To study the analgesic efficacy and side effects of Tramadol for painless labor in combination with Bupivacaine. Randomized, controlled, double blind, open prospective study conducted at Department of Obstetrics and Gynaecology, Chitwan Medical College from July 1st 2015 to June 30th 2016. 100 patients of ASA Grade I and II, aged between 20-35 years willing for epidural analgesia for labor pain were included in the study. They were divided into two groups: Group A-Control group and Group B-Study group. Subjects of Group A received 10 ml of 0.25% Bupivacaine and that of Group B received 10ml of 0.25% Bupivacaine with 1mg/kg body weight of tramadol. Analgesic efficacy was assessed by Visual Analogue Scale (VAS) and other vital parameters (Blood Pressure, Heart Rate and Respiratory Rate) before the administration of the drug and at different time intervals of 0, 5 min, 10 min, 15 min, 30 min, 45 min, 60 min and every hourly up to maximum of 5 hrs. Neonatal out comes were assessed by the use of APGAR scores and the side effects of the drugs in two groups were also evaluated. Total number of patients was 100, of ASA Grade I and II, aged between 20-35 years. The mean age of patients in Group A was 23.54 ± 3.74 years and 24.22 ± 3.64 years in Group B. Mode of delivery was spontaneous vaginal in 42 patients (84%) in group A and 45 patients (90%) in group B. Instrumental vaginal delivery was done in 1 patient (2%) of group A and none of group B. Cesarean section was done in 7 patients (14%) of group A and 5 patients (10%) of group B. There was no significant difference in heart rate, blood pressure and respiratory rate at various time intervals. Pain score of Group B was significantly less at 60th min and had lower values than Group A at various time intervals. Time for first top up was significantly delayed and the total dose of bupivacaine was significantly lower in Group B patients but the incidence of nausea and vomiting was significantly high among Group B patients. At one minute majority of the babies of group A had mean APGAR score 6.98 ± 0.55 versus 7.18 ± 0.60 in group B. At 5 minute, Group A had mean score of 8.02 ± 0.47 versus 8.22 ± 0.58 in Group B. There were no significant differences in 2 groups. In both the groups there was no significant effect on duration of second stage of labor and it wasn't prolonged in any of the patients. Epidural anesthesia with bupivacaine and tramadol provided better pain relief and reduced the total dose of bupivacaine in majority of the patients with no adverse effects on mother and fetus. As tramadol is cheap, safe and effective, it can be considered as a better option to improve quality of pain relief during labor.

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

Difficult intubating conditions, anticipated or unanticipated, are part of every anaesthesist's life. A large number of aids and various techniques have been described for intubating in such situations. The primary job of the anesthesiologist is to secure the airway and provide adequate ventilation to the anesthetised patient. Failure to manage difficult airway has led to many of the total deaths attributable to anesthesia. Proper airway examination and selection of appropriate method for airway intervention is of utmost importance. The retrograde intubation technique is one of the valuable alternative options in places where fiberoptic bronchoscope is not readily available or affordable in cases with anticipated difficult airway. We report a case of cancrum oris with sygnathia (fusion of jaw) leading to inability to open mouth posted for bilateral coronoidectomy with osteotomy of fused bone and lip repair. An awake retrograde nasal intubation with light sedation and local block was performed.

Supraclavicular brachial plexus block is extensively used for primary regional anaesthesia as well as postoperative analgesia for the surgical procedures of the upper limb. The evidence for the use of ultrasound in supraclavicular brachial plexus is growing day by day as it has the advantage of allowing real time visualisation of the plexus, pleura and vessels along with the needle and local anaesthetics spread. Despite this, complications can even arise with ultrasound guided supraclavicular brachial plexus block. Hoarseness of voice due to recurrent laryngeal nerve block is a rare complication of supraclavicular brachial plexus block. There are few reported cases of hoarseness of voice following the right supraclavicular block. There is only one reported case of hoarseness of voice following the left supraclavicular block. Here, we report a case of a 16-year-old boy who developed hoarseness of voice due to left recurrent laryngeal nerve following ultrasound guided left supraclavicular brachialplexus block.