The best option for life-saving operations is regional block anesthesia where both general and central neuraxialanesthesia are risky. It does not require fasting, special preparation, or preoperative optimization and can be given in emergency conditions.[1] Also peripheral nerve blocks (PNBs) are preferred for lower limb surgeries and orthopaedic surgeries because of peripheral location of surgical site and the potential to block pain pathways at multiple levels.[2] Furthermore, better cardio respiratory stability is observed with peripheral nerve blocks as central neuraxial blockade is having side effects such as hypotension, bradycardia, meningitis, postdural puncture headache, neurological deficit, etc.[3] Advancement in the newer techniques such as peripheral nerve stimulator and ultrasound anesthesia has shifted from general anesthesia (GA) and central neuraxial blockade for isolated limb surgery to peripheral nerve blocks.[4] But still there is no consensus on whether certain types of patients benefit more from a general, regional or mixture of the two types of anesthesia and anaesthesiologists have different priorities and preferences.[5] The onset of action of a peripheral nerve block is longer than a spinal (subarachnoid block), and the success rate of a satisfactory block is generally lower than for neuraxial blocks. However the cardiovascular stability and postoperative pain relief these regional blocks provide make them worthwhile techniques to perform especially in the critically ill patients.

Background: Recurrence of anterior shoulder instability is disabling condition for which treatment options have been insufficiently studied. Our patients don't seek definitive treatment initially, hence they tend to have engaging hill sacks with or without bony bank arts defect. Coracoid transfer as described by Latar jet and modified by Joe De Beer is one surgery which is suited for recurrent shoulder dislocations. There are various papers mentioning different results. Hence the purpose of this study was to know the functional outcome at two years duration in our set of patients with variable age and occupation. Methods: A cohort formed the basis of retrospective series study was done in tertiary care medical college hospital in Mangalore, Karnataka, India involving twenty-seven patients who underwent Latar jet procedure with congruent ark modification for recurrent anterior glen humeral instability by a single Orthopaedic surgeon in our Institute during July 2015 and Jan 2018. Twenty-four patients were available for follow-up. Clinical outcomes at a mean of three, twelve and twenty-four months postoperatively assessed by the Rowe and SPADI (Shoulder Pain and Disability Index) scores. Standardized anteroposterior and axial radiographs were used to assess the graft position and union. Results: No shoulder dislocations or subluxations observed post-surgery. Unspecified shoulder symptoms of pain were present in two patients. We noticed that there was significant increase in the functional outcome between the 3 rd , 12 th and the 24 th month follow up. At the end of 24months follow up sixteen patients had excellent and remaining eight had good results in terms of Rowe scoring. Conclusions: Later jet procedure with congruent arc modification and adequate rehab can effectively restore anterior glen humeral shoulder stability with good functional results.

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Introduction: Intra venous Regional Anaesthesia is one of the best procedures, providing better intra operative hemodynamic control, post-operative pain relief and rapid recovery from surgery specially upper and lower limb general and orthopedic surgeries. The purpose of the study was to evaluate the efficacy and superiority combination of Lignocaine & Bupivacaince over the any of the drug if used alone and also investigate prolong postoperative pain relief and reduce the requirement of rescue analgesia in upper and lower limb with least side effects.. Intravenous regional Analgesia (I.V.R.A) is simple, effective, economic and safe method of pain relief during limb surgery. Each patient was premeditated with Fentanyl 1 mcg/kg, I.V.Phenargan (0.5 mg / kg, I.V. Medazolam 1 mg I.V was given slowly intravenously 15 minutes earlier to surgery. Material and Methods: In our randomized control trial study, total 60 ASA class I and II patients of age between 15 to 65 years undergoing lower and upper limb orthopedic and other surgeries were given. Patients received 0.5% lignocaine 20 ml to 40 ml alone in one group A and groups B received 40ml to 60 ml of 0.5% of bupvacaine and group C received combination of lignocaine and Bupivacaine 0.5% respectively. All the patients were monitored for onset of sensory and motor blockade, intra operative hemodynamic, post-operative analgesia, adverse effect and complications. Results: Onset of sensory and motor blockade was early in group C. Addition of Bupivacaine with Lignocaine increases the post-operative pain free period significantly and the incidences of complications start to appear in Group A. The incidence of side effects like hypotension, Bradycardia and shivering were not seen in patients of group C. Group A patients receiving Lignocaine 0.5% had hypotension (5%), tachycardia (5%), shivering (0%), vomiting (5%) and convulsion (5%). Group B had rigor in 5 % of the patients and Group C patient had no complication. Conclusion: Addition of Lignocaine with Bupivacaine prolongs postoperative analgesia without altering block characteristics with no side effects and appears to be safe and reliable adjuvant to each other.

Introduction:Management of Mmonteggia fractures has always been debatable; Nnumerous variants have been described in the literature since its first description in 1814. We report a new variant of classical Mmonteggia fracture in a 33-year-old male. Case Presentation: A 33-year old male was brought to the emergency room with an alleged history of assault and was managed with an external wound. Antero-Pposterior and lateral radiographs showed segmental ulna fracture and radial head dislocation. The Ppatient was managed surgically with open reduction internal fixation with reconstruction plate for segmental ulna and closed reduction of radial head was attempted after achieving an anatomical reduction of the ulna. Close attention was paid to the early post-operative mobilization of the elbow joint with the help of a Hinged elbow brace and terminal functional outcome re re-evaluated at 6six months with a DASH score of 11 and MAYO score of 92. Conclusion: We report a rare type 1 monteggia equivalent not described in the literature. Despite the variability of the monteggia equivalents, the principle of management remains the same. Early mobilization of the elbow is of utmost importance to avoid post-operative stiffness. Keywords: Atypical, Equivalent, Monteggia, Segmental.