4, and 5 minutes after administration of the FIB being 5.1 ± 1.1, 4.1 ± 1.3, and 2.8 ± 0.8, and those after the FNB as 4.4 ± 1.1, 3.3 ± 1.1, and 2.1 ± 1.4 with P < 0.05, which was statistically significant. The mean first rescue analgesia time for the FIB was 7.1 ± 2.1 hours, while for the FNB it was 5.2 ± 0.7 hours. The P value was less than 0.001, which was significant. Conclusions: Both ultrasound guided FNB and FIB techniques provide sufficient analgesia for patient’s positioning before spinal anesthesia. However, the duration of postoperative analgesia provided by FIB was greater than that of the FNB.

Background: Use of propofol-based total intravenous anesthesia (TIVA) has increased in the past two decades due to better understanding of pharmacokinetics of intravenous anesthetic drugs. TIVA can be used as an alternative to inhalational anesthesia in minor gynecological procedures. Advantages of TIVA with propofol also include reduced nausea and vomiting, reduced atmospheric pollution, and a better wake up profile. The study objective was to compare two drug regimens: propofol-ketamine and propofol-fentanyl. Also, induction, maintenance and post-extubation parameters were evaluated. Materials & Methods: This study was a prospective randomized, single blinded study involving 72 adult patients ranging from 18 to 60 years, belonging to ASA grade 1 or 2 undergoing short gynecological procedures, were assigned into two groups. Propofol-ketamine was administered to group 1 while propofolfentanyl was administered to group 2. All the results were analyzed statistically using student's t-test, chisquare test and Fisher’s exact test. Results: In group 1 rescue boluses of propofol was in the mean of 29.38 mgs and in group 2 was in the mean of 21.33mgs which was statistically significant with a p-value of 0.009. Mean emergence time in group1 was 5.94 minutes whereas in group 2 was 4.89 minutes which was statistically significant with a p-value of 0.001. The mean recovery time in group 1 was 11.25 minutes whereas in group 2 was 9.17 minutes which was statistically significant with a p-value of 0.001. Conclusions: Propofol-fentanyl combinations showed better emergence time and recovery profile.

Background: Increased intraoperative bleeding during functional endoscopic sinus surgery (FESS) affects operative field visibility, which increases both duration of surgery and frequency of complic...

Introduction: Femoral Nerve Block (FNB) is used as an adjunct to postoperative analgesia in Anterior Cruciate Ligament (ACL) reconstruction surgeries. However, it causes a reduction in quadriceps strength following use. To mitigate the loss in muscle function and patient safety, surgeons and anaesthesiologists have recently been exploring the potential benefits of a motor sparing Adductor Canal Nerve Blockade (ACB). To date, few comparative studies exist to determine its clinical utility. Aim: To compare the efficacy of femoral nerve block versus ACB for postoperative pain and functional outcome in patients undergoing ACL reconstruction. Materials and Methods: This prospective, randomised controlled trial was done after approval from Institutional Ethics Committee, Kasturba Medical College, Mangalore, Karnataka, India, 76 ASA Class 1 and 2 patients posted for ACL reconstruction, aged 18-60 years were chosen after consent and were randomised into two groups using computer-generated block randomisation. Group F received femoral nerve block and Group A received adductor canal block postoperatively. Visual analogue scale score at 0, 12 and 24 hours and Medical Research Council grading at 2, 12 and 24 hours post-block were measured and compared between both groups. Data analysis was done using student unpaired t-test, student paired t-test and chi-square test. Results: Visual analogue scale scores at 0, 12 and 24 hours postoperative was 2.29, 3.26 and 3.86 in Group A and 2.59, 3.61 and 4.49 in Group F (statistically non significant). Average time for rescue analgesia was 1 hour and 8 hours in Group A and F respectively. Medical research council grading 2, 12 and 24 hours postoperative was 2.6, 4.09 and 4.77 in Group A and 2.8, 3.15 and 4.05 in Group F (statistically significant). Conclusion: Compared with femoral nerve block, the study suggests that adductor canal block preserves quadriceps strength but is equianalgesic for patients undergoing anterior cruciate ligament reconstruction.

Hip fractures are common injuries in the elderly population. Present day management is stabilisation of these fractures as early as possible. The use of internal fixation devices in the treatment of hip fractures has proved to be a major advancement in modern surgical therapy. Implants used for the fixation of hip fractures have evolved in the last two to three decades. Many complications of internal fixation have been described. Failure or complications following fixation of hip fractures include secondary osteoarthritis or avascular necrosis which may result in great disability and pain. Hip arthroplasty is a helpful reconstructive procedure in these patients who had complications following primary fixation surgery. In addition to technical problems of reconstruction in them, there may be associated difficulties of removal of metal work which has been used for previous surgeries. This is a case report of a patient who had complication following a hip fracture surgery about 33 years ago, now presented with secondary hip arthritis and a rare implant portion in situ.

