European Journal of Cardiovascular Medicine

Introduction:   Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. Epidural anesthesia is a technique that may be used as a primary surgical anesthetic or as a resource for postoperative pain management. It is safe and relatively easy to learn and perform. Material and methods: This are a prospective study was conducted in the Department of Anesthesia at Khaja Bandanawaz Institute of Medical Sciences, Kalaburgi over a period of 1 year. Spinal anaesthesia was given under all sterilised precaution, 3 ml of 0.5% bupivacaine heavy using a 25-gauge Quincke’s spinal needle through the L3-L4 intervertebral space in the sitting posture. Before giving the local anaesthesia, each patient throughout the technique asked to report verbally any time if he feels distress. Results: Duration to perform the procedure was significantly longer with epidural than spinal block. Intraoperative fluid requirement was statistically higher in Spinal than Epidural (p<0.0001). Duration of Surgery was significantly shorter in Spinal as compared to Epidural (p=0.0019). Systolic and mean blood pressure showed statistically significant reduction in Spinal as compared to Epidural (p<0.001). Duration of ambulation was significantly shorter in Epidural as compared to Spinal (p<0.001). Conclusion: Epidural anaesthesia can be a safe alternative to spinal anaesthesia for elective inguinal hernia repair.

Purpose: The study's primary objective is to compare the conventional dose of bupivacaine and a low dose of bupivacaine-fentanyl spinal anaesthesia in maintaining hemodynamic stability in patients undergoing TURP with a satisfactory sensory blockade. Methodology: Patients posted for elective TURP surgery were divided into two groups of 47 each. Group F (n=47) consisted of patients who received low-dose bupivacaine–fentanyl spinal anaesthesia[bupivacaine 5 mg with fentanyl 25mcg+ normal saline 0.5 ml]. And group B (n=47) consisted of patients who received a conventional dose of bupivacaine[bupivacaine 75 mg + normal saline 0.5 ml]. A combined spinal epidural technique was used. The peak dermatomal level of sensory block, the time to reach this level, motor blockade at the time of reaching peak sensory level, time to two-segment regression, and time to S2 sensory regression were recorded. Motor blockade was assessed with a Bromage scale(0=no motor block,1=hip blocked,2=hip and knee blocked,3=hip, knee, and foot blocked). Duration of motor block was considered as the time when Bromage score returned to zero. The pain was assessed every 10 minutes from the beginning of surgery using a 10-cm visual analogue pain scale. Adverse effects if any were recorded. Outcome variables were the level of segmental spinal block and any adverse events like a decrease in BP or decrease in Heart rate. Results: The peak sensory level attained in both groups was similar and adequate for surgery but the time to reach peak level was found to be significantly faster with the conventional dose. Two-segment regression difference and duration between the groups were not found to be statistically significant though the S2 regression was found to be faster in the conventional dose group and statistically significant. This was even though a lower dose was used in group B. The occurrence of hemodynamic instability (hypotension, bradycardia) was more in group B compared to group F, in which patients received low-dose bupivacaine(1mg) combined with 25mcg fentanyl. The occurrence of hypotension was 42.6% in group A compared with 29.8% in group B. The occurrence of bradycardia was 23.4% in group B compared with 12.8% in group F.Sensory block was adequate for all surgery in both groups. Conclusion: Low-dose bupivacaine with fentanyl spinal anaesthesia used in TURP cases decreases the occurrence of hemodynamic instability (hypotension and bradycardia) in elderly patients while providing adequate sensory block for the procedure

Introduction: Hyperbaric bupivacaine (0.5 %) has been the gold standard drug for the safe conduct of spinal anaesthesia in recent times. Various additives have been used along with hyperbaric bupivacaine to prolong the duration of analgesia. Out of these, fentanyl and midazolam have been two of the most commonly used. Here a clinical study was undertaken to compare the effects of intrathecal midazolam and fentanyl as additives to intrathecal bupivacaine for spinal anaesthesia. Aims: To compare the effects of intrathecal midazolam 1mg and fentanyl 25 μg as additives to 3ml of 0.5% hyperbaric bupivacaine (15mg) for spinal anaesthesia with respect to the onset and duration of sensory and motor blockade, duration of effective analgesia, perioperative hemodynamic changes and any side effects of these drugs. Methodology: This is a prospective randomized study studied in 100 patients posted for various elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. They were randomly divided into two groups, Group A (Midazolam) and Group B (Fentanyl) each consisting of 50 patients in the age group of 18 years to 60 years posted for elective surgeries under spinal anesthesia. Subarachnoid block was administered in L3-L4 intervertebral space. The data collected were statistically analyzed. Results: Addition of 25 μg intrathecal fentanyl to hyperbaric bupivacaine resulted in a statistically significant duration of sensory blockade (Group A ; 206.56 min; Group B ; 230.06 min) and motor blockade (Group A ; 225.56 min; Group B ; 251.88 min).  The duration of effective analgesia was also significantly longer in group B (Group A ; 246.2 min; Group B ; 264.32 min). Incidence of hypotension and bradycardia is found to be similar in both groups. There was no significant difference between the two groups with respect to the occurrence of nausea. 4% of people in fentanyl group developed pruritus where as none in midazolam group developed it. None of them had urinary retention, respiratory depression, lower limb weakness or any other neurological deficits. There were no statistical differences in the sedation scores between the two groups. Conclusion: The results suggest that the use of 25 μg intrathecal fentanyl provides longer surgical analgesia, prolongs the duration of sensory and motor blockade, and offers relative hemodynamic stability with minimal side effects. Hence fentanyl is an excellent additive to Bupivacaine for prolangation of spinal anaesthesia

Purpose: The purpose of the study was to evaluate the postoperative analgesia produced by low-dose Intrathecal Morphine as an adjuvant to 0.5% Hyperbaric Bupivacaine spinal anaesthesia and its side-effect profile in Lower Segment Cesarean patients. Methods: It was a prospective observational study conducted in 150 patients who underwent Cesarean section delivery under general anaesthesia. The duration of the study was one year, and it was conducted in a tertiary care hospital in the UAE. Result: This study included 150 participants. Postoperative VAS pain scores averaged 0.21 in the study population. Low-dose ITM provided postoperative analgesia for all 150 patients. The average 24-hour pruritus score was 0.01.   The study group's mean PONV grade was 1.01.  The first postoperative day was nausea-free for 88% of 132 participants. 149 patients (99.3%) had a respiratory rate exceeding 10/minute. The study population averaged 16.7 breaths per minute.  149 individuals (99.3%) had SpO2 above 92%. The study group averaged 98.1% SpO2. Our patients experienced no respiratory depression. The study group's average MAP was 81 mmHg, 100% of 150 patients had MAP values < 60 mmHg. Conclusion: The study concludes that the addition of 0.075 mg of Intrathecal Morphine is an excellent adjuvant to 12.5 mg of 0.5% Hyperbaric Bupivacaine spinal anaesthesia with the lowest side-effect profile in Lower Segment Cesarean patients for spinal anaesthesia and also recommends the use of I.V Ondansetron 8 mg immediately after spinal anaesthesia as an antiemetic prophylaxis to have a comparatively lower incidence of PONV postoperatively. This prophylactic ondansetron also tends to significantly reduce the frequency of hypotensive episodes which allowed us to use reduced doses of vasopressor infusions as well.

Background: Preloading or the infusion of intravenous fluid prior to the induction of spinal anaesthesia has remained the cornerstone in the prevention of spinal induced hypotension for a long time. However, its efficacy in the adult young non-parturient population still has to be conclusively determined as most previous studies have been conducted in the parturient or the non-parturient elderly population. This prospective study was undertaken for the comparative evaluation of the clinical parameters associated with spinal induced hypotension following spinal anaesthesia among three groups, i.e. a no preload group, a crystalloid (Ringer’s lactate solution or RL group) preload and colloid (3.5% polygeline solution or polygeline group) preload, in elective   lower-abdominal or lower-limb surgery involving minimal blood loss, in a young adult (20 - 50 years) non-parturient population.  Material and Methods: 75 ASA-I and ASA-II, young adult (20 - 50 years), non-parturient patients undergoing elective lower abdominal or lower limb surgery, involving minimal blood loss, were randomly allotted into three groups of 25 patients each, in a double-blind clinical trial, to receive either no preload, 3.5% polygeline solution (10 mL kg-1), or Ringer’s lactate solution (20 mL kg-1), as a preload before spinal anaesthesia. The measurements of the heart rate (HR), systolic arterial pressure (SAP), mean arterial pressure (MAP) and the peripheral arterial oxygen saturation (SpO2) were recorded on a serial basis. Hypotension was defined as a decrease in the SAP of 25% or more from the baseline (before-preload) values. The various parameters indicative of the incidence, severity, duration and timing of spinal-induced hypotension (SIH) and the incidence of cardiovascular side-effects  such as bradycardia and arrhythmias in all the three groups were recorded.  Results: There was a significant difference in the incidence of SIH [68% (no-preload); 24% (polygeline) and 32% (Ringer’s lactate); P = 0.003], mean therapeutic requirement of vasopressor (mephentermine) (P = 0.001), mean minimum systolic arterial pressure    (P = 0.000), mean minimum systolic arterial pressure (as percent of baseline) (P = 0.000), mean maximal heart rate (P = 0.038), mean number of hypotensive episodes (P = 0.001), mean total duration of hypotension   (P = 0.000), and mean peripheral arterial oxygen saturation (SpO2)   (P = 0.000) following spinal anaesthesia between the control, polygeline and Ringer’s lactate groups. There was no significant difference in the incidence of SIH [24% (polygeline) vs. 32% (Ringer’s lactate);     P = 0.529], mean therapeutic requirement of vasopressor (mephentermine) (P = 0.781), mean maximal heart rate  (P = 0.923), mean number of hypotensive episodes (P = 0.923), mean total duration of hypotension (P = 0.926), mean peripheral arterial oxygen saturation (SpO2) (P = 0.803) following spinal anaesthesia between the polygeline and Ringer’s lactate groups. The mean minimum systolic arterial pressure (P = 0.037) and the mean minimum systolic arterial pressure (as percent of baseline) (P = 0.012) following spinal anaesthesia remained significantly higher in the polygeline group than in the Ringer’s lactate group. There was no significant difference in the mean time of recording of the minimum systolic arterial pressure   (P = 0.592), the mean duration of a hypotensive episode (P = 0.145) and the incidence of bradycardia [20% (no-preload); 12% (polygeline) and 16% (Ringer’s lactate); P = 0.743] following spinal anaesthesia between the control, polygeline and Ringer’s lactate groups. A significant difference, if any, in the incidence of arrhythmias following spinal anaesthesia between the three groups could not be found out because of the number of patients developing this side-effect was very less. Conclusion: The polygeline and Ringer’s lactate preload were effective in significantly reducing the incidence, severity and duration of SIH, and in maintaining significantly higher mean SpO2 following spinal anaesthesia, when compared to a  no-preload. However, there was no significant difference in the mean time of recording of the minimum systolic arterial pressure, the mean duration of a hypotensive episode or the incidence of bradycardia following spinal anaesthesia, between the three groups. There was no definite advantage of a polygeline preload over a Ringer’s lactate preload, as there was no significant difference between the two in so far as reducing the incidence, severity and duration of SIH is concerned, or in maintaining significantly higher mean SpO2 following spinal anaesthesia.

