Tapentadol is a novel, centrally acting analgesic with dual mechanism of action, combining mu-opioid receptor agonism with noradrenaline reuptake inhibition in the same molecule. It has an improved side effect profile when compared to opioids and nonsteroidal anti-inflammatory drugs. The dual mechanism of action makes Tapentadol a useful analgesic to treat acute, chronic, and neuropathic pain.

Introduction:With the advent of ultrasound (US) guidance, this technique saw resurgence in the late 1990s. As US guidance provides real-time view of the block needle, the brachial plexus, and its spatial relationship to the surrounding vital structures; it not only increased the success rates, but also brought down the complication rates. Most of the studies show use of US guidance for performing brachial plexus block, results in near 100% success with or without complications. This study has been designed to examine the technique and usefulness of state-of-the-art US technology-guided supraclavicular brachial plexus block and compare it with routine nerve stimulator (NS)-guided technique.Aim:To note block execution time, time of onset of sensory and motor block, quality of block and success rates.Settings and Design:Randomized controlled trial.Materials and Methods:A total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and NS (Group NS). Both groups received 1:1 mixture of 0.5% bupivacaine and 2% lignocaine with 1:200000 adrenaline. The amount of local anaesthetic injected calculated according to the body weight and not crossing the toxic dosage (Inj. bupivacaine 2 mg/kg, Inj. lignocaine with adrenaline 7 mg/kg). The parameters compared between the two groups are block execution time, time of onset of sensory and motor block, quality of sensory and motor block, success rates are noted. The failed blocks are supplemented with general anesthesia.Statistical Analysis:The data were analyzed using the SPSS (version 19) software. The parametric data were analyzed with student “t” test and the nonparametric data were analyzed with Chi-square test A P < 0.05 was considered significant.Results:There was no significant difference between patient groups with regard to demographic data, the time of onset of sensory and motor block. Comparing the two groups, we found that the difference in the block execution time and success rates is not statistically significant. A failure rate of 10% in US and 20% in NS group observed and is statistically insignificant (P = 0.278). No complication observed in either group.Conclusions:US and NS group guidance for performing supraclavicular brachial plexus blocks ensures a high success rate and a decreased incidence of complications that are associated with the blind technique. However, our study did not prove the superiority of one technique over the other. The US-guided technique seemed to have an edge over the NS-guided technique. A larger study may be required to analyze the advantages of using US in performing supraclavicular brachial plexus blocks, which could help justify the cost of purchase of the US machine.

Background:TruviewPCD laryngoscope is specially designed to aid positioning of the endotracheal tube as well as to record entry of the tube into glottis. Aim of the study is to compare the view of glottic opening and ease of intubation between TruviewPCD laryngoscope and Macintosh laryngoscope in patients undergoing general anesthesia (GA).Methodology:Two hundred patients undergoing elective surgery, under GA were randomized into two groups, Group TV and Group ML. In Group TV, TrueviewPCD laryngoscope was used initially to visualize the vocal cords for Cormack and Lehane grading (CLG) and to spray the vocal cords with 10% lignocaine. Then the patient was ventilated for 1 min and Macintosh laryngoscope was used to visualize the vocal cords for CLG and proceed with intubation. In Group ML, Macintosh laryngoscope was used initially and later TruviewPCD laryngoscope. Time to intubation, CLG, number of attempts and hemodynamic parameters were recorded.Results:Ninety-six and 89 patients had CLG1 visualization when TruviewPCD laryngoscope was used as 1st and 2nd device respectively compared to 41 and 68 with Macintosh laryngoscope (P = 0.00). Four patients had CLG 4 visualization with Macintosh laryngoscope that turned out to be grade II visualization with TruviewPCD laryngoscope (P = 0.00). Mean time taken for intubation with TruviewPCD and Macintosh laryngoscope was 21.10 ± 5.64 s and 15.79 ± 2.76 s respectively (P = 0.00).Conclusion:Better visualization with lesser CLG was found with TruviewPCD laryngoscope but it took longer time for intubation than Macintosh laryngoscope. The hemodynamic response to intubation was significantly less with the use of TruviewPCD laryngoscope when compared to that of Macintosh laryngoscope.

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The ability of Diatomacious earth (DAE) in reducing the toxic effects of aflatoxin (AF) in broiler diet was evaluated. DAE was supplemented @ 400 and 800 mg kg -1 of feed along with 0.5 and 1 ppm of AF kg -1 of feed. Healthy unsexed day old broiler chicks (n=360) were assigned to 9 groups comprising of control and treatment groups. Feeding of AF resulted in significantly lower feed intake as well as body weight gain and increase in feed conversion ratio in comparison to the control groups. Supplementation of DAE in aflatoxin mixed diet significantly reduced the deleterious effects of AF on growth parameters. Feeding of AF alone caused significant decrease in serum levels of total proteins, albumin, triglycerides and cholesterol. However, significant increase was found in serum levels of AST, ALT, ALP, BUN and creatinine in AF fed broilers. Supplementation of DAE to the AF mixed feed ameliorated the adverse effect of AF on the serum biochemical values by causing increase in serum total proteins, albumin, triglycerides and cholesterol levels. In addition, a significant increase was recorded in AST, ALT, ALP, BUN and creatinine levels in DAE supplemented broilers. The study concluded that diatomaceous earth is an effective adsorbent to decrease the negative effects of aflatoxin in broiler chicken