Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia for ano-rectal surgeries. Its evident efficacy justifies its adoption as anesthesia of choice.

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Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes:i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power-in a swollen limb with/without preceding trauma.ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining-of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation-to indicate myonecrosis.iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration-its hallmark v. Emergent radical debridement vi. Primary closure with viable flaps -unconventional, if need be.

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