Background: Bupivacaine is a pipecoloxylidide derivative developed by Ekenstam in 1957 and first utilized in clinical practice in 1963. It is a racemic mixture of the D and L isomers. (2) (3) Bupivacaine is used for procedures that last 2 to 2.5 hours. For longer procedures it may be necessary to convert to general anaesthesia or augment with an intravenous anaesthetic drug. Objectives: The main aim of this study was to see how intravenous dexmedetomidine affected infraumbilical operations done under spinal anaesthesia with hyperbaric bupivacaine 0.5% to observe 1. duration of sensory block, 2. duration of two-segment regression, 3. duration of motor block, 4. intraoperative hemodynamic stability, 5. sedation score, 6. duration of postoperative analgesia and 7. side effects Material & Methods:  Study Design:A prospective, randomized, comparative study. Study area: Department of Anaesthesia, and Critical care, Government Medical college ,Srikakulam ,AP. Study Period: 1 year.  Study population: Adult patients of either   sex, aged between 18-55 years belonging to ASA class I and II without any severe co morbid diseases scheduled for elective infra umbilical surgeries. Sample size: study consisted a total of 100 cases. Study tools and Data collection procedure: A hundred patients undergoing infraumbilical surgeries under spinal anaesthesia were randomly divided into two groups of fifty each using a computer-generated random list. Group D patients got dexmedetomidine infusions of 1 mcg/kg over 10 minutes and subsequently 0.5 mcg/kg/hr until the completion of the surgery, while Group C patients (placebo control) had a similar ratio of normal saline infusion. Results: The median sensory block duration of the dexmedetomidine group was 207.60 (+21.001) minutes, two-segment regression time was 126.10 (+17.65) minutes and median motor block duration was 164.10 (+27.732) minutes. Median sensory block duration was 177.10 (+15.587) minutes in the control group median two-segment regression was 110.80 (+10.418) minutes and motor block duration were 150.40 (+15.937) minutes.Dexmedetomidine group had significantly prolonged sensory block (p < 0.0001) and two-segment regression (P = 0.001) when evaluated to control group. Conclusion: It can be concluded from the present study that Intravenous dexmedetomidine exacerbates the motor and sensory blockage induced by spinal anaesthesia. The risk of bradycardia is considerably raised when IV dexmedetomidine is used as an adjuvant to bupivacaine in spinal anaesthesia.

Objectives: Adding adjuvants to local anaesthetics hastens the onset and prolongs the duration of blocks with favourable postoperative analgesia. The principal objective of our study was to compare the duration of postoperative analgesia between the two intrathecal opioids (as adjuvants with bupivacaine). This prospective, randomized, double blind study was conducted at a tertiary care centre. Techniques: After institutional ethical committee approval and informed patient consent, sixty healthy patients who were scheduled for elective lower extremity surgery under spinal anaesthesia were divided into two equal groups and enrolled in the study. They received 15 mg of hyperbaric bupivacaine 0.5% with either nalbuphine 0.4mg (Group N) or fentanyl 25 mcg (Group F) Onset time and duration of sensory blockade along with 2 segment regression of sensory blockade were noted. Time for onset of complete motor block and duration of effective analgesia were also noted. Adverse effects, if any, were noted. Quantitative data are presented as means and standard deviations and confidence intervals, while qualitative data are presented as proportions. An independent t-test and a chi-square test for proportions were used to compare the significance of differences in the means using R software 3.2.2 version. P ≤ 0.05 was considered statistically significant. Results: Post operative analgesia lasted significantly longer in the nalbuphine group compared to the fentanyl group. Conclusion: Thus, nalbuphine is a better adjuvant to bupivacaine than fentanyl when administered intrathecally for lower extremity surgical procedures in terms of duration of postoperative analgesia.

Background: This study was conducted to evaluate and compare the effect of adding two different doses (10 mg and 20 mg) of intrathecal meperidine with 0.5% hyperbaric bupivacaine on the onset, incidence and intensity of shivering during lower limb surgeries under spinal anaesthesia. Methods: This was a hospital-based randomized controlled trial study conducted among 60 patients aged between 18 and 60 years of physical status ASA grade 1 and ASA grade 2 of either sex undergoing elective lower limb surgeries at the Department of Anaesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, from December 2015 to September 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.  Results: The onset and intensity of shivering were greater in group 1 than in group 2 (p =0.007). The duration of shivering was significantly prolonged in group 1 compared to group 2 (p=0.004). There was a significant drop in temperature in both groups at 25 minutes (p<0.001) and 1 hour (p<0.001). The noted side effects were vomiting and pruritis. Conclusion: 0.5% hyperbaric bupivacaine with 20 mg of meperidine prevents shivering better with respect to incidence, intensity and duration of shivering when compared to 10 mg meperidine. Hence, we conclude that meperidine can be safely used at dosages of both 10 mg and 20 mg for the prevention of shivering with no significant difference with respect to complications.

Introduction: Since the introduction of technology such as ultrasonography and Peripheral Nerve Stimulator (PNS), Peripheral Nerve Blockade (PNB) has become an appropriate outpatient anaesthetic. When compared to central neuraxial blockade, it has the advantage of providing surgical anaesthetic with superior cardiorespiratory stability. PNBs reduce the need for postoperative analgesics, reduce the incidence of nausea, shorten the time spent in the post anesthesia care unit, and boost patient and surgeon satisfaction. Materials and Methods: 120 patients undergoing lower limb orthopaedic procedure were allocated randomly into two groups. The study was single-blinded, randomised clinical trial. Group A (n=60) received spinal anaesthesia and Group B (n=60) received sciatic-femoral nerve block (Anterior approach). Both Genders (Male/Female), Age- 65 yrs.-75 yrs, Body weight- 40 kg -70 kg, ASA Physical status- II, III, Patients with controlled co-morbid conditions were included in the study. Results: Study result showed no statistically significant differences in demographic parameters and duration of operation in between the groups (Table 1). Mean time of onset of sensory block was later in Group - B (Mean 11.40 mins.) than in Group A (Mean 4.65 mins.) and this was statistically significant (P <0.005, Table 2). Mean time of onset of motor block was later in Group B (Mean 16.30) than in Group A and this was statistically significant (P < 0.005, Table 2). Mean time of duration of sensory block was greater in Group B (518.5) than in Group A (165.24) and this was statistically significant (P < 0.005, Table 2). Conclusion: we observed that duration of sensory block, motor block and post-operative analgesia were more prolonged in case of sciatic-femoral nerve block than spinal anaesthesia. Sciatic-femoral block (Anterior approach) was associated with stable haemodynamic, lesser complications and is better tolerated by patient with good satisfaction scale compared to spinal anaesthesia. So, we can conclude that sciatic-femoral nerve block (Anterior approach) is a better alternative than spinal anaesthesia in case of high risk geriatric patients undergoing lower limb orthopaedic procedure.

INTRODUCTION: Paravertebral block is a regional technique involving peripheral nerve stimulator guided injection of local anaesthetic 0.5% bupivacaine (isobaric) at T10 level and L1 level immediately lateral to vertebral column, into the space where spinal cord emerges from the intervertebral foramina and bifurcates into dorsal and ventral rami. This technique provides unilateral motor, sympathetic and prolonged sensory blockade. Spinal anaesthesia for inguinal hernioplasty is widely used which provides intense sensory and motor blockade. It suppresses the stress response to surgical intervention, decreases morbidity in high risk patients and enabling maintenance of analgesia in postoperative period, cardiovascular system specific adverse events such as arterial vasodilation. MATERIAL AND METHODS: This was a prospective, randomized, single blind, comparative study. Adult patients belonging to ASA Grade I and II between ages 18 to 65 years of both sexes undergoing elective unilateral inguinal hernia repair were enrolled in the study.Total 60 subjects were recruited & divided into two groups i.e. 30 subjects in each group. Group P- Peripheral nerve stimulator guided paravertebral block in unilateral inguinal hernia repair using 0.5% Bupivacaine (Isobaric). Group S-Spinal anaesthesia in unilateral inguinal hernia repair using 0.5% Bupivacaine (hyperbaric). RESULTS: In our study we found that mean time of onset of sensory block was significantly longer in Group P (5.80 ± 1.21min) as compared to Group S (3.00 ±00 min). The mean time to achieve maximum sensory level was longer in Group P (16.33±2.01min) as compared to Group S (4.00±0.00min). The mean time for onset of motor block in Group P(9.73±1.01min) was significantly longer than Group S (5.00±00 min). The mean duration of motor block was longer in Group S (210.53±14.0min) compared to Group P (196.67±16.31min). The mean time to achieve maximum motor level was longer in Group P (19.73±2.08min) compared to Group S (5.00±0.00min). Mean duration of surgery in Group P (82.33±10.40min) and in Group S (84.17±10.99min).  CONCLUSION: After comparison of Peripheral nerve stimulator guided paravertebral block with spinal anaesthesia in unilateral inguinal hernia repair following conclusions were drawn: Two segment paravertebral block provides an excellent anaesthesia with unilateral motor, sympathetic and prolonged sensory blockade. Paravertebral block provides prolonged post-operative analgesia, better haemodynamic control and lesser incidence of side effects like urinary retention.

