This study was conducted to determine whether any patient characteristics would be useful in predicting a difficult subarachnoid block. This study was designed to determine statistically the association of certain patient variables with a difficult subarachnoid block and develop a simple accurate and easily applicable "difficulty score" for subarachnoid block as well as assess its predictive value.

Mediastinal hematomas following internal jugular vein (IJV) cannulation is relatively a rare complication with a very few cases reported in the literature. We hereby report a case of posterior mediastinal hematoma in a 21-year-old primigravida who underwent exploratory laparotomy postcesarean section. In this patient, anatomical landmark guided central venous catheter insertion through the right IJV was attempted using modified Seldinger's procedure in intensive care unit (ICU) after the surgery. A total of three attempts were made. The procedure was abandoned since there was resistance felt during guidewire insertion. A routine postprocedural chest radiograph and subsequent high-resolution computed tomography (HRCT) showed a large posterior mediastinal hematoma that developed as a result of injury to the IJV and carotid artery during the procedure. The patient was hemodynamically stable throughout and hence managed conservatively. The hematoma resolved completely over a duration of 6 weeks. This case is being reported for its relative rarity and to signify the importance of obtaining a routine postprocedure chest radiograph and to state that even mediastinal hematoma can be managed conservatively in asymptomatic patients.

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Aim and objective:We evaluated the effect of preoperative single-dose pregabalin (PG) on postoperative pain in patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Materials and methods:In this double-blind study, 60 adult patients scheduled for elective on-pump CABG surgery were randomized into two groups of 30 each, viz., PG and placebo (PL). Patients received either oral PG 150 mg or a PL, 1 hour before surgery. All patients received general anesthesia. Postoperative pain relief was provided with intravenous tramadol 50 mg 8 hourly. Postoperative pain was assessed, both at rest and during coughing, with the 10-point verbal rating scale (VRS) at 6, 12, 18, and 24 hours after extubation. Time to extubation, pain scores, requirement of additional analgesics, and adverse effects were compared using chi-square test, unpaired t test, and Mann-Whitney U test. Results:The time to extubation was significantly prolonged in the PG group compared with PL (9.84 ± 1.88 vs 8.66 ± 2.12 hours, p = 0.027). The mean VRS scores at rest and during coughing were significantly lower in the PG group compared with PL (p < 0.05). However, the requirement of additional analgesics, such as paracetamol or tramadol was similar in the two groups. Conclusion:A single preoperative oral dose of PG 150 mg was effective in reducing postoperative pain in patients undergoing on-pump CABG compared with a PL.

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Introduction: Effective epidural catheter fixation is a key aspect of postoperative pain management in pediatric patients. We conducted a prospective, randomized study comparing the efficacy and safety of adhesive strip (Steri-Strips™) vs subcutaneous tunneling for successful epidural catheter fixation.