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Various adjuvants have been used with local anesthetics in spinal anesthesia to improve the quality of block and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. AIM: The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. METHODOLOGY: Fifty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were included in this prospective cohort study at Amala Institute of Medical Sciences. Patients received either 15 mg hyperbaric bupivacaine plus 25 μg fentanyl (group 1, n = 25) or 15 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group 2, n = 25) intrathecally. RESULTS: Patients in dexmedetomidine group (2) had a significantly longer duration of motor and sensory block than patients in fentanyl group. (1) The mean time regression of motor block to reach Bromage 0 was 176.2±5.71 min in dexmeditomidine group and 166.36±5.97 min in fentanyl group (P<0.05). Duration of analgesia was 239.52±9.05 min in Dexmeditomidine group and 189.96±5.35 min in fentanyl group (p<0.05). A significant decrease in heart rate was noted in dexmedetomidine group. CONCLUSION: Intrathecal dexmedetomidine is associated with prolonged duration of analgesia and motor block along with significant decrease in heart rate.

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BACKGROUND The Subclavian Vein (SV) is one of the preferred route for central venous catheterisation. There is limited data comparing the efficacy of Ultrasound (US) guided Supraclavicular (SC) and Infraclavicular (IC) approaches for SV cannulation in India. The purpose of this study was to compare the effectiveness of these procedures. METHODOLOGY We selected 130 patients aged ≥18 years (Mean age 59, men 57%) and recruited them equally into a supraclavicular and infraclavicular groups on alternate basis. Catheterisation was done by a single experienced anaesthesiologist using standard protocols. Information on age, sex, time for locating the vein, puncture time, number of attempts, catheter insertion time and incidence of complications were collected using a structured proforma. Data were analysed comparing the two groups using SPSS. RESULTS The mean time for locating the vein was 24 seconds (s) in the infraclavicular group which is significantly higher than that in the supraclavicular group, 17s (p<0.001). The puncture time was 54 s in the IC group and 40 s in the SC group (p=0.001). Catheterisation time was 132 s in the IC group and 120 s in the SC group (p=0.003). Number of multiple attempts was 22 in the IC group and 8 in the SC group (p=0.005). There were no complications and no guide wire misplacements in either group. CONCLUSION The supraclavicular approach for US-guided subclavian vein catheterisation in adults is clinically more advantageous in terms of shorter time for location, puncture time, catheterisation time, lower number of attempts & a potentially lower incidence of complications when compared to the infraclavicular approach.

in the affected regions of the articular cartilage than in the intact cartilage regions of the same knee. The expression of both autophagic markers (LC3b, Beclin-1 and ATG5) and the p16INK4A senescence marker was also increased in the affected regions of the human cartilage. Importantly, the expression of these markers in humans was detected in the numerous chondrocyte clusters that were present in the affected cartilage regions. These clusters were absent from mice OA cartilage, underlying different mechanisms at work in the two species. Conclusions: We have shown for the first time the expression of Klotho in articular cartilage, both in mice and humans. In both species, a similar expression pattern between the anti-aging protein Klotho, and autophagy and senescence markers was observed. However, the presence of cell clusters in human OA cartilage but not in mice reveals fundamental differences in the underlying mechanisms of osteoarthritis development.

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BACKGROUND: Brachial plexus blocks, alone or in combination with general anesthesia, has become one of the most important anesthesia techniques for surgeries in the upper limb. Prolongation of analgesia using perineural catheters are not yet popular, and we are in need for an adjuvant that can prolong the action of local anesthetics after single injection peripheral nerve blocks. Dexamethasone and clonidine are two commonly used adjuvants. This study was undertaken to compare the analgesic efficacy of dexamethasone and clonidine. MATERIALS AND METHODS: Ninety adult patients fitting under the inclusion criteria were assigned to three groups of thirty each and received ultrasound guided supraclavicular brachial plexus block. They received either dexamethasone 8 mg (Group D) or clonidine 1mcg/kg (Group C) or saline 2 ml (Group S) with 15 ml of 0.5% bupivacaine. The onset of sensory and motor blocks, duration of analgesia and the duration of motor block were assessed. RESULTS: The onset of sensory and motor block were comparable in all the three groups (17.50±2.86 minutes and 30.33±4.14 minutes; 17.17±3.13 minutes and 31.0±4.8 minutes; 18.33±3.55 minutes and 31.0±5.48 minutes for groups D, C and S respectively. The duration of analgesia and motor blockade was markedly prolonged in dexamethasone group (19.41±2.60 hours and 17.19±2.13 hours) and moderately prolonged clonidine group (11.49±1.66 hours and 10.41±1.18 hours) when compared to saline group (7.56±1.65 hours and 6.22±1.43 hours). CONCLUSION: Dexamethasone proves to be a better adjuvant compared to clonidine, as it considerably prolongs analgesia and is devoid of significant side effects. But the prolonged motor block is still a matter of concern and the search for an adjuvant that selectively prolongs analgesia without impairing motor function continues.