European Journal of Cardiovascular Medicine

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: Emergence agitation is a common side-effect of Sevoflurane anaesthesia in children. Dexmedetomidine, a specific α2- receptor agonist, may be useful adjuvant during general anaesthesia by promoting hemodynamic stability and decreasing the doses of anaesthetics and analgesics. The purpose of our study was to test the effect of Dexmedetomidine in reducing emergence agitation in children undergoing Sevoflurane anaesthesia.

Material and Methods: 60 children aged 3 to 7 years scheduled to undergo superficial lower abdominal or genital surgeries were included in the study. Patients were randomly assigned to receive either Inj. Dexmedetomidine 0.3µg/kg (Group D) or Inj. Fentanyl 1µg/kg (Group F) i.v prior to induction. After induction with 8% Sevoflurane, a laryngeal mask airway was inserted. Anaesthesia was maintained with 1-2% Sevoflurane and 50% nitrous oxide on spontaneous ventilation. Postoperatively, caudal epidural block was given. At the end of anaesthesia, the time of response to verbal commands (TRVC) and characteristics of emergence were recorded.

Results: Mean postoperative behaviour score in Group D was 1.7 ± 0.79 while that in Group F was 2.96 ± 0.96. There was significant reduction in the VAS score from 5.7 ± 0.98 in Group F to 2.4 ± 0.89 in Group D. 13.33% patients in Group D and 43.33% in Group F showed agitation.

Conclusion: We conclude that Inj. Dexmedetomidine 0.3µg/kg i.v reduces postoperative emergence agitation after Sevoflurane anaesthesia in children

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

Introduction: Pain during and after surgery results in intense changes in hemodynamics, increased metabolic and endocrine stress hormone production, and increased myocardial oxygen demand and consumption. Some patients require bothopioid and non-opioid analgesics within the first 24 hours followingsurgery. Pre-emptive analgesia is theintroducing of analgesic management beforeonset of noxious stimuli, which helps to prevent pain potentiation. It provide spain relief priorto surgery and throughout the perioperative period. Bilateral superficial cervical plexus block (BSCPB) is a technique where local anaesthetic mixtureis injected based on anatomical landmarks. It reduces the intraoperative analgesic requirements when administered before surgery. By decreasing analgesic requirements, the block produces tableintra operative vital sin comparison to general anaesthesia alone [3] Therefore, this study involved administering bilateral superficial cervical plexus blocks for thyroid surgeries in addition to general anaesthesia, along with assessment of intra- and post-operative hemodynamics, evaluation of postoperative eanalgesia, and detection of adverse effects. Materials and Methods: This randomized study was carried out in the Department of Anaesthesia, MGM Medical College and MY Hospital, Indore, among 60 consented patients aged 18 – 60 years belonging to ASA grade I/II and posted for elective thyroid surgeries under general anaesthesia, allocated into 2 groups of 30 each: Group A (without SCPB) and Group B (with SCPB), using a proforma, pre-anaesthetic evaluation, investigations followed by induction of anaesthesia and performing of SCPB. Data was collected, compiled and analysed using SPSS 22.0 (trial version). Result: Majority Group A (36.67%) and Group B (40%) participants belonged to 31-40 years and 18-30 years age group, respectively and were females (Group A=90%; Group B=83.3%). Most were classified as ASA grade I (63.3%). The HR, SBP, DBP and MAP in Group A intra-operatively, was found to be significantly higher than Group B (p-value-0.000). Post-operatively, it was observed that the HR and SBP was significantly higher in Group A at all the time intervals till 24 hours after the procedure (p-value=0.000). The DBP was higher initially in the post-operative period in Group A (p-value=0.000), however, 24 hours later, it was found to be comparable with Group B(p-value>0.05). Similar was the case with MAP, which was higher in Group A in the initial post-operative period, decreased gradually and 24 hours later, was comparable with Group B(p-value>0.05). Statistically significant difference was also observed between both the groups (p-value<0.05) with respect to VAS score. Requirement of first rescue analgesia was earlier in Group A (p-value<0.000). Post-operative complication were experienced more in Group A. Conclusion: It was concluded that BSCB block with injection Ropivacaine 0.75% and injection Fentanyl 25 mcg was effective in blunting hemodynamic stress response to pain and provided stable hemodynamics throughout the surgery. It also reduced the dose and requirement of opioid analgesics after the surgery.