Objective: Administration of warm intravenous (IV) fluid infusion and use of forced air warmers is the most easy and physiologically viable method for maintaining normothermia during surgery and postsurgical periods This study was conducted to assess the effect of combination of active warming (AW) methods namely warm IV fluid infusion and forced air warming versus forced air warming only (WA) on maternal temperature during elective C-delivery under spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for elective c-section were grouped into those who received both warmed IV fluid infusion and forced air warmer (Combination of active warming WI= 50) and those who received only forced air warmer (WA = 50). Core body temperature and shivering incidence were recorded using a tympanic thermometer from prespinal till the end of surgery every 10 min and in postanesthesia care unit (PACU) at 0, 15, and 30 min. Results: Core temperature showed statistically significant difference in 15, 35, 45, and 55 min between air warmer and warm infusion groups and in PACU at 0, 15, and 30 min, it was statistically significant (P = 0.000) among WI group (mean temperature = 36.79°C) when compared to WA group (mean temperature = 35.96°C). There was a lower incidence of shivering in WI compared to WA group, which is statistically significant. Conclusion: Combination of warm Intravenous fluid infusion and Forced air warming is better than forced air warming alone. In maintaining near normal maternal core body temperature during elective cesarean section following spinal anesthesia. Combined warming method also reduces shivering incidence.

Lasègue’s sign is an interesting and important clinical sign in medicine for the last 150 years. The Lasègue test is commonly used in the physical examination of patients with low back pain. It is a test for lower lumbosacral nerve root irritation for example, due to disc prolapse. It is evident that the method of performance of this diagnostic sign varies with the physician. This article reviews the historical background and method of eliciting the sign.

Objective Supraclavicular brachial plexus block is one of the easiest and the most consistent method for anesthesia and perioperative pain management in surgeries below the shoulder joint. In this randomised control trial, we aimed to compare the

Background The conventional approach is many a time associated with complications such as vascular puncture, inadequate analgesia etc. The lateral approach is hypothesized to be equipotent and much safer than the conventional approach. We aim to evaluate this hypothesis. Method After Institutional ethics committee clearance, the patients, after consenting, through computer generated block randomization, were allocated to either of the two groups-Group L or C. After the block, the duration for onset of sensory and motor blockade, the total duration of sensory& motor blockade and any complications were noted. A total of 60 patients were analyzed, 30 patients for the lateral approach and 30 patients for conventional approach. ASA 1 and 2 patients who were undergoing the surgeries of the upper limb were included in the study. Results The incidence of complications was much higher in conventional approach as compared to the lateral approach with a p value 0f 0.041. In conventional approach, in 2 (6.7%) of the patients the block failed to act completely, inadequate block was seen in 7 (23.3%) of the patients of which vascular puncture was seen in 4 (13.3%) patients. In lateral approach, inadequate blockade was seen in 1 (3.3%) patient but there was no vascular puncture. Conclusion Lateral approach is a much safer and reliable technique of supraclavicular brachial block.

Objectives: The objective is to compare the effectiveness of intra-articular injection of ropivacaine and bupivacaine in providing pain relief after arthroscopic knee surgery.Methods: A total of 60 patients of both genders aged 20–60 years, the American Society of Anesthesiologists physical Status I and II, undergoing day-care arthroscopic knee surgery under spinal anesthesia, were assigned into two groups randomly. Group 1 received 10 ml of 0.2% ropivacaine, while Group 2 received 10 ml of 0.25% bupivacaine intra-articularly at the end of the procedure. Pain was assessed for 24 h postoperatively using visual analog scale (VAS) and diclofenac sodium given as rescue analgesia when VAS >3. Time of first analgesic request and total rescue analgesic were noted and compared. Statistical analysis used: Students unpaired t-test and Chi-square test and Mann–Whitney test “Z” value wherever appropriate. A p0.05).Conclusion: Both ropivacaine and bupivacaine injected intra-articularly have similar efficacy statistically in relieving post-operative pain in day-care arthroscopic knee surgery.

Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The decrease in the number of acetylcholine receptors results in decreased efficiency of neuromuscular transmission. Although acetylcholine is released normally, it produces small end-plate potentials that fail to trigger muscle action potentials. Failure of transmission at many neuromuscular junctions results in weakness of muscle contraction. This also makes them susceptible to neuromuscular blocking agents which pose a challenge to the anesthesiologist. Here, we report a case of a patient who was a known case of MG posted for reverse shoulder arthroplasty, who was managed using a supraglottic airway device and spontaneous respiration.