Background and Aims:The primary aim of this study was to evaluate the effect of addition of dexmedetomidine on the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block.Material and Methods:Sixty patients of American Society of Anesthesiologists physical status I/II/III undergoing elective upper limb surgeries under supraclavicular brachial plexus block using nerve stimulator were randomized into two groups. Group A (n = 30) received 30 mL 0.5% ropivacaine and 1 mL normal saline, and Group B (n = 30) received 30 mL 0.5% ropivacaine and 1 μg/kg of dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included time to onset and duration of sensory/motor blockade.Statistical Analysis:Results on continuous measurements are presented as mean ± standard deviation and compared using Student's unpaired t-test. Results on categorical measurements are presented in number (%) and compared using Chi-square test.Results:Onset of sensory and motor block in Group A (13.0 ± 4.1 and 23.5 ± 5.6 min) was slower than those in Group B (9.5 ± 5.8 and 15.6 ± 6.3 min; P = 0.009 for sensory and P < 0.001 for the motor block). Duration of sensory and motor block in Group A (400.8 ± 86.6 and 346.9 ± 76.9 min) was shorter than those in Group B (630.6 ± 208.2 and 545.9 ± 224.0 min; (P < 0.001). The duration of analgesia in Group A (411.0 ± 91.2 min) was shorter than that in Group B (805.7 ± 205.9 min; P < 0.001). The incidence of bradycardia and hypotension was higher in Group B than in Group A (P < 0.001).Conclusion:Perineural dexmedetomidine with ropivacaine provides prolonged postoperative analgesia, hastens the onset of sensory and motor block and prolongs the duration of the supraclavicular brachial plexus block.

Background: Women undergoing hysterectomy present a unique set of challenges to the anesthesiologist in terms of postoperative pain management. This study was conducted to see the effect of single-dose perioperative duloxetine 60 mg on postoperative analgesia following abdominal hysterectomy under spinal anesthesia. Materials and Methods: This prospective randomized placebo-controlled study was conducted on 64 patients scheduled to undergo elective abdominal hysterectomy under spinal anesthesia. The patients were divided into two groups of 32 in each, Group D received duloxetine 60 mg 2 h preoperatively and Group P received placebo 2 h preoperatively. Postoperatively, the patients were evaluated by an independent observer for pain on rest and during cough at 0 (arrival at postanesthesia care unit), 2, 4, 6, 12, and 24 h. In addition, the postoperative analgesic requirements and adverse effects were noted. Statistical Analysis Used: Independent t -test/Mann–Whitney U-test was used to compare the pain score between two groups. Results: The demographic data were comparable between both the groups. The mean Visual Analogue Scale scores assessed postoperatively at rest and during cough which were not statistically significant between the two groups. The rescue analgesic consumption in Group D (0.97 ± 0.86) and Group P (1.25 ± 0.76) was comparable and statistically not significant. The total analgesic requirement between duloxetine (4.94 ± 0.84) and placebo (1.25 ± 0.76) group was comparable and statistically not significant. The incidence of nausea vomiting and somnolence was higher in Group D. Conclusion: We conclude that patients receiving a single dose of 60 mg duloxetine as premedication before hysterectomy under spinal anesthesia are no better than placebo on postoperative pain during the first 24 h.

No abstract

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology affecting most commonly larynx. A 5-year-old child with stridor was posted for microlaryngoscopic excision of laryngeal papilloma. We discuss the perioperative management of case with the various ventilation strategies. In child with stridor intubation remains the safest option. It is suggested to maintain spontaneous ventilation until intubation as mask ventilation could be difficult.