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: Epidural analgesia is widely regarded as the preferred method for pain management, facilitating early mobilization following orthopedic surgery and promoting enhanced bowel function. Methods: A total of 50 patients were randomly allocated into two groups of equal size, both of which were scheduled to undergo elective lower limb surgery. Group A was administered a dosage of 1 µg/kg of fentanyl, while Group B received a dosage of 1 mg/kg of tramadol. In both cases, the medications were diluted to a volume of 10 ml using 0.9% normal saline. Following the surgical procedure, patients underwent a comprehensive evaluation that included the assessment of various parameters such as the visual analogue scale (VAS) for pain, sedation score, respiratory rate, haemodynamic stability, onset of analgesic effect, quality and duration of pain relief, frequency of epidural doses, and the occurrence of any adverse effects. Results: The mean duration of analgesia onset in group A and group B was found to be 12.47± 2.51 minutes and 6.15±1.75 minutes, respectively (p < 0.001). The mean duration of analgesia in group A was 8.06±1.25 hours, while in group B it was 5.4±0.97 hours (p <0.001). Throughout the study, it was observed that the Visual Analog Scale (VAS) scores were consistently lower in group A. The mean visual analog scale (VAS) score was found to be statistically significant at p < 0.05 up to 24 hours, but at 48 hours, the p-value was greater than 0.05. In Group B, five individuals experienced symptoms of vomiting, while four individuals reported experiencing nausea. In Group A, two individuals reported symptoms of vomiting, two individuals reported experiencing nausea, and four patients experienced episodes of purities. Conclusion: Based on our research, it can be inferred that fentanyl exhibits a prompt onset and superior analgesic efficacy. Additional frequent top-ups were necessary when administering fentanyl

Introduction: The effective management of pain during and after lower limb orthopaedic surgeries is crucial for optimizing patient comfort and postoperative outcomes. Epidural analgesia, often employed in this context, relies on the adjunctive use of medications to enhance pain control. Among the numerous options available, two commonly used adjuvants are dexmedetomidine and fentanyl. This study aims to provide a comparative analysis of the efficacy and safety of these two medications when incorporated into epidural analgesia protocols for lower limb orthopaedic surgeries. By exploring their respective benefits and potential drawbacks, this research seeks to contribute valuable insights to the field of perioperative pain management, ultimately aiding clinicians in making informed decisions regarding the choice of adjuvants in orthopaedic surgical settings. Materials and Methods:  The present study included 120 patients who underwent lower limb orthopaedic surgery and were of both sexes, aged 20 years to 56 years, and of physical status I and II according to the American Society of Anaesthesiologists (ASA). Sixty patients each were randomly assigned to the two groups Group 1 [ropivacaine + dexmedetomidine (RD)] and Group 2 [ropivacaine + fentanyl (RF)]. Epidurally, 15 ml of 0.75% ropivacaine injection was given to both groups, along with 1 g/kg of dexmedetomidine for Group 1 and 1 g/kg of fentanyl for Group 2. Various block characteristics, such as the time to the first onset of analgesia at T10, the maximum sensory analgesic level, the duration of the motor blockade, the duration of the two segmental dermatomal regressions, and the duration of the first rescue analgesic, were also noted along with cardio-respiratory parameters and sedation scores. Data was rigorously gathered at the conclusion of the study and analyzed using Fisher's exact test, Chi-square test, and ANOVA with post-hoc significance. Statistical significance was set at 0.05 (if the P-value ≤ 0.05, it is significant). Results: The demographic profile of patients was comparable in both groups. The onset of sensory analgesia at T10 (7.65±1.93 minutes vs 9.76±2.19 minutes) and establishment of complete motor blockade (19.42±4.11 minutes vs 21.65±5.37 minutes) was significantly earlier in Group 1 [ropivacaine + dexmedetomidine (RD)].  Postoperative analgesia was prolonged significantly in Group 1 [ropivacaine + dexmedetomidine (RD)] (362.13±20.87 minutes) and consequently low dose consumption of local anaesthetic (74.56±9.82 mg vs 108.65±14.69 mg) during epidural top‑ups postoperatively. Sedation scores were much better in Group 1 [ropivacaine + dexmedetomidine (RD)] and highly significant in statistical comparison. The incidence of nausea and vomiting was significantly higher in Group 2 [ropivacaine + fentanyl (RF)] , while the incidence of dry mouth was significantly higher in Group 1 [ropivacaine + dexmedetomidine (RD)].  Conclusion: As an epidural adjuvant, dexmedetomidine appears to be preferable to fentanyl because it offers comparable stable hemodynamics, early onset and establishment of sensory anaesthesia, prolonged postoperative analgesia, lower post-operative local anaesthetics consumption for epidural analgesia, and significantly higher sedation levels.

