Background and Objectives:Alpha-2 agonists are mixed with local anaesthetic agents to extend the duration of spinal, extradural and peripheral nerve blocks. We compared clonidine and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of analgesia.Methods:Sixty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a randomized, double-blinded fashion. Group C received clonidine 1 μg/kg and Group D received dexmedetomidine 1 μg/kg added to bupivacaine 0.25% (35 cc). Onset and recovery time of sensory and motor block, duration of analgesia and quality of block were studied in both the groups.Results:Duration of sensory block and motor block was 227.00±48.36 and 292.67±59.13 min, respectively, in group C, while it was 413.97±87.13 and 472.24±90.06 min, respectively, in group D. There was no statistically significant difference in onset of sensory and motor block between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in group D was 456±97 min, while in group C, it was 289±62 min. Statistically, this difference was significant (P=0.001). The number of patients achieving grade IV quality (excellent) of block was higher in group D (80%) as compared with group C (40%) (P<0.05).Conclusion:Dexmedetomidine when added to local anaesthetic in supraclavicular brachial plexus block enhanced the duration of sensory and motor block and also the duration of analgesia. The time for rescue analgesia was prolonged in patients receiving dexmedetomidine. It also enhanced the quality of block as compared with clonidine.

Background:Dexmedetomidine, an α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilising properties without significant respiratory depression.Methods:We assessed the efficacy of dexmedetomidine in attenuating sympathoadrenal response to tracheal intubation and analysed reduction in intraoperative anaesthetic requirement. Sixty patients scheduled for elective surgery of more than 3 hours were randomly selected. Control group received isoflurane–opioid and study group received isoflurane–opioid-dexmedetomidine anaesthesia. Dexmedetomidine infusion in a dose of 1 μg/kg was given over 10 min before the induction of anaesthesia and was continued in a dose of 0.2–0.7 μg/kg/Hr until skin closure. All patients were induced with thiopentone, fentanyl and vecuronium. Haemodynamic variables were continuously recorded.Results:The need for thiopentone and isoflurane was decreased by 30% and 32%, respectively, in the dexmedetomidine group as compared to the control group. After tracheal intubation, maximal average increase was 8% in systolic and 11% in diastolic blood pressure in dexmedetomidine group, as compared to 40% and 25%, respectively, in the control group. Similarly, average increase in heart rate was 7% and 21% in the dexmedetomidine and control groups, respectively. Fentanyl requirement during the operation was 100±10 μg in the control group and 60±10 μg in the dexmedetomidine group.Conclusion:Perioperative infusion of dexmedetomidine is effective in attenuating sympathoadrenal response to tracheal intubation. It has significant anaesthetic and opioid sparing effect.

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Background: Open surgeries which were done predominantly in previous days are progressing to minimally invasive keyhole laparoscopic surgeries. In same way, airway management has been also progressed from ETT to lesser invasive Laryngeal Mask Airway (LMA). Materials and Methods: This was a prospective observational study which was conducted in patients who came for lower abdominal laparoscopic surgeries during study period of 3 year. All patients were divided into 2 groups with 30 patients in each group (group A-PLMA, group B -ETT). Age, weight, type of surgery, time required for insertion of device, hemodynamic monitoring, ventilatory parameters, postoperative complications in the form of laryngopharyngeal morbidity were recorded. Results: In total 60 patients, between the age group of 18-65 year were included which were divided into 2 groups with 30 patients in each group. PLMA required 15.13 seconds as compared to ETT which required 13.33 seconds for insertion of device. The sealing pressure for PLMA was measured by leak test and the average was 32.2 cmH2O. The mean heart rate, systolic BP, Diastolic BP and MAP at various interval was significantly higher in group B as compared to group A (P-value<0.001 for all). The mean ± SD of ETCO2 among the cases studied in Group A and Group B was 36.53 ± 1.87% and 35.13 ± 2.51% respectively. Mean of Peak airway pressure (PAP) among the cases studied in PLMA (Group A) and ETT (Group B) was 22.53 mmHg and 18.97 mmHg respectively No complication or adverse event was noted during postoperative period in PLMA group but in Group ETT, 2 cases were found having blood staining of tube with sore throat in same 2 cases. Conclusion: PLMA is also proved to be an equally effective airway device in laparoscopic surgeries in the form of adequate oxygenation and ventilation. Also PLMA is associated with minimal intraoperative and postoperative complications. PLMA provided equally effective pulmonary ventilation despite of high airway pressures without significant gastric distension, aspiration and regurgitation.

Objective Despite its proven pain-relieving properties, the analgesic effect of intra-articular bupivacaine when administered without adjuvants remains short-lived. The aim of this study was to compare intra-articular injection of Morphine versus Dexmedetomidine as an adjuvant to bupivacaine in arthroscopic knee surgeries for post-operative analgesia Methods A randomized double blinded study was conducted in 60 adults of American Society of Anaesthesiologists (ASA) I & II undergoing elective arthroscopic knee surgery. Patients were randomized to receive morphine 5mg (group M) or dexmedetomidine 1microgram/kg (group D) in combination with bupivacaine 0.25% 19cc. Vitals, Ramsay sedation score and VAS were monitored. Diclofenac Sodium (75mg) was administered intravenously as rescue analgesic at VAS >3. Time to rst request of analgesic and dosage of total analgesic consumption in 24 hours were recorded. Adverse effects, if any were noted. Cases in group M had Results adequate analgesia for 16.20 ± 3.75 hours which was signicantly higher (p value <0.001) than those in group D, that lasted for 9.47 ± 1.36 hours. Total number of analgesic injections required were higher in Group D than in group M (p value <0.001). In group M, none had any side effects while 2 out of 30 in group D had hypotension and urinary retention respectively. Conclusion Combination of intra-articular morphine with bupivacaine provides better analgesia than with dexmedetomidine with prolongation of time required to use rescue analgesic in post-arthroscopic knee surgery.