BACKGROUND & OBJECTIVES:Supraclavicular block of brachial plexus provides complete and reliable anaesthesia for upper limb surgeries. Ropivacaine, is an affective local anaesthetic in for brachial plexus anaesthesia. It is a potent blocker of Aδ and C fibres, rendering good sensory effect but less motor blockade. We evaluated the anaesthetic quality and length of analgesia with the addition of either fentanyl or dexmedetomidine to ropivacaine for Supraclavicular brachial plexus block. METHODS: In a prospective clinical trial, 90 patients were randomly allocated to either receive 30 ml ropivacaine 0.5% (Group R), 30 ml ropivacaine 0.5% with fentanyl 50 mcg (Group RF) or 30 ml ropivacaine 0.5% with dexmedetomedine 50 mcg (Group RD) in Supraclavicular brachial plexus. The characteristics for anaesthesia and analgesia were assessed for the three groups. OBSERVATIONS: Demographic profile was comparable in the groups. The onset of analgesia and time to complete analgesia was enhanced in Group RD and Group RF compared to Group R. Prolongation of sensory blockade and motor blockade with extended duration of postoperative analgesia was observed in Group RD and Group RF compared to Group R. There were minimum haemodynamic disturbances and side-effects in any group except for Grade 3 sedation score which was frequently noted in patients receiving dexmedetomidine as adjunct. RESULTS: Compared to the use of ropivacaine 0.5%, 30 ml alone for supraclavicular brachial plexus block, the addition of 50 mcg fentanyl or 50 mcg dexmedetomidine to ropivacaine enhanced onset of block and also increased duration of surgical anaesthesia with prolongation of post-operative analgesia. Furthermore blockade characteristics improved better with addition of dexmedetomodine than fentanyl without increasing incidence of unwanted side-effects.

Background: The aim of this study is to predict difficult airway on the basis of various airway assessment parameter in the paediatric population between 5-12 years age group. To assess the value of modified Mallampati test (MMT), upperlip-bite test (ULBT), thyromental distance (TMD), ratio of height to thyromental distance (RHTMD) from which Cormack Lehane grade was derived to predict difficult airway i.e. difficult intubation in paediatric patients ranging from 5-12 years age. Material and Methods: 100 ASA grade I & II paediatric patients of either sex between the age group of 5-12 years posted for elective surgery under general anaesthesia requiring endotracheal intubation were included in the study. Modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance of the patients were measured and recorded. All the distances were measured with the help of a flexible measuring tape so as to measure the distances accurately. Results: Modified Mallampati test has the highest sensitivity (75%) and specificity (92.05%) among all the other screening tests. It also has high positive predictive value (56.25%), negative predictive value (96.43%) and diagnostic accuracy (90%). Upper Lip Bite test has high specificity (79.55%) and negative predictive value (93.33%) with high diagnostic accuracy (77%). It has a sensitivity of 58.33% which is similar to the sensitivity of thyromental distance and ratio of height to thyromental distance. Thyromental distance has high specificity (65.90%) with high negative predictive value (92.06%). Conclusion: Modified Mallampati test is a useful bedside screening test for predicting difficult intubation in patients between 5-12 years age group. The Upper Lip bite test and thyromental distance has high specificity with high negative predictive value and diagnostic accuracy. The ratio of height to thyromental distance is least useful predictor of airway assessment.

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Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesias, venous and subarachnoid cannulation, suboptimal catheter placement and coiling of catheter can affect the quality of anesthesia. A prospective randomized controlled study was conducted to assess the effect of priming of epidural space with a single-injection dose of local anesthetic solution (10mL 2% lidocaine+ adrenaline and 10ml 0.5% bupivacaine) before catheter insertion. We randomized 100 patients into 2 equal groups and measured the quality of anesthesia and incidence of catheter related complications. METHODS: A group of 100 patients was randomized and divided in two groups. In Group A [needle group] (n _ 50), local anaesthetic solution was administered through epidural needle before epidural catheter insertion. In Group B [catheter group] (n _ 50), the catheter was inserted immediately after identification of the epidural space. Local anesthetic solution was then injected via the catheter. We noted the occurrence of paresthesia, inability to advance the catheter, or IV or subarachnoid catheter placement, number of attempts to insert catheter. Sensory and motor block were assessed 20 min after the injection of local anesthetic solution. Surgery was initiated when adequate sensory loss was confirmed. Infraumbilical, pelvic general surgeries, hysterectomies and lower limb orthopedic surgeries were included in study. RESULTS: All observations were noted and statistical test of significance was applied. In the catheter group, the incidence of paresthesia during catheter placement was 16% compared with 4% in the needle group (x 2 =4.0, P<0.05). Intravascular catheter placement occurred in 8% versus 0% of patients in the catheter and needle groups, respectively (x 2 = 5.34, P<0.05). The number of attempts to pass catheter was more than one in catheter group as compared to needle group. (x 2 =4.33, P<0.05) More patients in the needle group had excellent quality of surgical conditions than the catheter group (94% versus 35%) (x 2 =9.75, P<0.05). CONCLUSION: We conclude that priming of epidural space with a single injection local anaesthetic dose via the epidural needle before catheter placement improves the quality of anesthetic blockade and reduces catheter-related complications.