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. 

Background: Endotracheal intubation can elicit significant hemodynamic responses, necessitating effective management to reduce potential complications. This study compared the efficacy of Fentanyl and Nalbuphine in attenuating these responses. Methods: A total of 100 patients undergoing endotracheal intubation were randomized into two groups, receiving either Fentanyl or Nalbuphine. Heart rate, systolic and diastolic blood pressures, mean arterial pressure, rate pressure product, and oxygen saturation were measured at various time points pre- and post-intubation. Results: Nalbuphine significantly reduced heart rate from 3 minutes post-intubation (p<0.05), and was more effective in lowering systolic and diastolic blood pressures (p as low as 0.0001). Mean arterial pressure was better managed with Nalbuphine, particularly noticeable from 3 minutes onward (p<0.05). Rate pressure product was consistently lower in the Nalbuphine group, starting from 1 minute post-intubation (p<0.05). Oxygen saturation levels remained stable and comparable in both groups. Conclusion: Nalbuphine showed superior efficacy in attenuating the hemodynamic responses to endotracheal intubation compared to Fentanyl. Its significant impact on heart rate and blood pressure control, without compromising respiratory function, suggests it as a preferable alternative in clinical anesthesia practice

Background- Effective pain relief and minimum motor block are the necessary constituents of an ideal epidural block. Fentanyl is a lipophilic opioid most commonly used as an adjuvant to local anaesthetic. Ropivacaine is an alternative to bupivacaine, with greater sensitivity for sensory fibres than motor fibres, thus producing less motor blockade than bupivacaine. This study assessed the analgesic effect of very low dose fentanyl (1mcg/ml) as an adjuvant to either ropivacaine or bupivacaine. without compromising its beneficial effects and avoiding the undesired side effects. AIM- To study the effect of fentanyl as an adjuvant to bupivacaine and ropivacaine in epidural analgesia for laboringparturient. Method- 44 nulliparous labouring parturients of ASA I & II at term with singleton pregnancy of vertex presentation without any obstetric complication were randomly allocated into two groups of 22 each. Group B received bupivacaine 0.125% with fentanyl 1 mcg/ml bolus dose till VAS<3. Similarly, Group R received ropivacaine 0.125% with fentanyl 1 mcg/ml. Analgesia was maintained with intermittent bolus of study solution. Analgesic efficacy was measured in terms of duration of analgesia, onset of analgesia, highest level of sensory block, motor block, side effects if any; obstetric and neonatal outcomes were also recorded. Results- There was no significant difference between the two groups in terms of duration of analgesia, level of sensory block achieved, time required to achieve level of sensory block, motor block or side effect profile. There were minimal side effects and neonatal outcomes were good. Obstetric outcomes and maternal satisfaction level was also comparable between the two groups. Conclusion- Fentanyl when used in a low dose of 1 mcg/ml with equal concentration of two local anaesthetic bupivacaine and ropivacaine provides good analgesia in all stages of labour avoiding the side effects of opioids.

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: 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.

Purpose: To evaluate patient discomfort and tolerability during bronchoscopy using two sedation protocols: midazolam alone versus a combination of midazolam and fentanyl, assessed by the Richmond Agitation-Sedation Scale (RASS). Methods: In this prospective, randomized trial, 100 patients undergoing bronchoscopy were divided into two groups. Group M received midazolam alone, while Group MF received midazolam and fentanyl. Sedation levels were assessed using the RASS, while procedural tolerability was rated by observers. Adverse events were monitored. Results: Patients in Group MF achieved a more consistent sedation depth, indicated by RASS scores closer to the target range (0 to -3) compared to Group M (p<0.001). Procedural tolerability was rated as "good" or "excellent" in 92% of Group MF cases, versus 76% in Group M. Mild respiratory depression occurred in 6% of Group MF but resolved with supplemental oxygen. Conclusions: The combination of midazolam and fentanyl enhances procedural tolerability and sedation consistency during bronchoscopy, with minimal adverse effects. This sedation protocol may be preferred in settings where stable sedation is crucial.