Background: Hypotension is the most prevalent adverse effect of spinal anaesthesia for caesarean section, which demands specific prevention and treatment interventions. Present study was aimed to study correlation of symphysio-fundal height and abdominal girth with incidence of hypotension in caesarean section following spinal anesthesia.Material and Methods:Present study was single-center, Cross sectional study, conducted in pregnant women of age 19-35 years, height 151-170 cms, full term gestation, undergoing elective and emergency caesarean section under spinal anaesthesia. Results: In present study, total of 87 patients were included. Hypotension was present in 70.1% of the patients. 52.3% of patients with SFH of 32-35cms and 88.4% of patients with SFH of 36-39cms were hypotensive. The p-value was statistically significant (p=0.001). 55.1% of patients with AG of 86-95cms and 89.5% of patients with AG of 96-105cms were found to be hypotensive. Mean total dosage of rescue ephedrine in SFH 32-35cms was 7.91±2.86. Mean total dosage of rescue ephedrine in SFH 36-39cms was 11.05±5.13. Mean total dosage of rescue ephedrine in AG 86-95cms is 8.54±3.86. Mean total dosage of rescue ephedrine in AG 96-105cms is 10.94±5.13. We found negative correlation between SFH and SBP with ‘r’ = -0.389 which is found to be statistically significant and 13.11% patients required atropine. Conclusion: In patients undergoing elective and emergency caesarean section under spinal anaesthesia the symphysiofundal height and abdominal girth showed significant negative correlation with systolic blood pressure.

This randomized clinical study conducted at MKCG Medical College & Hospital aimed to assess and compare the effectiveness of prophylactic infusion of ephedrine and phenylephrine in maintaining arterial pressure during lower segment caesarean section (LSCS) under sub-arachnoid block. The study included 80 full-term pregnant patients undergoing elective LSCS, with 40 patients in each group. The primary outcomes evaluated were changes in arterial pressure, heart rate, and fetal outcomes.

The results indicated that both ephedrine and phenylephrine were effective in maintaining arterial pressure within 20% of the baseline, with phenylephrine demonstrating a better blood pressure maintenance profile. Additional bolus dose requirements were significantly higher in the ephedrine group. Phenylephrine caused a reduction in heart rate, while ephedrine resulted in a significant rise. Neonatal outcomes, as measured by Apgar scores, were comparable between the two groups, but phenylephrine was associated with less fetal acidosis than ephedrine.

In conclusion, prophylactic infusion of phenylephrine at 15 micrograms/min proved more efficacious in maintaining arterial pressure during LSCS compared to ephedrine at 1.5 mg/min. The study suggests that phenylephrine may offer advantages in terms of maternal and fetal outcomes in the context of spinal anesthesia for caesarean section.

Cesarean section is one of the most common surgical procedures in Parturients. Regional anaesthesia has been considered the first choice because of several advantages over general anaesthesia. Bupivacaine is a commonly used drug but bupivacaine alone sometimes does not provide adequate duration of analgesia even with higher sensory blockade. Addition of opioids decreases side effects of bupivacaine and prolongs post-operative analgesia. The concept of post-operative analgesia is popular nowadays. Effective post operative analgesia promotes improved mother child bonding, early ambulation, discharge, greater patient satisfaction and early breastfeeding25. We have conducted this study to observe the effect of addition of different dose of Fentanyl citrate to Hyperbaric Bupivacaine intrathecally in cesarean section on duration of analgesia, onset and duration of motor and sensory blockade, hemodynamic stability, side-  effects. In this study, we compared varying doses of intrathecal fentanyl 10mcg, 15mcg, and 20 mcg on clinical efficacy and side effects in parturients undergoing cesarean section under spinal anaesthesia. The parturients were allocated to three groups of 30 each. All patients received a total volume of 2.5 ml containing 2 ml of 0.5% hyperbaric bupivacaine with 0.5 ml of a solution containing either10 mcg (0.2 ml)Group A, 15 mcg (0.3 ml) Group B, or 20 mcg (0.4 ml)Group C of preservative-free fentanyl with normal saline. • Primary aim of our study was to observe the duration of analgesia. There was statistically significant difference in duration of analgesia among all the three groups. Duration of analgesia was prolonged more in Group B and C as compared to Group A. • There was no significant difference in onset of sensory block among all the three groups. Highest sensory dermatomal level was T5-T6 • There was statistically significant difference in time of sensory regression of sensory blockade to L1 dermatome among all the three groups. • There was no significant difference in time to achieve motor block of bromage score 3 among all the three groups. • There was statistically significant difference in duration of motor block among all the three groups. Duration of motor block was prolonged more in Group B and C as compared to Group A. • Intraoperative and postoperative hemodynamic parameters were comparable in all three groups and statistically insignificant. • No significant sedation was found among all the three groups.  • None of the patients had hypotension, bradycardia, urinary retention, or  respiratory depression like complications. 

Objective: To determine the sensitivity and specificity of perfusion index in the right toe and index finger as a predictor of post-spinal hypotension in parturient undergoing Lower Segment caesarean Section (LSCS). Methods: 75 Parturient aged 18 to 35 years who were undergoing LSCS elective procedures, of ASA-II were included in the study. Intraoperative assessment of vital parameters including heart rate, NIBP, Respiratory rate, Sp02 and perfusion index at both finger and toe were recorded every 2 minutes till the 15th minute and then every 5 minutes till the end of the surgery. The data for the study was calculated using the SPSS 20.0 package program. Results: In this study, the mean age was 25.91 years (±3.82), heart rate 95.55 bpm (±14.9), Finger PI 5.64 (±3.49), Toe PI 3.38 (±3.36), and MAP 98.28 mmHg (±8.70). Using ROC analysis, baseline cutoffs for predicting hypotension were identified, Finger PI 3.55 (83.3% sensitivity, 51.1% specificity) and Toe PI 1.85 (80% sensitivity, 56% specificity). Conclusion: The Perfusion Index (PI) can be used as an effective tool for predicting hypotension in healthy parturients posted for elective caesarean section under subarachnoid block. Continuous monitoring of toe PIs during induction of spinal anaesthesia might help to predict the development of post-spinal hypotension and reflect the aorto-caval compression by the gravid uterus.

Aim: The purpose of this study was to compare the efficacy of bolus dose of Phenylephrine Versus Mephentermine for hypotension correction in patients undergoing elective caesarean section surgery. Methodology: After obtaining approval from the ethical committee and obtaining informed consent, 60 parturients aged between 18 - 40 years of age and gestational   age from 34 to 40 weeks posted for elective lower segment cesarean section were included. They were randomly divided into Group P (n=30) and Group M (n=30). The parameters observed were level of Anaesthesia, hemodynamic variables, number of doses required to correct hypotension and adverse effects. Results: A total of 60 patients were analyzed. Within 5 minutes of Spinal anaesthesia there was no significant difference between Group-P and Group-M on drop of average Systolic blood pressure, Diastolic blood pressure and average Heart rates at different minutes. But after administering the drug for hypotention correction Group P shows very high average SBP and DBP correction compared to Group M which is statistically significant (p<0.0001) and Group P shows a fall in the heart rate compared to Group M which is statistically significant (p<0.0001). Conclusion: Phenylephrine is observed to be hemodynamically more suitable than Mephentermine in patients undergoing elective caesarean section surgery.

Introduction: Several techniques are used to minimize spinal anaesthesia induced maternal hypotension, such as left uterine displacement, reducing the dose of local anaesthetic, usage of intrathecal opioids, preloading and co-loading with different intravenous fluids. However, the evidence is inconclusive, and no technique reliably produces decreases hypotension. Opioids are the most frequently used local anesthetic adjuvants in neuraxial blocks. Methodology: 60 pregnant patients were divided into two groups Group BD and Group FD of 30 patients each. Group BD received single bolus dose of 2.2ml of solution which included 1.8ml (9mg) of 0.5% hyperbaric Bupivacaine with 0.4ml (20mcg) of Fentanyl. Group FD received fractionated dose of spinal anaesthesia where, out of the total 2.2ml of drug preparation, 1.6ml was administered initially and the remaining 0.6 ml was given after 90 seconds interval. Hemodynamic parameters in the intraoperative and postoperative periods were recorded. Time to onset of sensory block at T6 and that of Motor block to Bromage Scale 3, duration of sensory and motor block was noted. Results: There was a statistically significant difference between the two groups in terms of onset of sensory and motor blocks, with group FD having a faster onset of both sensory and motor blocks. Additionally, group FD had a significantly prolonged duration of both sensory and motor blockade. When comparing of hemodynamic parameters, a significant drop in the intraoperative SBP, DBP and MAP was observed in Group BD compared to Group FD. Post-operative hemodynamic and pain parameters were comparable in both groups and no major adverse events were observed in our study. Conclusion: Sub arachnoid block with 9mg (1.8ml) of 0.5% hyperbaric Bupivacaine and 20mcg (0.4ml) of Fentanyl, when administered as a fractionated dose provides early onset and duration of sensory and motor blocks with better hemodynamic stability compared to a single bolus dose in patients undergoing caesarean section

Background, Aims and Objectives: Shivering is a common problem in obstetric patients undergoing cesarean section under spinal anaesthesia and its incidence is approximately 30% to 55%. Aim of our study was to compare the efficacy of intravenous Dexmedetomidine, intravenous Tramadol with placebo in prevention of post-spinal anaesthesia shivering in obstetric patients undergoing caesarean section. Secondary objective was to observe any side effects like nausea, vomiting, hypotension, bradycardia and sedation. Materials and methods: This prospective, randomized, and double-blinded study was conducted in the department of Anaesthesia , PGIMS, Rohtak . 126 Healthy pregnant women, 20-40 years of age, without any comorbid conditions requiring caesarean section under spinal anaesthesia were enrolled for the study and randomly allocated into one of the three groups according to computer generated randomisation . Group A (n=41) received 0.5 mcg/kg Dexmedetomidine, Group B (n=43) 0.5 mg/kg Tramadol and Group C (n=42) plain 100 mL normal saline IV infusion after spinal anaesthesia and delivery of baby. Shivering, sedation, blood pressure, heart rate was measured intraoperatively. Result: All data were summarised as mean ± SD for continuous variables, numbers and percentages for categorical variables. There was a significant difference between the various groups in terms of distribution of Incidence of Shivering (χ2 = 48.199, p-value < 0.001) . 9.8% (n=4) of the participants in the Group A, 53.5% (n=23) of the participants in the Group B, and 85.7% (n=36) of the participants in the Group C had shivering. Conclusion: This study showed dexmedetomidine as a better drug for the prevention of shivering after spinal anaesthesia as compared to tramadol as it has a low incidence of shivering, benefits of awake sedation and not associated with nausea and vomiting.

