<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Supraclavicular brachial plexus block is widely used for surgery below shoulder joint. Adding adjuvant to local anesthetic drugs enhance the duration of block as well as postoperative analgesia. Dexamethasone very potent glucocorticoid when added to local significantly prolongs the duration of analgesia</span>.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This randomized, single blind, controlled study include 100 patients of either sex, aged 18–60 years, ASA status I–III, undergoing upper limb surgery were randomly allocated to receive either 0.375% 30 cc bupivacaine with 2 ml normal saline (group C, n=50) or 0.375% bupivacaine with 2 ml (8 mg) dexamethasone (group D, n=50). The observed parameters include onset and duration of motor and sensory block, duration of effective analgesia any side effects and hemodynamic (pulse rate, NIBP, SpO2). </span><span lang="EN-IN"> </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Mean onset time of sensory and motor block in group C was significantly longer as compared to group D. (p&lt;0.0001) The duration of sensory and motor blockade was significantly prolonged in group D compared to group C. (p&lt;0.0001) The duration of effective analgesia was also significantly prolonged in group D (931.2±69.88 mins) compared to group C (454.8±34.47 mins) (p&lt;0.0001)</span>.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Addition of dexamethasone to 0.375% bupivacaine in brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade. It also prolongs the duration of effective analgesia. </span></p>

INTRODUCTIONThe approach of airway has evolved greatly in recent times since development of endotracheal intubation by Mc Evan in 1880 to present day use of modern supraglottic airway. The tracheal intubation requires skill and continuous training and practice and usually requires direct laryngoscopy, which may cause laryngopharyngeal lesions. It also produces reflex sympathetic stimulation and is associated with raised levels of plasma catecholamine, hypertension, tachycardia and myocardial ischemia, depression of myocardial contractility, ventricular arrhythmias and intracranial hypertension. Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anaesthesia both in adults and children. The first successful supraglottic airway device -laryngeal mask airway (LMA) classic, an inflatable supraglottic airway device became available in 1981.2 I-gel is the most recent development in supraglottic airway devices. It is made of ABSTRACT Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia both in adults and children. This study was carried out to compare classical laryngeal mask airway (LMA) and i-gel, regarding ease of insertion, adequate placement of device, ability to maintain ETCO 2 and SPO 2 , perioperative hemodynamic parameters and intra operative and postoperative complication. Methods: This prospective, randomized clinical study was done on 100 patients of either sex, age between 5 to 60 years, ASA grade I-III who underwent different surgical procedures under general anesthesia in supine position. After giving premedication, induction of anesthesia was done with inj. Propofol 2-3 mg/kg and inj. Succnylcoline 1.5-2 mg/kg. In "sniffing air" position, airway was secured with either LMA or i-gel. An effective placement of device was checked by a square wave capnography, normal chest expansion, SPO 2 >95%, and absence of audible leak. Patients were observed for time and ease of insertion, number of attempts, perioperative hemodynamic changes and complications. Results: No statistically significant difference was reported between both the groups, regarding heart rate, BP, SPO 2 and ETCO 2 . Duration of insertion was more in group LMA. Insertion was easy and was possible in first attempt in 88% of patients without much manipulation in group i-gel. Conclusions: I-gel is a better alternative supraglottic airway device than LMA in view of ease of insertion with minimal manipulations and minimal complications. Hemodynamic parameters, SPO 2 and ETCO 2 were maintained in both the groups.

Objectives: Fingertip injuries are frequent and there are many techniques used for reconstruction fingertip injuries. The authors reviewed the outcomes of fingertip reconstruction, including sensation and shape, using the combined technique of the cross-finger flap and full thickness skin graft and defined the optimal dimensions of fingertip defect that is applicable to this technique. Between 2019 and 2021, 40 cases, aged 3-60 years (mean, 28.1 years), who hadMethods: undergone fingertip reconstruction using a combination of the cross-finger flap and full thickness skin graft were reviewed. The presence of fingertip and nail deformity and the results of the Semmes-Weinstein (S-W) monofilament and static two-point discrimination tests were analyzed. Fingertip deformities were noted in 12 cases whereResults: the defect was more than 50% of the Tamai zone I or extended to zone II. Mild nail plate deformity was found in 12 cases with more than 40% of the nail bed defect. 8 out of these 12 cases presented with partial phalangeal tuft defects. 32 fingers were examined using the Semmes-Weinstein test, and their scores were between 2.83 and 4.31 in 20 fingers and 4.56 in 12 fingers. 24 were examined for static two-point discrimination, with 5 mm in 12, 6 mm in 4, and 10 mm in 2. The color and contour of all donor fingers were almost typical. The combination of the cross-finger flap andConclusions: full-thickness full thickness skin graft is applicable to around 50% of fingertip defect within the Tamai zone I, achieving a satisfactory shape and regaining more than protective sensation.

Patients with burns to their hands require rehabilitation for their early return to work and good quality of life. The aim of this study was to evaluate the effect of early intervention with occupational therapy in patients with burns to their hands. This study included 60 patients with second or third degree hand burns. Patients were included to the study 2 weeks after their burn wounds and grafted areas had healed. They had 3 occupational therapy sessions per week for 8 weeks. These sessions included active and passive range of motion exercises, stretching exercises, active resistive exercises and practicing activities of daily living. Before and after the 8 weeks of occupational therapy using the DASH questionnaire, functionality of the hand was assessed. Before intervention with occupational therapy, the average DASH score was 62.5, and after 8 weeks of occupational therapy it was 30.4 (average difference between the pre-intervention and post- intervention DASH scores is 32.1 points, p < 0.001). After 8 weeks of occupational therapy, patients performed daily living activities with relatively very less difculty, and functionality of the hands was also increased. This study suggests that early intervention with rehabilitative therapies is benecial and may result in improved hand function.

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