Background: Regional anaesthesia has found its uses in many aspects of orthopaedic surgery including more recently, spine surgery. Neuraxial or regional anaesthesia are often the preferred techniques for surgical anaesthesia in patients with multiple comorbidities. For instance, osteoporosis-related complications such as hip fractures are common in the growing geriatric population. Orthopaedic surgery aims to recover functional capacity in patients but it carries a specific morbidity and mortality. Orthopaedic surgery conveys several challenges for the anaesthesiologist, including prevention of thromboembolic complications, reduction of peri- and postoperative bleeding and management of autologus blood transfusion and postoperative pain. Material and Methods: This is a prospective study was conducted in the Department of orthopaedic and Anaesthesia at Shadan Institute of Medical Sciences, Teaching Hospital and Research Center. Three hundred and ten consecutive cases posted for orthopaedic surgeries were taken up for study. Anaesthesia technique was decided based on the nature of surgery, willingness and medical status of the patient and experience of the anaesthesiologists. RA was planned whenever possible. In the morning of operation the RA technique was explained to the patients and intravenous (IV) access established. Preoperative medication was given using IV fentanyl and midazolam in titrated doses. Ketamine was used in children and appropriate block given using standard technique. Nerve stimulator was used wherever applicable Results: Age of the patients ranged from three months to 92 years. Maximum number of patients belonged to the age group of 21- 50 years (63.2%). As per the demographic data. In our study, Knee arthroscopy and repair was 28.38%, Femoral was 17.41%, Radius and ulna was 15.16% and least were Ankle and foot, Wrist and hand surgery was 1.93%. In our study Subarachnoid block was 40.96% followed by Combined spinal-epidural 17.09%, General anaesthesia 12.90%. Conclusion: In a conclusion, the use of regional anesthesia techniques for postoperative outcomes in orthopedic surgeries has been investigated in lots of clinical studies and case reports. Most of the authors proposed that regional anesthesia in orthopedic patients may be associated with better postoperative pain control and a reduction in intraoperative blood loss when compared with general anesthesia. In the future regional anesthesia techniques will be more preferable anesthetic technique in orthopedic surgeries

Background and Aims: Literature on the comparative evaluation of the intubating dose of cisatracurium and atracurium is sparse in India. We evaluated neuromuscular blockade, recovery characteristics, and safety profile between the two non-depolarizing neuromuscular blocking drugs; cisatracurium besylate and atracurium besylate at equipotent doses (3xED95) in adult patients undergoing abdominal laparoscopic surgical procedures. Methods: Fifty surgical patients under general anaesthesia were randomised into two groups. Anaesthesia was induced with 2 mg/kg propofol and 2 μg/kg fentanyl in all the patients. Neuromuscular blockade was achieved using an equipotent dose of either cisatracurium 0.15 mg/kg (Group A) or atracurium 0.6 mg/kg (Group B). Onset time, duration of action, and recovery profile after administration of cholinesterase inhibitor were noted using neuromuscular monitoring using Train Of Four (TOF). Intubating conditions, haemodynamic changes, and safety characteristics were also evaluated. Results: The mean onset time and duration of action for cisatracurium were 4.44 ±0.45 minutes, 50.09 ±5.3 minutes while, for atracurium, the values were 3.14 ±0.23 minutes, 41.03 ±1.69 minutes respectively (p <0.001). Intubating conditions, haemodynamic changes, and safety profile were comparable between the groups. Recovery time following administration of cholinesterase inhibitors in the cisatracurium and atracurium group were 2.84±0.23 and 3.68 ±0.21 minutes respectively (p <0.001). Conclusion: Equipotent dose of atracurium had faster onset than cisatracurium. But, the duration of action was longer in cisatracurium as compared to atracurium. The recovery profile of cisatracurium was faster and better than atracurium. Both the drugs have comparable haemodynamic parameters, intubating conditions, and safety profile.