Background: Maintaining hemodynamic stability during spinal anesthesia for caesarean sections is crucial for optimal maternal and fetal outcomes. Norepinephrine and phenylephrine are commonly used vasopressors to manage hypotension in this setting, but their comparative efficacy and safety are not well-established. Objective:   The study was planned with overall objective to compare the efficacy of Norepinephrine and     Phenylephrine infusions required to manage hypotension during spinal anaesthesia for caesarean    section and to compare the maternal adverse effects. Methods: This is an institution based Comparative Prospective study, it’s conducted from One and half year (February 2023 – May 2024) after getting permission from Institute Ethics Committee (IEC) and approval of The West Bengal University of Health Sciences (WBUHS) at Operation theatre of Department of Gynaecology & Obstetrics, Murshidabad Medical College & Hospital, Berhampore, West Bengal. Results: Requirement infusions was higher for the Phenylephrine infusions group subjects than the Norepinephrine infusions group subjects, and which was not statistically significant. The mean (SD) infusions required for Norepinephrine group subjects was 3.033(0.7063) and for Phenylephrine infusions group subjects was 3.267(0.6798). Conclusion: Norepinephrine infusion is more effective than phenylephrine in maintaining hemodynamic stability during spinal anesthesia for caesarean section, with fewer adverse effects. These findings suggest that norepinephrine may be a preferable option for managing hypotension in this clinical setting.

Background: Spinal anaesthesia is the most commonly performed technique in parturients undergoing Lower Segment Caesarean section (LSCS). This randomized double-blinded study compared the hemodynamic effects of levobupivacaine and ropivacaine in parturient with pre-eclampsia undergoing emergency LSCS. AIM: The commonest side effect of subarachnoid block is hypotension and bradycardia and so to counter that, there has been developments of newer amide group of local anaesthetics. Both hyperbaric levobupivacaine and hyperbaric ropivacaine, have shown better hemodynamic effects as compared to conventional hyperbaric bupivacaine. So, in this study we shall further compare hyperbaric levobupivacaine and hyperbaric ropivacaine and consider its outcome in parturients with pre-eclampsia undergoing emergency Lower Segment Caesarean section (LSCS). Material And Methods: Eighty parturients with pre-eclampsia scheduled for emergency LSCS were randomized into Group L and Group R of 40 parturients each. Group L parturients received 1.4ml of 0.5% hyperbaric levobupivacaine while Group R parturients received 1.4 ml of 0.75% hyperbaric ropivacaine with fentanyl 0.4 ml (50 mcg/ml) as an adjuvant in both groups was injected intrathecally at L2-L3 interspinous space. Primary objective was to compare perioperative hemodynamic changes. Secondary aim was to compare onset and duration of sensory and motor block, duration of analgesia and quality of motor block. Results: Group L provides better hemodynamic stability and postoperative analgesia as compared to Group R. Conclusion: Ropivacaine and levobupivacaine are the newest drugs utilized for neuraxial blockade and they have demonstrated a superior pharmacological safety profile. Levobupivacaine emerges as the more favorable option when considering cardio stability and hemodynamic stability in parturients with deranged hemodynamics.

Background- Levobupivacaine and ropivacaine, both relatively new amide local anesthetic agents, have been developed to overcome the problems associated with bupivacaine toxicity. This study was conducted to compare clinical efficacy and characteristics of 0.5% hyperbaric levobupivacaine with 0.75% hyperbaric ropivacaine for subarachnoid block in lower limb orthopaedic surgeries. Methods- This was a prospective randomized double-blind study conducted among 60 patients scheduled for elective lower limb orthopaedic surgeries under spinal anaesthesia. The patients were randomly allocated into two groups Group L and Group R. Group L (n = 30) received 3ml of 0.5% hyperbaric levobupivacaine and Group R received 3 ml of 0.75% hyperbaric ropivacaine. Onset and duration of sensory and motor blockade, hemodynamic parameters, patient satisfaction score and adverse effects were recorded. The data was analysed using SPSS version 24.0 with appropriate tests and a P<0.05 was considered significant. Results-The distribution of patients was comparable with respect to age, sex, ASA grades and duration of surgery (P>0.05). Mean time to reach highest sensory level was significantly higher in Group L (19.2±1.4 min) than Group-R (17.9±1.2 min) (P<0.05). The mean time of two segment regression from highest sensory level blockade was less in group R (Group R 65.7±3.3 min Group L 72.4±5.1 min; P<0.05). However, the time of regression from highest sensory level to S1 was significantly less in Group L (Group L 180.8±7.3 min; Group R 188.4±3.7 min; P<0.05). Mean time of onset of motor blockade (Bromage scale 3) was 19.2±1.3 min in group L and 19±1.2 in group R and the difference was not statistically significant (p = 0.484). Patients in hyperbaric ropivacaine group had a significantly faster recovery from motor blockade recorded as mean regression to motor blockade (Bromage scale 0) (Group R 119.5±6 min vs Group L 128.8±7 min; P< 0.05). Both drugs were also found to be safe and comparable in terms of impact on hemodynamic parameter and no complication was observed. Conclusion- Hyperbaric levobupivacaine and hyperbaric ropivacaine are reliable in term of efficacy and safety for subarachnoid block in lower limb surgery. However, hyperbaric ropivacaine is a better alternative than hyperbaric levobupivacaine in patients where early mobilisation is required as it offers a faster recovery from motor blockade.

Background- Shivering is distressing for the patient’s undergoing surgery under both regional and after general anaesthesia. Shivering increases expenditure of cardiac and systemic energy, resulting in increased oxygen consumption and carbon dioxide production, lactic acidosis and raises the intraocular and intracranial pressure. It also interferes with haemodynamic monitoring intra operatively Aims- To evaluate the effectiveness of prophylactic use of intravenous ketamine, clonidine and tramadol in control of shivering in patient undergoing elective surgeries under spinal anaesthesia. Materials and methods- A Prospective, Randomized, Double Blind Comparative Study, done in Tertiary Care Superspeciality Hospital with in a span of 1 year. Adult patients posted for various elective surgeries under Spinal Anaesthesia. Patients scheduled for elective surgeries under spinal anaesthesia, Age group of 18-60 years of both sexes and ASA grades I or II included in study. The subjects were randomized in to 4 groups by using computer generated SPSS 16 software in to random numbers to receive ketamine, tramadol or clonidine. The patients were randomized into four groups of 42 patients each. Results- The age range was 18-60 years for all the groups.  There was no significant difference between the groups for age and sex distribution (p>0.05). There was no significant difference observed in the duration of surgery (p=0.46). There was no significant difference observed in the median level of spinal anaesthesia in the four groups (p=0.052). There was significant difference observed in the distribution of grade of shivering in normal saline group compared to tramadol, ketamine and clonidine group (p=0.0499). There was no significant surface temperature difference between the groups (p=0.67). There was statistically significant difference observed in ketamine group with respect to heart rate compared to tramadol, clonidine and normal saline groups till 40min after spinal anaesthesia with p-value of <0.001 except the baseline values (p=0.93). After 40 min, there was no statistically significant difference observed among the groups. There was statistically significant difference observed in ketamine group with respect to mean blood pressure compared to tramadol, clonidine and normal saline groups till 50 min after spinal anaesthesia with p-value of <0.001 except for baseline value (p=0.870) and value at 5 mins (p=0.0012).  After 50 min, there was no statistically significant difference observed in four groups. Conclusion- We conclude that giving either ketamine 0.5 mg/ kg, clonidine 75 mcg or tramadol 0.5 mg/kg i.v. prophylactically just before neuraxial blockade significantly decreases the incidence of shivering without causing any major side-effects. Using ketamine may be more beneficial as it improves the hemodynamic profile by its sympathomimetic effects and it sedates the patient effectively, which increases patient comfort during surgery, maintains cardiorespiratory stability and prevents recall of unpleasant events during the surgery.

Post-dural puncture headache is one of the common complications of spinal anesthesia. Although self-limiting, it is problematic for the patient. The aim of this study was to determine the prevalence of postdural puncture headache after spinal anesthesia in parturient women undergoing caesarean section at the Department of Anesthesiology in a tertiary care center. Methodology: This study was a prospective observational study done in a tertiary medical college in central India from 1stOctober 2023 to September 2024 on parturients who underwent cesarean section under spinal anaesthesia. The pregnant patients aged 18-45 years of the American Society of Anesthesiologists Physical Status II/IIE who underwent elective or emergency cesarean section under spinal anaesthesia were included. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Observation And Results: In our study we observed that the prevalence of post-dural puncture headache was 7% (4.53-9.67, 95% Confidence Interval). A total of (42.86%) cases experienced post-dural puncture headache in the first 24 hours followed by (32.14%) and (21.42%) cases in 48 and 72 hours respectively. Moderate pain was complained of by(11.11%) and  (7.41%) cases at 48 and 72 hours post-caesarean section respectively.

Background Many studies are there using adjuvants such as clonidine and fentanyl with bupivacaine in the subarachnoid block for prolonging postoperative analgesia. However, literature is divided regarding the dosage and efficacy of both intrathecal adjuvants. Furthermore, these adjuvants have their own side effects. Hence, search for ideal intrathecal adjuvant between clonidine and fentanyl to bupivacaine goes on. Methods This is a prospective and observational study was conducted in the Department of Anaesthesia, Shadan Institute of Medical Sciences Teaching Hospital & Research Centre. Inclusion criteria were 150–195 cm height and 50–120 kg weight. Patients were excluded if they had conditions that preclude spinal anaesthesia, had a psychiatric disorder, had chronic pain, were on antihypertensive medication or when they were unable to communicate in the Local language. Written informed consent was obtained from all patients. To allow for sufficient time for informed consent, the patients were provided with written information at the outpatient preoperative evaluation clinic a few days before the actual operation. Before induction of spinal anaesthesia, all patients received an i.v. infusion of Ringer’s lactate (1500 ml) or normal saline and standard intraoperative monitoring was used [ECG, pulse oximetry and non-invasive blood pressure (NIBP)]. Results  Majority of patients in the both the groups belonged to the group 26 to 55 years. Samples were age matched. The number of males and females in each group was same (n=30) and samples in both groups were matched with respect to sex. Majority of female patients in the both the groups belonged to the group 160 to 170 cms and males 171 to 175 cms, Samples were height matched. The majority of surgeries fall under the gynaecology category. Lower abdominal and lower limb surgeries are less common, with lower abdominal surgeries being the least frequent. This breakdown indicates a higher demand or prevalence for gynaecological procedures compared to the others. Conclusion Both the drugs offer similar surgical conditions and prolongs postoperative analgesia (clonidine more than fentanyl), so we suggest fentanyl as better choice when sedation is not desirable and clonidine is recommended where sedation is acceptable. The administration of local anaesthetics in combination with opioids intrathecally is an established technique for managing postoperative pain following abdominal, pelvic, thoracic or orthopaedic procedures on lower extremities. Local anaesthetics with opioids demonstrate significant synergy.

