BACKGROUND: Intravenous regional anaesthesia, though a effective, reliable and safe technique, has its own share of disadvantages. OBJECTIVE: To compare the analgesic efficacy of lidocaine alone versus combination of lidocaine with dexamethasone for intravenous regional anaesthesia. METHODS: A total number of 50 patients of ASA physical status I and II aged 15 to 65 years undergoing ambulatory hand surgery were recruited. 25 patients received 40 ml of 0.5% lidocaine whereas 25 patients received 40 ml of 0.5% lidocaine and 8mg dexamethasone. Onset, duration and recovery times of sensory and motor block, time to request for first analgesic and total analgesic consumption in 24 hours were recorded. RESULTS: The onset and duration of sensory and motor block did not differ significantly amongst the two groups. The recovery time of sensory and motor block was significantly longer in the study group as compared to the control group. The patients in the study group had a significantly longer pain free interval as compared to the control group. The total analgesic consumption in first 24 hours as well as the total number of patients requiring analgesia was significantly lower in the study group as compared to the control group. CONCLUSION: Adding 8 mg dexamethasone to an intravenous regional anaesthesia solution did not shorten sensory and motor block onset time but prolonged sensory and motor block recovery time, besides reducing postoperative analgesic consumption. JMS 2012;15(2):123-27

We report a case of 28 year old female presenting for an emergency cesarean section with an established diagnosis of peripartum cardiomopathy. Surgery was successfully accomplished under epidural anaesthesia using 15 ml. of 0.5% Bupivacaine, administered in increments. Patient was monitored intra-operatively with Noninvasive blood pressure, pulse oximetry and continuous ECG. Patient's peri-operative course was uneventful. Therefore, it is concluded that in patients with peripartum cardiomyopathy, coming for cesarean section, epidural anaesthesia administered in increments is a safe, acceptable and a better anaesthetic option. JMS 2012;15(1):69-71.

Post operative nausea and vomiting (PONV) continue to be frequent occurrences, even when conventional antiemetics are prophylactically used. In a randomized double blind study, 60 female patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were divided into 2 groups of 30 patients each and received 4 mgs of Ondansetron (Group I) or a combination of Ondansetron 4 mgs and 4 mgs of dexamethasone (Group II) pre-operatively. Patients were observed for 24 hours post operatively and interpretation of symptoms of nausea and vomiting was done according to Gan and Alexander scale (0-2). 70 % of patients in Group II and 43 % patients in Group I did not experience PONV; the difference was statistically significant (p<0.01). 3 patients (10%) in Group II and 10 patients (33%) in Group I required rescue antiemetic medication during the 24 hour study period. The difference was found to be highly significant(p<0.001) The difference in the incidence of PONV between the two groups after 6 hours to 24 hours was highly significant (p<0.001). It was concluded that prophylactic administration of combination of Ondansetron and dexamethasone is effective than Ondansetron when used alone, in reducing in incidence of PONV with prolonged effects.

Background: Spinal anaesthesia used in caesarian section is associated with hypotension which can have maternal and fetal side effects. To determine the efficacy and ideal dosing of Phenylephrine in attenuating the hypotensive episodes during caesarean section under spinal anaesthesia.Methods: 100 patients were allocated to four groups, placebo group (PE 0) and 3 fixed phenylephrine infusion regimens, phenylephrine 25 μg/min-1 (PE 25), phenylephrine 50 μg/min-1 (PE 50), and phenylephrine 75 μg/min-1 (PE 75). Blood pressure, heart rate were noted among primary variables and fetal parameters like umbilical blood pH and lactate were recorded as secondary parameters.Results: There was a significant reduction in heart rate with increasing the infusion dosage of phenylephrine, with a mean of 86.8 beats/min at the end of procedure in placebo group and 69.4 beats/min in 75 μg group (p value <0.001). There was significant statistical difference among systolic blood pressure in the four groups after 7 min of the procedure and p-value of <0.05 with better attenuation of hypotension in infusion groups as compared to placebo. Similarly there was significant statistical difference in diastolic blood pressure among the four groups after 8 min of the procedure with p values <0.05.Conclusions: Prophylactic phenylephrine infusions reduced the incidence and severity of maternal pre-delivery hypotension. Among the fixed rate phenylephrine infusion regimens investigated, infusion rates of 50 μg/min-1 were associated with greater maternal hemodynamic stability compared with 25 and 75 μg/min-1, with minimal side effects and intervention.