Introduction A common anesthetic method for a range of lower limb orthopedic procedures is spinal anesthesia due to its ease of administration, robust sensory and motor blocking, and reliable surgical anesthesia. However, the length of spinal anesthesia caused by local anesthetics alone is often brief; for this reason, adjuvants are employed to prolong analgesia and improve block quality. The quality and duration of spinal anesthesia have been enhanced by intrathecal opioids such as morphine, fentanyl, and butorphanol used as adjuvants to local anesthetics. Material And Method Written informed permission was obtained from research participants. A computer-generated random number was used to divide the minimum number of patients who met the inclusion criteria into two groups. Group A patients got 3 milliliters of 0.5% hyperbaric bupivacaine along with 0.2 milliliters, butorphanol (200 micrograms). Group B patients got 0.15 ml of buprenorphine (150 micrograms) together with 3 ml of 0.5% hyperbaric bupivacaine. Result The gathered information was imported into Microsoft Excel 2016 and examined using IBM SPSS Statistics for Windows.Descriptive statistics were employed to characterize the data: for continuous variables, the mean and standard deviation were utilized, and for categorical variables, frequency analysis and percentage analysis. Using the Independent sample t-test, the bivariate samples in the independent groups were compared to see whether there was a significant difference. Conclusion According to our study onset of sensory blockade and faster with butorphanol and duration of sensory blockade was more in buprenorphine compared to butorphanol whereas motor blockade is comparable in both groups. Buprenorphine group required rescue analgesia at 4hrs postoperatively whereas butorphanol group required rescue analgesia at 2nd hr Hence we conclude that buprenorphine would be beneficial for lower limb orthopedic surgeries as it provides prolonged duration of analgesia although further studies need to be done in a greater number of patients and for prolonged duration of procedures..

Background and Aims: Literature is sparse comparing the intrathecal use of hyperbaric ropivacaine and levobupivacaine for lower limb procedures. To take advantage of stereoselectivity, ropivacaine and levo-(S)-bupivacaine were developed. Both are less cardiotoxic than bupivacaine. This study was undertaken with the aim of comparing the block characteristics following intra-thecal administration of hyperbaric levobupivacaine (0.5%) with hyperbaric ropivacaine (0.75%) for lower limb orthopedic surgeries under sub-arachnoid block. Material and Methods: This randomised, comparative study was undertaken in a tertiary care, teaching hospital after taking necessary approvals (IRB and IEC), in consenting adult patients fulfilling the inclusion and exclusion criteria, posted for elective lower limb orthopaedic surgeries under subarachnoid block. After standard sample size calculation, a total of 80 patients were enrolled and randomised into two groups (40 patients in each group). Group L received 3 ml of preservative-free, 0.5 percent hyperbaric Levobupivacaine with 20 microgram fentanyl; and Group R received 3 ml of 0.75% hyperbaric Ropivacaine (preservative free) with 20 mcg fentanyl, intra-thecally. The vital parameters, onset of motor and sensory blockade as well as duration of motor and sensory blockade were noted at regular intervals, tabulated and subjected to statistical analysis. Results: As regards to demographic variables, both the groups were comparable. In terms of onset of motor block (minutes), there was a significant difference between the two groups (p = 0.001), with onset of motor block (minutes) being higher for Levobupivacaine. Ropivacaine had a faster onset of motor block as compared to levobupivacaine. Between the two groups, there was a substantial variation in the number of hours that the motor block lasted (p = 0.001), with the duration of motor block (hours) being longer in the levobupivacaine group. Levobupivacaine produced longer lasting motor block than ropivacaine. In terms of onset of sensory block (minutes), there was a significant difference between the 2 groups (t = -8.746, p = 0.001). Ropivacaine had a faster onset of sensory block as compared with levobupivacaine. The duration of sensory block (hours) varied significantly across the 2 groups (p = 0.001), with the Group L (levobupivacainegroup) having longer duration of sensory block (hours). Ropivacaine had a lesser duration of sensory blockade as compared with levobupivacaine. Participants in the group Group L (levobupivacaine group) had a higher proportion of MAP fall >10% from baseline as compared to Group R (Ropivacaine). Conclusions: In demographically similar group of patients, intra-thecal ropivacaine showed earlier onset of both sensory and motor block than levobupivacaine. Duration of both sensory and motor blocks was longer with levobupivacaine than ropivacaine. Hemodynamic parameters (HR, SBP, DBP, ECG, SpO2) remained similar and stable with both the drugs, although the systolic BP fall was more with levobupivacaine than ropivacaine. Level of block achieved with both the drugs in the used doses were similar in our study.