Background And Justification: Spinal Anaesthesia is widely regarded as a reasonable anaesthetic option for caesarean delivery, provided there is no contraindication. Pregnancy causes major physiological changes to the mother’s body. An understanding of the physiological changes in pregnancy is the key to safe obstetric anaesthesia. Spinal Anaesthesia is associated with hypotension which can have maternal and foetal side effects. Methods: This study was performed on 100 patients, after getting informed consent. In this study the baseline hemodynamic parameters of the patient was noted during intra operative period. After spinal anaesthesia is performed by the Anaesthesiologist, hemodynamics such as Heart Rate, Blood Pressure, Mean Arterial Pressure and SPO2 was noted for every 3 minutes for first 20 minutes after which it was noted for every 5 minutes, till end of the surgery.  Results: From the descriptive statistics and chi square test, after spinal anaesthesia performed there is a hypotension, p=0 which is <0.05, hence statistically significant, and there is fall in heart in rate, p=0.0029 which is <0.05, hence statistically significant.  Conclusion: 100 pregnant patients who underwent spinal anaesthesia for elective caesarean section were included in this study. Based on the result we concluded that hypotension and bradycardia are the frequent response after spinal anaesthesia due to arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardio inhibitory receptors. This study benefits to the anaesthesiologist in prediction of possible adverse effects and to overcome the same.

Background: Spinal anaesthesia is widely used for lower limb surgeries, but its effectiveness is limited by the relatively short duration of postoperative analgesia. Nalbuphine, a mixed κ-agonist and μ-antagonist opioid, has been explored as an adjuvant to prolong analgesia and enhance patient outcomes. This study evaluates the efficacy and safety of intrathecal nalbuphine as an adjuvant to bupivacaine in lower limb surgeries. Methods: A randomized, double-blind, prospective study was conducted on 60 patients (ASA I-IV) undergoing lower limb surgeries. Patients were assigned into two groups:Group BN (n=30): Received 0.5% hyperbaric bupivacaine + 2 mg nalbuphine.Group B (n=30): Received 0.5% hyperbaric bupivacaine + normal saline.The primary outcomes included sensory and motor block characteristics, duration of analgesia, and postoperative pain scores (VAS). Hemodynamic parameters and adverse effects were also monitored.Results: The onset of sensory and motor blockade was comparable between the groups (p > 0.05). However, the duration of sensory and motor block was significantly prolonged in Group BN (p < 0.05). Time to first rescue analgesia was significantly longer in Group BN (284.4 ± 31.33 min) compared to Group B (162.56 ± 8.12 min, p < 0.001). Postoperative VAS scores were lower in Group BN at all intervals (p < 0.001). Hemodynamic parameters were stable, with minimal adverse effects in both groups.Conclusion: Intrathecal nalbuphine (2 mg) as an adjuvant to bupivacaine significantly prolongs sensory and motor blockade, enhances postoperative analgesia, and maintains stable hemodynamics with minimal adverse effects. These findings support its use as a safe and effective adjunct in spinal anaesthesia for lower limb surgeries.

Background: Intrathecal administration of local anaesthetic drug for spinal anaesthesia can achieve adequate sensory and motor blockade required for lower limb orthopaedic surgeries. However, the traditionally used drug bupivacaine has been associated with severe cardiovascular and CNS toxicity. Newer long-acting local anaesthetics, levobupivacaine and ropivacaine due to their three-dimensional structure seem to have lesser toxic effects on the central nervous system and the cardiovascular system. Through our study we intend to clinically compare the efficacy of 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Materials and methods:  A prospective, randomized, double blinded, clinical, parallel arm study was conducted including a total of 70 patients posted for lower limb orthopaedic surgery. The patients were randomly divided into 2 groups of 35 patients each. Group A received 15 mg 0.5% (3ml) hyperbariclevobupivacaine for spinal anaesthesia. Group B received 22.5 mg 0.75% (3ml) hyperbaricropivacaine for spinal anaesthesia. The total duration of analgesia along with time taken for onset and regression of sensory block and motor block was recorded and statistical analysis was performed. The two groups were also compared based on peri-operative hemodynamic parameters and adverse effects encountered. Results & conclusion: The findings in the 2 groups were comparable regarding duration of analgesia, the maximum dermatomal height of sensory block and the time required to achieve maximum dermatomal height. However, hyperbaric 0.75% ropivacaine was found to produce faster onset as well as regression of sensory and motor block compared to hyperbaric 0.5% levobupivacaine.

Background: Bradycardia is a recognized complication during spinal anaesthesia (SA), although its incidence and associated risk factors remain variable across studies. This study aimed to assess the incidence of bradycardia during SA and identify its association with demographic, clinical, and pharmacological factors. Methods: A prospective observational study was conducted involving 300 patients aged over 16 years, classified as ASA I or II, undergoing elective lower abdominal surgeries under SA. Data collected included demographics, comorbidities, medications, and intraoperative parameters. Bradycardia was monitored throughout the perioperative period, and statistical analyses were performed using SPSS. Results: Bradycardia occurred in 16% of patients. A higher incidence was noted in individuals aged >50 years (64.6%), those with cardiovascular comorbidities, history of syncope or anaemia, and patients on beta blockers or calcium channel blockers. Nausea and vomiting were also significantly associated. No significant associations were found with gender, BMI, intraoperative fluid volume, or bupivacaine dose. Conclusion: Bradycardia during spinal anaesthesia was significantly linked to older age, cardiovascular comorbidities, specific medications (beta blockers and CCBs), and symptoms such as nausea and vomiting. Awareness of these risk factors allows early intervention and better perioperative management, reducing the likelihood of adverse outcomes.

Background: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating large renal calculi. While traditionally performed in the prone position under general anaesthesia, recent advances support the use of supine positioning and spinal anaesthesia to improve ergonomics, reduce anaesthetic risk, and enhance recovery. Miniaturization of PCNL tracts has also gained popularity in an effort to minimize morbidity without compromising efficacy. Objective: To evaluate the feasibility, safety, and surgical outcomes of supine PCNL and mini-PCNL performed under spinal anaesthesia at a tertiary care centre. Materials and Methods: This prospective observational study included 35 patients with renal stones >10 mm who underwent supine PCNL or mini-PCNL under spinal anaesthesia. Parameters evaluated included operative time, stone-free rate (SFR), exit strategy, hospital stay, and complications (Clavien-Dindo classification). Statistical comparisons were made using Chi-square and Fisher’s Exact tests. Results: The mean operative time was 68.8 minutes overall, with shorter durations noted in mini-PCNL (18.3 min) compared to standard PCNL (24.8 min). The overall stone-free rate was 94.3%, with two patients requiring adjuvant ESWL. Most mini-PCNL procedures were completed using a tubeless DJ stent approach. Complications were observed in 10 patients (28.6%), mostly Grade I–II. Exit strategy was significantly associated with complication rates (p = 0.014), while tract size and access site were not. No major anaesthesia-related events or organ injuries occurred. Conclusion: Supine PCNL and mini-PCNL under spinal anaesthesia are effective and safe treatment modalities for renal calculi. Exit strategy selection significantly influences complication rates and should be tailored to intraoperative findings. The results support broader adoption of minimally invasive, tubeless PCNL in appropriate cases.

Aim: To compare the hemodynamic effects of 5 units IV bolus + 10 units IV infusion of Oxytocin vs single IV bolus dose of 100 micrograms Carbetocin administered in parturients undergoing elective Caesarean section under spinal anaesthesia. Methodology: It was a Prospective randomized controlled double-blind study, conducted at Siddhartha Medical College, Government General Hospital, Vijayawada during the period from January 2023 to June 2024. Present study includes full-term parturients of age18 to 40 of ASAII undergoing elective Caesarean section under spinal anaesthesia. Results: In the present study, A significant increase in heart rate was observed initially in the oxytocin group when in comparison to carbetocin group but by 30 minutes, no significant difference existed between either groups. Carbetocin demonstrated more stable blood pressure profiles compared to oxytocin. Oxytocin caused significant decreases in systolic, diastolic, and mean arterial pressure sat 5 and10 minutes post-administration, which normalized by 30 minutes. Carbetocin and oxytocin showed similar initial uterine tone, but carbetocin maintained higher tone at 5, 10, and 30 minutes post-administration. No significant difference was existed in the incidence of adverse effects in both groups. Conclusion: The present study concluded that, Carbetocin shows a more stable hemodynamic profile in comparison to Oxytocin. Carbetocin has more potent and extended period of adequate uterine tone in comparision with Oxytocin.

Background and Aim: Spinal anaesthesia is widely recognized as a safe and efficient method for administering anaesthesia during surgeries involving the lower abdomen and legs.Clonidine is a medication that acts as an alpha-2 adrenergic agonist, and it can increase the potency of local anaesthetics when administered directly into the spinal fluid.This study was done to determine efficacy of adding intrathecal clonidine to bupivacaine hyperbaric(0.5%) in spinal anaesthesia in patients undergoing infra-umbilical surgeries. Methods: In a prospective observational study,60 patients with ASA grade i/ii were distributed  into two groups:Group A-received inj. Bupivacaine (hyperbaric)0.5% 3ml(15 mg) + normal saline 0.2 ml was administered Intrathecally

and Group B-received inj.Bupivacaine (hyperbaric)0.5% 3ml(15 mg) + inj.Clonidine 0.2 ml(30 µg). Parameters like onset of blockade, duration of sensory and motor block, duration of analgesia, hemodynamic changes and side effects were observed. Results: The onset of sensory and motor block was comparable in both groups. Mean duration of sensory block was significantly higher in Group B(264. 61 ± 19.2 mins.)(p< 0.001). Mean duration of motor block was significantly higher in Group B(225.20 ± 13.2 mins)(p < 0.001). Group B had prolonged mean duration of analgesia (378.06 ± 10.2 mins)(p < 0.001) as compared to Group A. Hemodynamic parameters were comparable in both groups.  Conclusion: Intrathecal addition of clonidine significantly prolongs the duration of sensory and motor block providing good postoperative analgesia and improves the quality of block with minimal acceptable side effects as compare to bupivacaine alone.

