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: To compare the efficacy of USG guided central venous catheterisation at internal jugular vein (IJV) and at the Pirogoff’s confluence [IJV, subclavian vein (SCV), Brachiocephalic Vein (BCV)].: A prospective, comparative, randomized, hospital based study was conducted on 100 patients requiring central venous access. After explaining the study to the selected patients, they were randomized into two groups with the use of sealed envelope method i.e. group A (Central venous cannulation of IJV) and group B (central venous cannulation of Pirogoff’s confluence of IJV, SCV, BCV). Data was collected with respect to the efficacy of USG guided cannulation on the basis of time for visualisation, access time, number of attempts, time to CVC, total time of procedure, length of catheter inserted. Any complications encountered were recorded.: There was no difference between number of attempts in either of groups, mean visualization, access time and time to CVC was longer in group B with statistically significant difference. Mean length of catheter inserted was shorter in group B with statistical significant difference. Procedure time required was comparatively more in group B. : The results indicated that Ultrasound guided cannulation of group A is efficacious than group B in terms of time required to culminate the procedure as well as complications but cannulation of Pirogoff’s confluence is a novel approach giving easier access, better visualisation and length of catheter inserted is lesser than IJV.

Supraclavicular brachial plexus block is the most suitable mode of anaesthesia for various upper limb surgeries. Dexmedetomidine added to local anaesthetics shortens the onset time and prolongs the duration of block and post-operative analgesia in the brachial plexus block. However, there remains limited knowledge of its analgesic efficacy and duration in peripheral nerve and nerve plexus blockade. d: This prospective randomized double-blinded study was conducted with 60 patients of ASA physical status class I/II, scheduled for elective unilateral upper limb surgery. Patients were randomized into 2 groups of 30 each. All patients in Group L received a brachial plexus block with 29 ml of 0.5% levobupivacaine + 1ml of normal saline. Group LD received 29 ml of 0.5% levobupivacaine + 1ml of dexmedetomidine 1ml(100mcg). The primary objectives were the onset and duration of sensory and motor block. The onset of sensory and motor block was earlier in Group L (12.4 ± 3.1 min and 20.5 ± 3.8 min) than Group LD (15.9 ± 2.7 min and 22.1 ± 3.2 min), (P = 0.0000 and 0.0801). The duration of sensory and motor block was longer in Group LD (1198.0 ± 48.5 min and 1178.3 ± 41.4 min) than Group L (710.3 ± 87.3 min and 688.7 ± 86.6 min), (P =0.0000). The duration of analgesia was longer in Group LD (1222.0 ± 49.2 min) than Group L (726.3 ± 91.1 min), (P < 0.0001). Dexmedetomidine added with levobupivacaine prolongs the duration of sensory as well as motor block in brachial plexus block using the supraclavicular technique with haemodynamic stability.

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