BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above) for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotropism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effectiveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: Randomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1-L2 level and after conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine) with an incremental dosage of 1ml at a time, till the complete onset of analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia (Pre & post operatively), duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorded. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac. 10% of patients had fair quality of analgesia and relaxation only. In 3% patients the epidural block failed, in whom general anaesthesia was given. Overall success rate was 97%. Intraoperative and post-operative complications were very minimal. No cases of hypotension, bradycardia, nausea vomiting, total spinal block and respiratory depression were seen. CONCLUSION: From the present study it can be inferred that 0.5% Bupivacaine 5-6 ml is effective for segmental epidural block for inguinal hernia repair. Segmental epidural block is safe anaesthesia with minimal physiological alterations. With less side effects.

BACKGROUND: Utility of succinylcholine for rapid sequence induction is a common practice for more than last 50 years. The ED95 dose of succinylcholine is 0.3mg/kg. Regularly 2-3 times ED95 doses of non-depolarizing muscle relaxants are being used for tracheal intubation, but succinylcholine is being used traditionally in a dose of 1mg/kg which is more than 3.5 times ED95. However, according to the available literature evidence doses as small as 0.4mg/kg may also provide clinically acceptable intubating conditions with the possibility of earlier return of neuromuscular function which avoids critical hemoglobin desaturation in unanticipated difficult airway& CVCI situations. We did a study to evaluate the ease of tracheal intubation with low doses of succinylcholine in Indian population. AIM: To evaluate tracheal intubating conditions and serum potassium levels with different doses of succinylcholine. DESIGN: A prospective randomized double blind comparative study. METHODS: 80 patients belonging to ASA PS I&II were randomly divided into 4 groups A,B,C&D who received 0.5mg/kg,0.6mg/kg,0.7mg/kg& 1mg/kg of succinylcholine respectively. All the patients were pre-medicated with Tab. Alprazolam 0.25mg PO previous night and fentanyl 1mcg/kg 5min before induction, induced with sleep dose of thiopentone followed by administration of test drug. After 1min, 3yrs experienced anesthesiologist attempted tracheal intubation& assessment of intubating conditions were done using Cooper& colleagues criteria. N-M effects were monitored preoperatively and up to 3min after dug administration. Haemodynamic parameters& serum potassium were measured preoperatively, continued up to 5min& 1 hour after drug administration respectively. RESULTS: Clinical intubation cumulative scores in GROUP A were significantly different from other GROUPS (B, C, D) with (p<0.05) on ANOVA. N-M monitoring has revealed significant twitch height depression in Group D (p<0.05) at 60 sec after drug administration along with significant twitch height recovery in between the four groups (p<0.05). With Bonferroni multiple comparison test Group D is statistically different from Group A&B with no difference between Groups C&D. Haemodynamic monitoring and serum potassium levels were increased but not clinically significant. CONCLUSION: To conclude, 0.6mg/kg of succinylcholine can be attempted for rapid sequence induction as it provides equally good intubating conditions with early recovery.

BACKGROUND:Pain is a subjective experience with sensory and emotional components that are inextricably linked to each other. Pain during labour is very intense for many mothers. Severe labour pains may adversely affect both mother and fetus. Variety of regional analgesia techniques are available, Of all these techniques epidural analgesia using local anaesthetics and opiates has gained popularity as a safe and effective technique of pain relief largely replacing other modalities. AIM: The present study was undertaken to compare bupivacaine and fentanyl with a combination of bupivacaine and butorphanol by intermittent bolus epidural technique in relieving pain during labour. DESIGN: Randomized control study. METHODS: A total number of 100 parturients studied were divided into two groups randomly. . Maternal blood pressure, pulse rate, fetal heart rate were monitored every 1-2 min for first 10 min and then every 5-10 min for subsequent 30 min and later every half an hour. Time of onset of analgesia, level of sensory blockade and motor blockade, if any was noted. VISUAL ANALOGUE PAIN SCALE [VAPS] assessed pain at different time intervals. The sedation was assessed by WILSON GRADING, BROMAGE SCALE assessed the motor blockade. RESULTS: The onsets of analgesia were quicker in group-1 parturients who received 0.1% bupivacaine with 0.0002% fentanyl. The duration of analgesia with the 1st dose was significantly more in the group-2 also the requirement of top up doses was also less in group-2 and also the quality in group-2 was superior. There was no significant increase in the requirement of instrumentation, surgical intervention in both the groups. Neonatal outcome was good and almost equal in both the groups without any respiratory depression even with addition of low dose butorphanol by epidural route. CONCLUSION: From this study it may be concluded that using a combination of 0.1% Bupivacaine with 1mg Butorphanol during epidural analgesia for labour provides excellent pain relief, prolonged duration of action with simultaneously decreasing the top-ups required, thereby reducing the total local anesthetic requirement compared to 0.1% bupivacaine with 0.0002% fentanyl [20mcg]

BACKGROUND:Regional anaesthesia is noted for its simplicity, safety and effectiveness. Though spinal anaesthesia provides an efficient block it has some limitations. Epidural anaesthesia is one of regional techniques for lower abdominal and lower limb surgeries. Bupivacaine is the drug of choice for providing effective epidural analgesia. Ropivacaine is new long acting local anaesthetic with similar chemical structure but with less cardio toxicity and CNS toxicity. We did a Prospective Randomised control study to compare between two groups-20ml of 0.75% Ropivacaine (Isobaric) and 20ml 0.5% Bupivacaine (Isobaric) for epidural anaesthesia in lower abdominal and lower limb surgeries in adults aged 18 to 60 years. AIM: To compare in two groups-20 ml of 0.75% Ropivacaine (Isobaric) and 20 ml 0.5% Bupivacaine (isobaric) for epidural anaesthesia in lower abdominal and lower limb surgeries in adults DESIGN: A Prospective randomized control study. METHODS: The study population was randomly divided into 2 groups with 30 patients in each group. Study group R-received 20ml of 0.75% Ropivacaine (Isobaric) by epidural route Study group B-received 20ml of 0.5% Bupivacaine (isobaric) by epidural route and compared 1. Onset of sensory and motor block, 2. Highest level of sensory block, 3. Degree of motor blockade (Using Modified Bromage scale) 4. Duration of motor blockade. 5. Duration of sensory analgesia. 6. Haemodynamic changes heart rate, blood pressure, respiratory rate. 7. Side effects if any. RESULTS: 0.75% Ropivacaine has a shorter duration of motor block when compared with 0.5% Bupivacaine. The onset of sensory and motor blocks, highest level of sensory block, degree of motor block and duration of sensory analgesia are similar to that of Bupivacaine. The haemodynamic changes and side effect profile of Ropivacaine is also not significantly different from that of Bupivacaine CONCLUSION: Based on the present clinical comparative study, we conclude that Ropivacaine can be used as a safe alternative to Bupivacaine for epidural anaesthesia in lower abdominal and lower limb surgeries. The shorter duration of motor block with Ropivacaine suggest that it could be effectively used for early mobilization of patients in the post-operative period.

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