Background: Nowdays Laparoscopic surgery is becoming more and more popular since it is less intrusive and has lower morbidity.Traditionally general anesthesia (GA) is preferred and widely used anaesthesia technique for laparoscopic surgery due to a variety of factors .GA is typically used during laparoscopic surgery because it is considered the best method for achieving excellent muscle relaxation and tolerance to pneumoperitoneum. Laparoscopic surgery under spinal anesthesia is feasible, widely studied, and also avoids the complications of GA. This  study was conducted  to compare various variable outcome like the hemodynamic alterations, surgical conditions and patient acceptance of spinal anesthesia with general anesthesia.The shorter duration of anaesthesia and lesser required assistance for positioning the patients are other advantages of SA. Aims and Objective 1.The primary objective was to compare anaesthesia duration between both the groups. 2.Secondary objectives were to compare blood loss, hemodynamic stability, operative time, surgeon satisfaction, patient satisfaction, PACU time, total analgesic dose given in first 24 hours and duration of hospital stay between both the groups.Materials and Methods: In this study included 100 patients ASA I and II scheduled for elective lower abdomen laparoscopic procedures, divided into two groups. General anesthesia was given to Group G and spinal anesthesia to Group S. The patients were randomly categorized into Group G and Group S in the order of admission. We use random sampling method to select the cases. Patients were randomized into two groups, Group S and Group G; with 50 patients in each group. In group S, patients were given spinal anaesthesia and in group G, patients were given general anesthesia.Results: Demographics variable outcome  are comparable in both groups. In comparison to group S, group G mean heart rate, systolic blood pressure and diastolic blood pressure were all greater. The group S demonstrated excellent hemodynamic stability. Seven of the group S cases reported right shoulder pain and discomfort, managed with iv Propofol, although no case was converted to general anesthesia. 8% of the group S, 32% of the group A experienced postoperative nausea and vomiting. In the initial postoperative period, postoperative discomfort was less severe in Group S, and Group G required more rescue analgesia. Conclusion: It has been concluded that Spinal anesthesia for lower abdominal laparoscopic surgery is safe and promising anesthetic technique, with favorable intraoperative surgical circumstances, stable hemodynamics, and postoperative pain management throughout the patient hospital stay. So we concluded that we can safely and reliably use spinal anesthesia as an anesthetic technique in cases of Lower abdominal surgery.

Background: Lower segment caesarean section is one of the most frequently performed surgeries in obstetrics. Caesarean sections are performed mostly under spinal anaesthesia. Shivering is one of the distressing complications. Aim and Objective : The aim of this study was to compare the efficacy of intravenous (i.v) magnesium sulfate and tramadol with placebo (normal saline) on post spinal shivering in elective caesarean section when used as prophylaxis. Methodology: The study was conducted in tertiary care hospital .One hundred and sixty-five pregnant women between 18 and 35 years age, belonging to the American Society of Anaesthesiologists’ physical Status II, undergoing elective caesarean section under spinal anaesthesia were enrolled into the study. The Patients belonging to Group C (control group, n = 50) received isotonic saline 100 mL i.v, Group T (tramadol group, n = 50) received tramadol 0.5 mg/kg in 100 mL isotonic saline i.v, whereas those in Group M (magnesium sulfate group, n = 50) received magnesium sulfate 30 mg/kg in 100 mL isotonic saline i.v after administering spinal anaesthesia. Incidence and grades of shivering were being  noted. Data were analyzed using one-way ANOVA, SPSS -24 test and Chi-square test. Results and Discussion: The incidence of shivering in Group C, Group T, and Group M were 64%, 44%, and 40%, respectively. The incidence of shivering in Group M and Group T was significantly low when compared to Group C (P = 0.008; P = 0.0017), whereas there was no statistically significant difference between Groups T and M (P = 0.81). Conclusion: It was found that Magnesium sulfate and tramadol significantly reduced the incidence of shivering compared to placebo when used as prophylaxis in pregnant women undergoing cesarean section under spinal anesthesia. Magnesium sulphate reduces the severity of the shivering .

Background: Spinal anaesthesia has been reported as an alternative to general anaesthesia for performing laparoscopic cholecystectomy (LC). Study aimed to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia (SA) in comparison to general anaesthesia(GA) Methods:  A prospective, randomised study conducted over a two year period at a hospital in India from January 2023 to December 2024. Patients meeting inclusion criteria were randomised into two groups. Group A and Group B received general and spinal anaesthesia by standardised techniques. Both groups underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were secondary outcome measure. Results:  Out of 235 cases enrolled in the study, 114 cases in Group A and 110 in Group B analysed. Mean anaesthesia time appeared to be more in the GA group (49.45 vs. 40.64, P = 0.02) while pneumoperitoneum time and corresponding the total surgery time was slightly longer in the SA group. 27/117 cases who received SA experienced intraoperative events, four significant enough to convert to GA. No postoperative complications noted in either group. Pain relief significantly more in SA group in immediate post operative period (06 and 12 hours) but same as GA group at time of discharge (24 hours). No late postoperative complication or readmission noted in either group. Conclusion:  Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups in developing countries where cost factor is a major factor.

Background: Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Methods: A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally. Results: No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group). Conclusion: Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.

Background: The anaesthesiologists and obstetricians encounter specific challenges while managing pregnant patients with congenital complete heart block (CCHB) who require cesarean delivery due to pregnancy-induced physiological changes which requires precise planning to ensure maternal and fetal hemodynamic stability and better outcome. The case involves a 20-year-old primigravida patient weighing 52 kg and measuring 141 cm in height who was pregnant at 38 weeks and 2 days while maintaining a stable fixed heart rate between 48 and 53 bpm due to congenital complete heart block. The patient underwent pacemaker implantation as a past medical procedure before experiencing an infection, which led to the device removal. An emergency LSCS under spinal anaesthesia required the patient to undergo surgery, while the anaesthesiologists anticipated and effectively treated complications of bradycardia and hypotension by using close monitoring and pre-emptive transcutaneous pacing support, targeted fluid therapy and vasopressor use. A 2.6 kg healthy female baby received good Apgar scores during delivery. The patient demonstratedfew sustained episodes of bradycardia during the perioperative period, which were successfully managed because of effective preoperative planning between multiple disciplines, as well as constant monitoring during surgery and after delivery to ensure the wellbeing of patients with congenital cardiac conduction disorders.

Objective: This study aims to evaluate the efficacy of dexmedetomidine in sedation, general, and spinal anaesthesia, with a focus on its effects on anaesthetic requirements, hemodynamic stability, and postoperative recovery. Methodology: This study employs a secondary research approach to assess the efficacy and safety of dexmedetomidine across clinical settings such as anaesthesia and ICU sedation. A comprehensive review of peer-reviewed articles, meta-analyses, RCTs, and observational studies from 2015-2024 was conducted using databases like PubMed and Scopus. Key studies focusing on dexmedetomidine's effects on sedation, analgesia, hemodynamic stability, and postoperative recovery were selected. Data were extracted and synthesized to compare dexmedetomidine with other sedatives, providing insights into its clinical benefits and safety profile. Results: Dexmedetomidine minimized the use of other anaesthetic supplements by cutting down the volatile anaesthetic agents by between 30-40 percent and opioids by half in the post-operative period. This drug also helped maintain haemodynamic stability by rarely causing rapid changes in the pressure in the blood vessels and the rate at which the heart was beating. Also, patients who received dexmedetomidine had better postoperative outcomes, which includes; less pain score, faster time to be liberated from mechanical ventilator, and less time spent in the intensive care medicine unit. Conclusion: Dexmedetomidine is best suited as a sedative and in combination with general as well as spinal anaesthesia, it displays minimal anaesthetic demand, stable blood pressure control and enhances post operative recovery. For this reason, it has been embraced in anaesthesia regimens because of its opioid sparing benefits particularly in vulnerable patients

Background: In elective caesarean sections, spinal anaesthesia is the most commonly utilized anaesthesia technique, except for cases involving laboring mothers and significant fetal distress requiring general anaesthesia [1]. Objectives: 1. To evaluate and compare hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), respiratory parameters including rate (RR) and SPO2 with epidural magnesium sulfate vs dexmedetomidine vs normal saline during the postoperative period. Material & Methods: Study Design:    It is a randomized, double blinded, prospective, placebo controlled comparative study. Study area: The Pre-operative room, Gynecological operation theatre, Post anaesthesia care unit (PACU) of Dr PSIMS & RF.  Study Period: January 2019 to September 2019. Study population: Patients with ASA physical status 1 or 2, undergoing elective caesarean section at term pregnancy under spinal anaesthesia at Kona Seema institute of medical sciences, Malappuram.  Results: All the patients were observed up to 6 hours postoperatively and it was found that there were 38, 16, 87 episodes of hypotension in group A, B and C respectively. The rate of occurrence of hypotension was estimated to be 1.19, 0.50,2.71 per patient in gr. A, B and C respectively. It clearly shows the superiority of group B over group A & group C.  Conclusion: In conclusion, our findings indicate that administering intramuscular phenylephrine at a dosage of 4mg helps to decrease both the occurrence and intensity of hypotension following spinal anaesthesia in caesarean sections when compared to 2 mg of phenylephrine or placebo.

Background: Central neuraxial blocks are commonly used for surgeries involving the abdomen and lower limbs. Subarachnoid block (SAB) with hyperbaric bupivacaine is often favored over epidural anesthesia due to its quicker onset and more substantial block. It is also economical and straightforward to perform. Aim: To assess effect of intravenous dexmedetomidine in prolongation of sensory and motor blockade obtained with bupivacaine spinal anaesthesia in patients undergoing lower abdominal and lower limb surgeries. Material & Methods: Study Design:    It is a randomized, double blinded, prospective, placebo controlled comparative study. Study Period: January 2018 to June 2018. Study population: Study is in patients undergoing lower limb and lower abdominal surgeries.  Sample size:  60. Study tools and Data collection procedure: A detailed history, complete physical examination was done for all patients. Before the commencement of anaesthesia, patients were instructed on the methods of sensory and motor assessments. Intravenous line was secured and ringer lactate solution 15ml/kg was infused 10 minutes before initiation of procedure. Monitors connected and baseline values of heart rate, blood pressure and oxygen saturation were noted before the procedure. Results: Applying student unpaired t test, p value was found to be <0.001 implying time to two segment regression was very highly significantly in study group. Mean time for analgesic dose was found to be higher in study group and p value < 0.001 implying requirement of analgesia was significantly prolonged in study group. Conclusion: Based on our research, we determine that administering a single intravenous dose of dexmedetomidine at 0.5 mcg/kg over 10 minutes, delivered 20 minutes after a spinal block, extends the duration of sensory blockade, provides an enhanced level of sedation, and lengthens the time needed for postoperative rescue analgesia.

