Background: During orthopaedic surgical procedures such as trigger finger repair or tendon repair, differential nerve block (DNB) can permit intraoperative assessment of adequacy of surgery. The current study was undertaken to compare the efficacy and safety of 0.15% ropivacaine and 0.1285% ropivacaine in producing DNB for hand surgeries. Methods: This was a randomized controlled trial of 40 participants, aged 18-60 years, either gender, ASA I/II requiring hand or forearm surgery. Participants were randomized to receive 25 ml of either 0.15% (Group R15) or 0.1285% ropivacaine (Group R1285). Onset of sensory and motor block, requirement of additional analgesia or general anaesthesia for surgery was noted. Results: DNB was achieved in 18/20 (90%) patients in Group R15 and in 10/20 (50%) patients in Group R1285 (P=0.057). In group R15, mean time to achieve DNB was 15.26±3.5minutes and it was12.78±5.6 minutes in R1285 group (P=0.165). Mean duration of DNB was 15.52±3.7 minutes among R15 and 18.89±3.3 minutes among R1285 (P=0.027). Duration of surgery was 20 minutes in both groups. Two patients (10%) in each group developed full motor block and 8 (40%) patients among R1285 needed general anaesthesia. Conclusion: Differential block sufficient to permit surgery of short duration is possible with both concentrations but success rate is higher with 0.15% ropivacaine.

Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4 hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical–biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins' compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing’s reflex would at least contribute partly, if not solely to the respiratory distress.

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Aims: To compare sensory, motor effects and haemodynamic stability of 2ml intrathecal isobaric ropivacaine (0.75%) with 3ml hyperbaric bupivacaine (0.75%) in patients undergoing endoscopic urological surgery. Study Design: Randomized controlled trial involving 142 patients undergoing transurethral resection of prostate (TURP) and URS (urethroscopy) in a tertiary care hospital, India. Methods and materials: Patients were randomly allocated to, Group 1 (3ml of 0.5% (15mg) hyperbaric bupivacaine) and Group 2 (2ml of 0.75% isobaric ropivacaine(15mg)). Onset and highest level of sensory block, onset and duration of motor block, quality of anaesthesia and muscle relaxation, haemodynamic parameters and adverse effects if any were studied. Statistical analysis used: Unpaired t-test was used to test continuous variables and chi square test/Fisher's exact test for categorical variables. Results: The mean of highest sensory block, 2 segment regression of sensory block and time for sensory level to regress below T10 was significantly more in group 1 compared to group 2 (P<0.05). There was a significant delay of mean time to onset of motor block to Bromage score 1 in group 2(P<0.001). The mean duration of complete motor blockade was significantly more in group 1 (P value <0.001). Hypotension was most commonly seen in group 1. Conclusion: Ropivacaine provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to hyperbaric bupivacaine.

Introduction:Monitoring body temperature and maintaining normothermia are now essentially the standard-of-care during anesthesia. This study was designed to compare the temperature measured by nasopharyngeal temperature probes inserted by landmark method and fiberscope-guided method with esophageal temperature. We hypothesized that placing the temperature probe at the level of fossa of Rosenmuller will reflect core temperature as it is in close relationship to the brain.Subjects and Methods:Sixty-five patients aged 18–60 years were enrolled in this cross-sectional study. Two methods were used in our study to place the temperature probes. In landmark-based method, we inserted temperature probe through nostril for a depth equal to philtrum-tragus distance. In fiberscope-guided method, the temperature probe was inserted into nostril and its tip was positioned at fossa of Rosenmuller under fiberscope guidance.Results:The nasopharyngeal temperatures were recorded at seven time intervals along with esophageal temperature. Mean temperatures were calculated at three different sites. The degree of agreement between two methods at seven time intervals was also calculated. Both methods had good correlation with esophageal temperature. Depth of insertion of temperature probes was documented. There was difference in depth of insertion of temperature probe of around 4.26 cm between two methods, probe length from philtrum to tragus (D1) being longer than distance from fossa of Rosenmuller to nares (D2).Conclusions:Nasopharyngeal temperature measured at fossa of Rosenmuller with probe inserted by fiberscope-guided method and that measured by landmark-based method with probe inserted according to philtrum-tragus distance shows good correlation with esophageal temperature.