Background and Aims:Several locoregional techniques have been described for providing postoperative analgesia after breast surgery. The optimal technique should be easy to perform, reproducible and provide good analgesia. This randomised control study was designed to evaluate the postoperative analgesic effect of ultrasound-guided erector spinae plane (US-guided ESP) block for modified radical mastectomy (MRM) surgery.Methods:A total of 40 females belonging to American Society of Anesthesiologists' 1 or 2 posted for MRM were randomly allocated into Group 1 (control group) and group 2 (ESP group). Patients in Group 1 received only general anaesthesia (GA) and were managed for pain postoperatively according to routine protocol, while group 2 (ESP group) patients received unilateral US-guided ESP block preoperatively (20 mL 0.5% bupivacaine to the operating side) followed by GA. The primary objective of study was to record postoperative 24 h cumulative morphine requirement. Differences between the two groups were analyzed using the Mann–Whitney U-test or a two-tailed Student's t-test.Results:Postoperative morphine consumption was found to be significantly less in patients receiving US-guided ESP block compared to control group (1.95 ± 2.01 mg required in ESP group vs 9.3 ± 2. 36 mg required in control group, P value = 0.01)). All the patients in control group required supplemental morphine postoperatively compared to only two patients requiring that in US-guided ESP block group (P < 0.01).Conclusion:US-guided ESP block when given prior to MRM surgery provided effective postoperative analgesia. CTRI registration no. - CTRI/2018/03/012712 registered in the clinical trial registry, India.

Intravenous dexmedetomidine in combination with 25 mL of bupivacaine (0.5%) accelerated the onset of sensory and motor block and prolonged the duration of sensory and motor block when used for brachial plexus block, without resulting in any adverse events.

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Introduction:Opioids are widely used in conjunction with local anesthetics as they permit the use of lower dose of local anesthetics while providing adequate anesthesia and analgesia. It both provides adequate anesthesia as well as lower drug toxicity neuraxial administration of opioids in conjunction with local anesthetics improves the quality of intraoperative analgesia and prolongs the duration of postoperative analgesia. Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects. The present study was conducted to decrease the overall dose of local anesthetics with opioid combination for urological procedure with respect to quality of anesthesia and recovery with patient's satisfaction.Materials and Methods:The study population was randomly allocated by computer generated table into two groups; Group A: 5 mg 0.5% bupivacaine + 25 mcg and Group B: 5 mg 0.5% bupivacaine + 25 mg butorphanol.Results:Highest level of sensory block was T9 and T8 with the fentanyl group and butorphanol group, respectively. The onset of sensory block was early in fentanyl group than butorphanol group. Duration of both sensory and motor block was significantly higher in butorphanol group. There was no incidence of itching in both groups. There were two patients in fentanyl group and one in butorphanol with hypotension for which injection mephentermine was given. Two patients in fentanyl group complained of nausea and vomiting, for which injection ondansetron was given. One patient complained of pain in fentanyl group for which injection propofol with injection fentanyl was supplemented.Conclusion:Low-dose bupivacaine with butorphanol group was devoid of any side effects in the present study but low dose bupivacaine in addition with fentanyl is superior in terms of early postoperative recovery resulting in early discharge and better outcome in comparison to bupivacaine and butorphanol group, which is beneficial in elderly patients with comorbidity.

IgM) appears persisting for few months, rarely beyond 6-12 months, coinciding with elevated serum aminotransferase activity and faecal HAV shedding. At about the same time, IgG class of antibodies to HAV (anti-HAV IgG) also appears, but persists for prolonged period and is protective in nature. 1 To our knowledge, no ABSTRACT Background: Hepatitis A is a preventable infectious disease with global distribution. Knowledge about the epidemiology of hepatitis A in a particular region will helpful for appropriate management of cases as well as preventive strategies for that region or area could be planned. The aim of the present study was to determine the prevalence of hepatitis A virus (HAV) as cause of acute viral hepatitis (AVH) in Central Karnataka, India. Methods: Blood samples were collected from AVH cases over a period of six months from June 2015 to November 2015 among patients attending a tertiary care centre, Davangere, Karnataka, India. Samples were tested for HAV IgM antibody (anti-HAV IgM) using a commercially available immunochromatographic assay. Results: Out of 51 samples tested, 19 (37.25%) were positive for anti-HAV IgM. Seropositivity for HAV was higher in females (43.75%) than males (34.29%). Agewise anti-HAV IgM positivity showed highest rate in 1-5 years age group (50.0% ), followed by 6-10 years group (42.86%) with a decline in older age groups (> 15 years). Conclusions: HAV causes AVH most commonly in early childhood and a small number of adolescents and adults. Females are more commonly infected than males. The preventive strategies and control measures of hepatitis A will be determined by future definition of HAV epidemiology in the Central Karnataka region, India.

Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis.

Background: Laparoscopic surgery in recent times has noteworthy advantages over conventional surgery, yet recovery is prolonged due to debilitating shoulder tip pain (STP) and operated site pain. Various studies have compared the effect of trocar site, intraperitoneal instillation of local anesthetic (LA) for pain relief while only a few studies have tested the combination of these two techniques. Hence, this study was undertaken to compare the combination of these two techniques versus trocar site alone for STP particularly. Subjects and Methods: This prospective, randomized, comparative study was conducted on 52 patients who were undergoing laparoscopic abdominal surgery. The patients were allocated into either of the two groups. Group I ( n = 26): trocar site infiltration (20 mL) and intraperitoneal instillation (20 mL) of 0.25% levobupivacaine and Group II ( n = 26): trocar site infiltration (20 mL) of 0.25% levobupivacaine and saline (20 mL) intraperitoneally. Postoperative STP was the primary outcome while surgical site pain, nausea, and vomiting were secondary outcomes. Results: There were no statistically significant differences between the groups with regard to shoulder pain, surgical site pain, total rescue analgesics, and incidence of nausea and vomiting ( P > 0.05). Conclusion: Trocar site infiltration with intraperitoneal instillation of LA or trocar site infiltration alone was found to be equally effective. However, we suggest that it is better to provide a combination of trocar site infiltration plus intraperitoneal instillation of LA if we have to restrict opioid usage such as in day-care surgeries.

The aim of this study is to examine the effects of granisetron on the sensory and motor block and haemodynamic changes resulting from subarachnoid block using hyperbaric bupivacaine. Methods: Forty ASA I and II adult patients undergoing infraumblical surgery under spinal anesthesia were included in this prospective, randomised, double blind study. They wrere randomly divided into two groups.Using computer generated random numbers, patients were allocated to one of two groups: Control Group: Patients of this group received normal saline. Granisetron Group: Patients of this group received 1mg Granisetron. Patients of both groups received heavy 0.5% Bupivacaine intrathecally. Result: All the demographic parameters were comparable.19 patients (67.8%) in saline group while 13 patients (46.4%) in granisetron group had hypotension which was treated with IV ephedrine. Saline group had more than three episodes of hypotension while none of the patients in granisetron group had hypotensive episodes more than two.The maximum cephalad spread of sensory block was similar (P = 0.13).T Patients who received granisetron had significantly faster sensory regression times by two segments from T12 -S1. However motor regression is similar in both group. There were no significant differences between the two groups in haemodynamic variables. Conclusion: IV administration of granisetron, in a dose of 1 mg, before intrathecal bupivacaine results in a faster recovery of sensory block in adult patients. There is also less incidence of hypotension in Granisetron group.