Background: Spinal anaesthesia has become a cornerstone of modern obstetric anaesthesia with ongoing research and development aiming to optimize its use and reduce any potential complications. Objective: to compare 2 doses of phenylephrine i.e. 75mcg and 50mcg in prevention of oxytocin induced hemodynamic changes in caesarean section under spinal anesthesia Methods: A randomized controlled trial was carried out on 64 patients, aged 20-40 years, classified as ASA grade II, scheduled for elective or emergency lower segment caesarean section. The study received approval from the Ethical Committee of Rohilkhand Medical College and Hospital, Bareilly. The 64 participants were randomly assigned to two groups, Group 1 and Group 2, with 32 patients in each group. Result: The differing hemodynamic responses to the two phenylephrine doses. The 75mcg bolus dose of phenylephrine was more effective in stabilizing blood pressure, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), especially during the critical period after oxytocin administration and cord clamping. Statistically significant differences were observed at various time points. For example, at 2 minutes post-cord clamping, phenylephrine demonstrated a significant advantage in SBP (p=0.019), and this trend continued at 4 minutes (p=0.037), 6 minutes (p=0.007), 8 minutes(p=0.005) and 10 minutes (p=<0.001). Similarly, phenylephrine consistently maintained higher MAP values, with significant differences at 1 minute (p=0.002), 2 minutes (p<0.001), and 3 minutes (p=0.0023) post-cord clamping. These results underscore 75mcg phenylephrine’s efficacy as a vasopressor that provides robust blood pressure control in the perioperative period. Conclusion: phenylephrine 75mcg is better suited for ensuring hemodynamic stability during the perioperative period, particularly for blood pressure control. These results provide valuable insights for anesthesiologists in tailoring intraoperative management strategies for caesarean sections under spinal anesthesia.

Background: Postdural puncture headache, often classified as a minor complication, can be severe and debilitating and has been considered the neurological complication of spinal anesthesia. Aim: To determine the incidence of postdural puncture headache with and without reinsertion of stylet before removing spinal needle in patients undergoing LSCS under spinal anesthesia. Methods: After obtaining the ethical clearance from the Institutional Ethical Committee the present prospective observational study was conducted in the Department of Anaesthesiology, Critical Care and Pain Management. Data was collected from all patients who received spinal anesthesia for LSCS according to our routine protocol.  Written informed consent was taken from all patients for participation in this study. Patients who fulfilled the inclusion and exclusion criteria we observed two groups viz. Group A (without Stylet reinsertion) and Group B (with Stylet reinsertion) after receiving spinal anesthesia for LSCS. Patients from both the study groups were observed intraoperatively and postoperatively. Patients not fulfilling criteria for postdural puncture headache or having other causes of headaches were dropped from the study. Patient were asked about onset of headache, duration of headache, severity of headache (VAS), associated symptoms like nausea, vomiting, neck stiffness, aggravating and relieving factors, history of fever with headache. The recorded data was compiled and entered in a spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA). Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. A P-value of less than 0.05 was considered statistically significant. All P-values were two tailed.  Results:  Incidence of PDPH in Group A was 10% (n=11) with none of the patients in Group B. The association between PDPH and the two study groups was statistically significant with a p value of 0.003. In Group A patient’s onset of PDPH was within 24-48 hours in 5 (45.5%) followed by within 24 hours in 4 (36.4%), 48-72 hours in 2 (18.2%). None of the patients had PDPH at or after 72 hours. Out of 11 patients with PDPH, severity was mild in 7 (63.6%) patients, moderate in 4 (36.4%). None of the patients in Group A had severe PDPH. Duration of PDPH was 1-4 days in majority of patients i.e. 8 (72.7%), 2 (18.2%) had PDPH for 8-10 days while only 1 (9.1%) patient had PDPH for 5-7 days with a mean duration of 4.2+1.56 days.  Conclusion:  We concluded that reinsertion of the stylet before spinal needle removal after spinal anaesthesia has a significant impact on incidence of PDPH. To understand the response of stylet reinsertion before removing spinal needle in patients undergoing LSCS under spinal anaesthesia further large sample studies are needed.

Background: The incidence of spinal anesthesia-induced hypotension has been reported to be as high as 80-85 % in patients undergoing elective caesarean section under spinal anaesthesia; hence, vasopressors play a vital role in their management. The choice of the most effective vasopressor for SAIH during caesarean section continues to be one of the main challenges in obstetric anesthesia.The present study compared intravenous norepinephrine and mephentermine for the maintenance of blood pressure during spinal anaesthesia for caesarean section in pregnant females. Materials & Methods: After approval from ethical committee and registration in Clinical Trials Registry India (CTRI/2022/10/046224), the present study was conducted on 60 pregnant females undergoing lower segment caesarean section under subarachnoid block. Patients were divided into 2 groups of 30 each. Group N received bolus intravenous norepinephrine 6µg and group M received mephentermine 6mg for the maintenance of intraoperative systolic blood pressure. HR, SBP and DBP were recorded at every 1 min interval till delivery of the baby and thereafter at every 5 min interval till the completion of surgery. Complications were also recorded. Results:The number of bolus of norepinephrine required was significantly higher than number of bolus of mephentermine Proportion of patients with number of drug boluses:- 4, 5, 6, 7 was significantly higher in group N as compared to group M. (4:- 3.33% vs 0% respectively, 5:- 36.67% vs 0% respectively, 6:- 50% vs 0% respectively, 7:- 13.33% vs 0% respectively). Proportion of patients with number of drug boluses:- 1, 2, 3 was significantly lower in group M as compared to group N. (1:- 0% vs 36.67% respectively, 2:- 0% vs 56.67% respectively, 3:- 0% vs 6.67% respectively). (p value <0.0001).Patients in both groups (GroupM vs Group N) were found to be comparable, with no statistical significance in terms of maternal complications (Headache:-30% vs 10% respectively (p value=0.104), Shivering:- 33.33% vs 16.67% respectively (p value=0.136), Local tissue ischemia:- 0% vs 0% respectively) (p-value=0.104)and neonatal APGAR scoreat 1 minute (p value=0.145)(6.47 ± 1.01 vs 6.83 ± 0.65), and at 5 minutes (p-value 0.254) (8.3 ± 1.32 vs 8.77 ± 0.9) between group M and group N. Conclusion: Authors found that intravenous norepinephrine controls blood pressurein parturients after SAB however, needs more drug as compared to mephentermine.

Background: Spinal anaesthesia using traditional local anaesthetics only, without adjuvants have a shorter duration of action and so leads to an early analgesic requirement in the postoperative period. The aim of the study was to compare 0.5% heavy bupivacaine with buprenorphine versus 0.5% heavy bupivacaine with fentanyl for lower abdominal and lower limb surgeries. Material and Methods: Present study was randomized comparative study, conducted in patients of age 18-60 years of age, under ASA 1 and 2, undergoing lower abdominal and lower limb surgeries under spinal anaesthesia. Systematic random sampling technique in which 30 subjects were selected for each group as Group B (n=30)- Hyperbaric Bupivacaine (0.5%) 2.5ml with buprenorphine 60 µg in 0.5 ml & Group F (n=30)- Hyperbaric Bupivacaine( 0.5%) 2.5ml with fentanyl 25 µg in 0.5ml. Results: We compared mean sedation score, mean VAS score between the group at same time period & no statistically significant difference was noted at any time. In this study the mean highest level of Sensory block in Group B was 6.50±1.96 and in Group F was 7.26±2.18.The comparison was statistically significant. The Time to highest sensory level block in Group B was 9.72±2.91mins compared to Group F which was 8.43±2.56mins. The p value is 0.04 which is statistically significant. In this study the comparison of mean highest motor block between the groups at same time period in Group F was 5.46±1.64 compared to Group B which was 4.06±1.10. The p value was 0.043 which statistically significant. The comparison of mean time to post analgesia between the groups at same time period was 457.29±2.28 in Group B when compared to Group F was 361.88±3.26. The p value is 0.001 (p<0.05) which is highly significant. Conclusion: Buprenorphine as adjuvant prolongs the duration of postoperative analgesia and the request for first analgesics. 

Background: Local skin infiltration of 2% lignocaine is a standard procedure which is usually used prior to lumbar puncture. It is invasive and itself leads to fear and anxiety in patients before application and is also associated with pain during the procedure. EMLA cream provides surface analgesia, hence the fear, anxiety and pain of analgesic infiltration is prevented. Against this background, the present study aimed to find out the efficacy of topical EMLA cream in comparison to the standard infiltration technique in reducing pain of needle insertion during lumbar subarachnoid block and have better patient satisfaction level.Methods: This prospective, single blinded, randomized controlled study was conducted in the Department of Anaesthesiology and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak after obtaining approval from Institutional Ethical Committee. Patients aged 18-60 years, of either sex undergoing elective lower abdominal, pelvic and lower limb surgeries belonging to ASA grade I and II were selected. Sixty patients were divided into two groups of 30 each: Group1 EMLA- 2.5 gms of 5% EMLA cream per 10sq.cm was applied for a minimum of 60 minutes prior to lumbar puncture and covered with an occlusive dressing; Group 2 Lignocaine - skin and deeper structures were infiltrated with 2ml of 2% lignocaine just prior to lumbar puncture. Hemodynamic parameters, pain scores and patient satisfaction were recorded. Results: Demographic characteristics were comparable between the two groups. The heart rate and mean arterial pressure values before and after lumbar subarachnoid block were statistically similar between the two groups (p>0.05). VAS scores in both groups were comparable with no significant difference amongst the two groups. The 4-point pain scale was comparable with no statistical difference between the two groups (p=0.59). There was a significant difference in patient satisfaction score in the two groups (p=0.03). Conclusion: EMLA cream is an effective alternative to lignocaine infiltration for analgesia during administration of spinal anaesthesia when using a 25G spinal needle.

