BACKGROUNDPost laparoscopic cholecystectomy patients complain more of visceral pain as a result of stretching of the intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Intraperitoneal instillation of local anaesthetic agents has become an important method to control postoperative pain, nausea, vomiting and reduced hospital stay. The purpose of this double-blinded randomised controlled trial was to compare the analgesic efficacy of intraperitoneal instillation of local anaesthetic agents alone or in combination with opioids, ∝-2 agonists such as clonidine and dexmedetomidine to reduce postoperative pain following laparoscopic cholecystectomy. MATERIALS AND METHODS135 were equally divided into three, allocated to one of the groups by random allocation cards using computer generated random numbers. Group A (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + 5 mL normal saline (NS); Group B (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + tramadol 1 mg/kg (diluted in 5 mL NS); or Group C (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + dexmedetomidine 1 mcg/kg (diluted in 5 mL NS). RESULTSWe found bupivacaine in combination with tramadol (Group B) has significantly lower VAS score at all points of time (P < 0.001) and overall VAS score and postoperative analgesia was statistically lower than with Group A. But bupivacaine + dexmedetomidine had even better VAS score underlying high efficacy of drug. Time to first request of analgesia in postoperative period was significantly delayed in Group C as compared to Group A (P= 0.86). CONCLUSIONWe conclude that intraperitoneal instillation of dexmedetomidine 1 mcg/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and significantly reduces the analgesic requirement in postoperative period as compared to bupivacaine 0.25% alone and may be better than bupivacaine combined with tramadol.

Background: Supraclavicular brachial plexus block is a good alternative to general anesthesia in surgeries of elbow, forearm, wrist and hand. The aim of this study was to assess the effect of dexamethasone as an adjuvant with bupivacaine in supraclavicular brachial plexus block in upper limb surgeries.Methods: This study was carried out on 60 adult patients of both sexes planned for upper limb surgery during the period from May 2015 to Jan 2016 after approval by the institutional Ethical Committee. Inclusion criteria were American Society of Anesthesiologists physical Status I-II and age between 18 and 50 years. Patients were randomly allocated to two groups of 30 patients each [group I (bupivacaine alone) and group II (bupivacaine + dexamethasone)]. Group I received 30ml of 0.5% bupivacaine with 2ml normal saline while group II received 30ml of 0.5% bupivacaine with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. Statistical analysis was performed with SPSS for Windows (SPSS Inc., Chicago, IL, USA), version 16.0. For analysis of demographic data and comparison of groups, χ2, unpaired Student's t-test and Mann-Whitney U-test were performed. Power of significance p-value of <0.05 was considered to be statistically significant. We evaluated onset, quality and duration of sensory and motor block along with side effects if any.Results: The mean onset of sensory and motor block in Group I and II was statistically insignificant. The duration of motor and sensory block was significantly prolonged in Group II than in Group I. There were no statistically and clinically significant differences in respiratory and hemodynamic parameters.Conclusions: We conclude that dexamethasone as an adjuvant in supraclavicular brachial plexus block prolongs the duration of motor and sensory block with insignificant side effects.

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Background: Ultrasound guided transvers abdominis plane (TAP) block is a recent modality of managing postoperative pain in lower abdominal surgeries. Aims and Objective: This study was carried out to evaluate postoperative analgesic effectiveness and opioid sparing effect of ultrasound guided transverse abdominis plane block in total abdominal hysterectomy. Materials and Methods: One hundred patients of age group 25 to 65 years enrolled for total abdominal hysterectomy under general anesthesia were studied in the postoperative period at Lal Ded Hospital, Government Medical College, Srinagar over a period of 18 months. Patients who received injection Ropivacaine by ultrasound guided TAP were kept in Group A and others who received only conventional analgesia were kept in Group B. Postoperative pain scores were assessed by VAS score at 1,2,3,4,5,6,12,18 and 24 hours. Time of first rescue analgesia, total opioid consumption and postoperative adverse events were also observed. Results: Postoperative VAS pain scores were significantly reduced at all time intervals in TAP bock group (Group A) when compared with conventional analgesia group (Group B). Mean time for first rescue analgesia was 377 min in Group A as compared to 169 minutes Group B and the difference was statistically significant (p<0.05). The mean opioid consumption in Group A was 104±4.38 mg and in Group B it was 324±26.15mg and the difference between the two was statistically significant (p<0.05). Postoperative adverse events were insignificant. Conclusion: Ultrasound guided TAP block provides effective postoperative analgesia and reduces opioid consumption in abdominal hysterectomy patients under general anesthesia.