Background: Transverses abdominis plane (TAP) block is a new regional anaesthetic technique for postoperative analgesia in abdominal surgeries, as a part of multimodal analgesia. We evaluated effect of two different doses of clonidine as an adjunct in TAP block in patients underwent unilateral inguinal hernioplasty. Methods: Sixty adult patients undergoing unilateral inguinal hernioplasty were randomized into two groups, Group A (n=30) received bilateral TAP block with bupivacaine 0.25% 38cc + clonidine (1cc) 150 microgram +1cc NS=40cc, Group B (n=30) received bupivacaine 0.25% 38cc+clonidine (2cc) 300 microgram=40cc, at the end of surgery. The postoperative pain was evaluated by visual analog score (VAS) for pain scoring at 2, 4, 6, 12 and at 24 hours. Subjective assessment of duration of analgesia was done. Results: The VAS score in patients who received clonidine 300 microgram Group B as an adjunct was significantly lower than who received 150 microgram Group A. Duration of analgesia was longer in Group B. 2 patients in Group B showed bradycardia treated with atropine. Sedation score was lesser in Group A. Conclusions: Clonidine showed dose dependant analgesia and adverse effect in TAP block for postoperative analgesia. Higher doses of clonidine may be used as an adjunct in TAP block.

Background: Peritonitis is a common emergency encountered by surgeons the world over. Despite a better understanding of pathophysiology, advances in diagnosis, surgery, antimicrobial therapy and intensive care support, peritonitis remains a potentially fatal affliction. Intra-abdominal sepsis is important causes of mortality and morbidity. The treatment is based on rapid fluid resuscitation, initiation of antibiotic therapy and surgical intervention. The antibiotic chosen must cover the most frequently expected bacterial species depending upon the site of perforation. Objectives of the study was done to identify the type of organism present in bowel perforation and their sensitivity pattern to different antibiotics. A guideline will be framed for advising antibiotics to be used for different kinds of perforation.Methods: This was a prospective study of one year on 50 patients of secondary peritonitis due to bowel perforation, conducted in Amaltas institute of Medical Sciences, Dewas.Results: This study included 50 patients with an average age of 36 years (range: 3 days-75 years). There were 40 males and 10 females. The mean duration of hospitalization was 10.6 days (range: 3-25 days) with predominant site of perforation was ileum. E. coli emerged as main pathogenic microbe even in site specific culture, was closely followed by Klebsiella. A combination of third generation cephalosporins with sulbactam and metronidazole has been the most promising therapy to treat secondary bacterial peritonitis due to bowel perforation. It needs to be emphasized that although the sensitivity studies reveal an edge for meropenem over cefaperazone sulbactam, yet the preference of cephalosporin with sulbactam over meropenem is justified, considering the economic constraints and with a suitable foresight, to keep meropenem as a reserve drug because trends indicate that our microbes are fast becoming resistant to the promising combination of third generation cephalosporin with sulbactam and metronidazole.Conclusions: This study suggests that the current recommended empirical antibiotics need to be reassessed.