Introduction: Spinal anaesthesia-induced hypotension is common during caesarean sections, potentially compromising uteroplacental perfusion. Vasopressors like phenylephrine and mephentermine are frequently used to restore blood pressure, but their efficacy and side-effect profiles differ. This study compares the effectiveness and maternal-fetal outcomes of bolus phenylephrine versus mephentermine. By understanding the differences in response profiles between these agents, clinicians can better tailor vasopressor use based on individual patient needs and optimize both maternal and fetal safety. Materials and Methods: This randomized, double-blind study was conducted over 6 months in the Department of Anaesthesiology at a tertiary care hospital consist of 100 ASA I and II parturients undergoing elective caesarean section under spinal anaesthesia. Group P received 50 µg phenylephrine IV bolus; Group M received 6 mg mephentermine IV bolus for hypotension (SBP < 100 mmHg or drop >20% from baseline). Hemodynamic parameters, number of doses required, and side effects were recorded. All patients received 10 ml/kg Ringer lactate preloading. Spinal anaesthesia was administered in the L3–L4 interspace using 0.5% hyperbaric bupivacaine (2.0 mL). Sensory block to T6 was confirmed. Results: Both groups were well-matched in terms of age, weight, baseline systolic blood pressure (SBP), and heart rate (HR). The lack of statistically significant differences (p > 0.05) indicates successful randomization. Group P (phenylephrine) restored SBP in 2.8 ± 1.2 minutes, significantly faster than Group M (4.1 ± 1.3 minutes). Group P required fewer bolus doses (1.4 ± 0.6) compared to Group M (2.3 ± 0.8), which was statistically significant. Bradycardia occurred more often in Group P (24%) vs. Group M (6%), highlighting a major side effect of phenylephrine. No significant difference in 1-minute and 5-minute Apgar scores between the groups. Conclusion: Phenylephrine is more effective in rapidly restoring blood pressure but is associated with bradycardia. Mephentermine maintains heart rate better but may require repeated dosing. Both agents are safe for fetal outcomes

Introduction: Aim And Objective: To measure the transverse diameter of Right Common Femoral Vein before spinal anesthesia and assess its association with Post Spinal hypotension in patients posted for elective cesarean section. Methods: 60 pregnant women aged 18 – 24 years posted for Elective Cesarean Section chosen for our study. Transverse diameter of right common femoral vein was measured in supine position using ultrasound prior to spinal anaesthesia. Hypotension was defined as a drop in systolic arterial pressure by more than 20 percent from baseline. Patient and obstetric characteristics with respect to postspinal hypotension were studied. Result: A Longer transverse diameter [>11.8 mm] was associated with occurrence of postspinal hypotension Conclusion: Transverse diameter of common femoral vein can aid in predicting parturients at risk of hypotension before spinal anaesthesia.

Introduction: Anesthesia for daycare surgeries demand rapid recovery with no residual anesthetic effects and minimal perioperative side effects. Chlorprocaine is an amino ester local anesthetic with short half-life, regained its importance in the recent past in day care surgeries¹. Opioids as adjuvant to Chlorprocaine have shown to prolong the duration of postoperative analgesia without much effect on motor block, favoring early mobilization. The optimal dose of Chlorprocaine which can ensure efficacy without prolonging recovery remains unclear.  Objective: To compare the efficacy, safety, and recovery profiles of 20 mg versus 30 mg intrathecal Chlorprocaine with 25 mcg fentanyl in patients undergoing lateral anal sphincterotomy as daycare procedures under spinal anesthesia. Methods: A randomized, double-blind study was conducted on 60 patients undergoing elective lateral anal sphincterotomy. Patients were assigned into two groups: Group A (20 mg chlorprocaine + 25 mcg fentanyl) and Group B (30 mg chlorprocaine + 25 mcg fentanyl). Primary outcomes included onset and duration of sensory and motor block, duration of effective analgesia and time to ambulation and discharge readiness. Secondary outcomes included patient satisfaction, need for rescue analgesia, and adverse effects. Results: Group B had faster onset and prolonged sensory and motor blocks compared to Group A (p < 0.05). However, Group A demonstrated significantly earlier ambulation (p = 0.03) and discharge readiness (p = 0.02). Both groups showed comparable analgesia quality and patient satisfaction. No major adverse events were recorded. Conclusion: Intrathecal 20 mg chloroprocaine with 25 mcg fentanyl is adequate for daycare lateral anal sphincterotomy, providing satisfactory surgical anaesthesia with faster recovery compared to 30 mg with 25mcg fentanyl. It may be preferred for procedures requiring early ambulation and discharge

Introduction: Acute cerebral venous thrombosis (CVT) is an uncommon but treatable cerebrovascular disorder with heterogeneous presentations and imaging patterns. Functional outcomes in modern cohorts are generally favorable, with 80–90% achieving independence at follow-up; nevertheless, a subset suffers persistent headaches, cognitive or mood symptoms, epilepsy, or visual deficits, underscoring the importance of structured follow-up and rehabilitation. Contemporary data suggest improving outcomes with timely diagnosis and anticoagulation, including direct oral anticoagulants (DOACs). Materials & Methods: We conducted a prospective, single-center observational study of consecutive adults with radiologically confirmed acute CVT over 24 months. Demographics, risk factors, clinical features, neuroimaging, treatment, and outcomes—modified Rankin Scale (mRS) at discharge and 3 months—were recorded. A standardized case-record form captured demographics, vascular risk factors, hormonal exposures, peripartum status, infection, dehydration, malignancy, and thrombophilia testing (protein C/S deficiency, antithrombin, factor V Leiden, prothrombin G20210A, antiphospholipid antibodies), when clinically indicated. Presenting features included headache characteristics, seizures, focal deficits, papilledema, altered sensorium, and blood pressure.  Results: Among 120 patients (mean age 32.8±10.6 years; 68% women), headache (82%), seizures (38%), and focal deficits (33%) predominated. Superior sagittal (61%) and transverse sinuses (49%) were commonly involved; 28% had cortical vein thrombosis. Parenchymal lesions occurred in 41% (venous infarct 29%, hemorrhage 22%). All received heparin followed by vitamin-K antagonists or DOACs; 46% were discharged on DOACs. In-hospital mortality was 2.5%. Favorable functional outcome (mRS 0–2) occurred in 78% at discharge and 88% at 3 months. Conclusion: Most patients with acute CVT are young women with headache-predominant presentations and multisinus involvement. Early anticoagulation—often transitioned to DOACs—is associated with high rates of good functional recovery.

This single blind randomized controlled trial was undertaken to compare the effectiveness of infusion Phenylephrine and infusion Norepinephrine in elective caesarean section in maintaining maternal haemodynamics and its effects on new born. 80 pregnant patients of 36 weeks or more gestational period, aged 18-40 years, ASA I and II, selected for elective caesarian delivery were divided into two equal groups. Group N (N=40) received norepinephrine 6 ug/ml/hr infusion and Group P (N=40) received phenylephrine 100 ug/ml/hr infusion immediately before injection of spinal anaesthesia medication. A standardized spinal anaesthesia consisting of hyperbaric (0.5%) bupivacaine 10-12 mg and fentanyl 20 mcg was administered by a 25-gauge spinal needle (Quinckes needle) in sitting position at L2-L3 or L3-L4 intervertebral space in both groups.  Documentation of SBP, DBP, MAP, HR was done in a regular interval. After delivery of the baby, 10u oxytocin was given slow iv and umbilical cord was collected and sent for ABG analysis at 0 and 5 minutes along with APGAR score recording. Hemodynamics and any side effects if present were observed for 4 hrs. There is a significant statistical improvement not only in the maternal PR, SBP, DBP and MBP taken over time but also the pH, Hco3 and lactate readings taken at 0 and 5 mins of the new born babies in the Group N compared to the Group P. To conclude, norepinephrine effectively prevents maternal hypotension and improves fetal acidosis in comparison to phenylephrine in elective caesarean section under spinal anaesthesia.

Background: Adjuvant agents are usually added to the local anesthetic agents during the use of subarachnoid block for prolongation of subarachnoid block for prolongation of both analgesic and anesthesia duration.  Aim: The present study was aimed to comparatively assess the efficacy of two different doses of 30 µg and 50 µg intrathecal clonidine as an adjuvant to the hyperbaric ropivacaine in subjects undergoing lower limb surgeries.  Methods: The present study assessed 180 subjects that were randomly divided into two groups of 90 subjects each where Group I subjects were given 3ml of 0.75% hyperbaric ropivacaine along with 30µg clonidine which was diluted with normal saline for total of 3.5mL volume. Group II subjects were given 50 µg clonidine with 3ml of 0.75% hyperbaric ropivacaine diluted with normal saline for total of 3.5mL volume. The study compared hemodynamic changes, complications, side-effects, sensory and motor blockade, and analgesia duration. Results: The study results showed that 30µg clonidine took longer time to reach highest spinal level with 12.4±1.24 minutes compared to 50µg clonidine that took 11.6±1.4 minutes with p=0.003. For two segment regression, time was significantly longer with 50µg clonidine compared to 30µg clonidine with p<0.001. Durations for motor and sensory block was also higher with 50µg clonidine compared to 30µg clonidine with p<0.001. Analgesia duration was significantly longer in 50µg clonidine group with p<0.001. Higher incidence of hypotension and bradycardia was seen with 50µg clonidine that were managed using standard interventions. Conclusion: The present study concludes that 50µg of intrathecal clonidine provides higher analgesic effects in comparison to 30µg clonidine. However, it is linked with a higher risk of hypotension and bradycardia. Timely interventions and careful watch and monitoring are vital when clonidine is used in higher dose compared to a low dose.

Background: The Inferior Vena Caval Collapsibility Index (IVCCI) is a simple, non-invasive ultrasonographic tool to assess intravascular volume status and fluid responsiveness. In spinal anaesthesia (SA), hypotension is a common complication, often related to preoperative hypovolemia from fasting. Identifying fluid-responsive patients preoperatively may help prevent intraoperative hypotension. However, limited studies have evaluated IVCCI for this purpose. Aim: To evaluate preoperative IVCCI and correlate it with hemodynamic changes following spinal anaesthesia. Methods: An observational study was conducted on 80 ASA I and II patients undergoing elective surgery under SA. Preoperatively, an 18G IV line was secured, and inferior vena cava (IVC) diameters during inspiration and expiration were measured using a 2–6 MHz curvilinear probe in the subcostal long-axis view with M-mode ultrasound. IVCCI was calculated as: IVCCI = [(IVCₑₓ – IVCᵢₙ) / IVCₑₓ] × 100 Patients were then given 500 mL Ringer Lactate over 15 minutes, and IVC measurements were repeated. After SA, hemodynamic parameters (SBP, DBP, MAP, HR) were recorded every 10 minutes. Results: Pre-bolus mean IVCCI was 40.51% (SD 3.06), suggesting preoperative hypovolemia. Post-bolus IVCCI reduced to 36.37% (SD 2.17), indicating fluid responsiveness. A significant negative correlation was found between IVCCI and hemodynamic parameters, especially MAP (r = -0.2, p < 0.0001). Conclusion: IVCCI is a useful, bedside predictor of fluid status and responsiveness. A preoperative fluid bolus effectively reduces IVCCI and helps maintain intraoperative hemodynamic stability in patients undergoing spinal anaesthesia. Incorporating IVCCI assessment into routine preoperative evaluation may help anticipate and manage SA-induced hypotension.