AIMS:Brachial plexus nerve blocks have analgesic and opioid sparing benefits for upper extremity surgery. Single-injection techniques are limited by duration of local anaesthetic agents, however Continuous block techniques can be used for prolonged anaesthesia and analgesia but it presents management challenges. The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset,duration and postoperative analgesia following upper limb surgeries. METHODS AND MATERIAL: A prospective, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Sixty patients were randomly divided into two groups, Group B and BD.Group B received 30 ml of 0.375% bupivacaine with 2 ml normal saline while Group BD received 30 ml of 0.375% bupivacain with 2ml(8mg) dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post operative analgesia and intra and postoperative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group BD as compared to Group B patients(P < 0.0001). No significant side effects were noted. CONCLUSIONS: The addition of 8 mg of dexamethasone to bupivacaine in supraclavicular brachial plexus block prolongs the duration of motor and sensory block and extends the analgesia period.KEYWORDS: Anaesthesia adjuvants; Dexamethasone; Brachial plexus block. INTRODUCTION:Brachial plexus block is a suitable alternative to general anesthesia for elbow, forearm and hand surgery. (1) Local anaesthetics alone does not provide analgesia for more than 4-8 hours Prolonging the duration of sensory and motor blockade of regional anaesthetic techniques is often desirable to provide intra operative anesthesia and analgesia in the post operative period without any systemic side effects. Several adjuncts have been studied to potentiate efficacy of brachial plexus block including opioids, midazolam, neostigmine, bicarbonate,hyaluronidase and α2 agonists. (2,3,4) Perineural injection of steroids is reported to influence post operative analgesia.They relieve pain by reducing inflammation and blocking transmission of nociceptive C-fibres and by suppressing ectopic neural discharge. Some studies have demonstrated the analgesic effect of local spinal and systemic corticosteroids in combination with bupivacaine. (5,6,7) The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset,duration and postoperative analgesia following upper limb surgeries.

Introduction: Tetanus is still a major health problem in developing countries. There is paucity of published data regarding pediatric tetanus in study area. This study was conducted to describe the clinical profile, management outcome and prognostic indicators of tetanus in children in our region. Material and Methods: This was a 5 year retrospective study of 24 pediatric tetanus patients < 18 years of age (excluding neonatal tetanus) from January 2010 to December 2014 admitted in Pediatric Intensive care unit of Chhattisgarh Institute of Medical Sciences Bilaspur (C.G.). Mean, summation, percentage and frequency distribution were used where applicable. Results: A total of 24 cases were evaluated. The male to female ratio was 1.4: 1. The majority of patients (79.1%) were < 10 years of age. The mean age of cases were 6.94 ± 3.02 years (age range2 ½-12 years). Only 25% children with tetanus had prior tetanus immunization. Post injury tetanus (41.6%) and Otogenic tetanus (37.5%) were the most common mode of infection. The average incubation period and period of onset were 7.5 ± 3.13 days and 3.2 ± 0.96 days respectively. Complication rate was 54.1%. Mortality rate was 33.3%. Incubation period < 5 days, onset time < 3 days, presence of autonomic dysfunction, need for mechanical ventilation and severity of tetanus were associated with higher mortality. Conclusion: Otogenic tetanus is a common mode of infection in children. Emphasis should be given to maintenance of ear hygiene and appropriate tetanus immunization in children with chronic ear discharge.

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Duchenne Muscular Dystrophy (DMD) is a severe, progressive, X linked muscular wasting disorder that ordinarily has full clinical expression only in males. Females are affected in rare instances. We report a case of Duchenne Muscular Dystrophy in a female child with Turner's syndrome.

Survival after nylon rope suicidal hanging is a rare occurance. We describe here a patient who attempted suicide by nylon rope hanging and developed post obstructive pulmonary edema was managed successfully. Patient recovered completely with ventilatory support in next 60 hours without any neurological deficit.This case highlights an unusual complication of hanging and its recovery. KEYWORDS: Post obstructive pulmonary edema,cerebral edema, Nylon rope attempted suicidal hanging. KEYMESSAGES: Patient was lucky enough to be rescued and brought to the hospital early, even after nylon rope attempted suicidal hanging. Such cases need to be managed aggressively as there are chances of their complete recovery INTRODUCTION:Depression is increasing at an alarming rate globally. (1,2,3) Hanging is one of the oldest and common mode of suicide in the young adults. Death takes about 8-10 minutes in such cases. (4) The mortality and morbidity change dramatically if such patients are rescued early and managed aggressively, even in small ICUs. Here we report a case who presented in severe pulmonary and cerebral edema after attempted suicidal nylon rope hanging.