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: Effective pain management is a crucial aspect of postoperative care for minimally invasive surgeries, such as laparoscopic nephrectomy. Regional anesthesia techniques like the transmuscular quadratus lumborum block (TMQLB) and thoracic paravertebral block (TPVB) have gained attention as part of multimodal analgesia strategies aimed at minimizing opioid use and enhancing recovery. While TPVB is a well-established technique, TMQLB has emerged as a promising alternative due to its ease of administration and potential for broader sensory coverage. This study aimed to compare the analgesic efficacy, opioid-sparing effects, and postoperative recovery outcomes of TMQLB and TPVB in patients undergoing laparoscopic nephrectomy through a prospective randomized controlled trial. Materials and Methods: This prospective, randomized, double-blind, single-center study was conducted to compare the analgesic efficacy and recovery outcomes of transmuscular quadratus lumborum block (TMQLB) and thoracic paravertebral block (TPVB) in laparoscopic nephrectomy patients. A total of 68 participants, aged 17–80 years and classified as ASA I–III, were enrolled and randomized into two groups. All blocks were performed under ultrasound guidance using 0.5% ropivacaine at a dose of 0.4 ml/kg. The primary outcome was 48-hour postoperative cumulative morphine consumption, while secondary outcomes included sensory block dermatomes, intraoperative hemodynamic changes, Numerical Rating Scale (NRS) pain scores, postoperative recovery data, and quality of recovery scores. Data analysis was performed using GraphPad software, with a significance threshold of p < 0.05. Results: A total of 68 patients were randomized into two groups (n=34 each), with 30 patients per group included in the final analysis. Both groups had similar baseline characteristics. Postoperative cumulative morphine consumption was significantly lower in the TPVB group at all time points (p < 0.05), though pain scores were comparable. The postoperative pain NRS at rest and on movement, incidences of side effects, anesthesia-related satisfaction, and quality of recovery scores were similar between the two groups (all P > 0.05). The TMQLB group achieved a broader sensory block (p = 0.002). Intraoperative hemodynamics were stable, with no significant differences between groups. The TMQLB group required more sevoflurane and fentanyl. Postoperative recovery, including gas passing, urination, mobilization, and length of stay, showed no significant differences. Complication rates and quality of recovery were similar, with high patient satisfaction in both groups. Conclusion: The present study demonstrated that transmuscular quadratus lumborum block (TMQLB) provides a comparable postoperative analgesic effect to T10-level thoracic paravertebral block (TPVB), as reflected by similar 48-hour cumulative morphine consumption in patients undergoing laparoscopic partial nephrectomy. TMQLB shows promise as a viable alternative to TPVB in select surgical settings and patient populations, warranting further research to explore its potential applications and benefits.

Background: This study aimed to evaluate the effectiveness of a low dose of hyperbaric ropivacaine administered with and without fentanyl via intrathecal injection in elderly patients undergoing mesh hernioplasty. Method: Eighty patients were randomly assigned to two groups of 40. Group RP received 2ml of 15mg hyperbaric Ropivacaine (0.75%) combined with 0.2ml normal saline (total volume of 2.2ml), while Group RF received 2ml of 15mg hyperbaric Ropivacaine (0.75%)  with 10ug of fentanyl (also total 2.2ml), both administered intrathecally. The onset, duration, quality of sensory-motor block, and any side effects were recorded for both groups. Results: The onset of sensory-motor block was significantly early in the RF group compared to the RS group (p<0.05). In terms of peak sensory dermatome level, 80% of patients in the RF group reached T8, compared to 65% in the RS group. Additionally, the duration of sensory-motor block was significantly longer with prolonged postoperative analgesia in the RF group (p<0.05), with better overall anesthesia quality reported. Both groups maintained hemodynamic stability with no difference in side effect between both group. Conclusion: The findings of our study strongly support the use of a low dose of hyperbaric ropivacaine combined with fentanyl for spinal anesthesia in elderly patients undergoing mesh hernioplasty. This combination offers rapid onset, superior quality of anesthesia, and a lack of side effects, reinforcing its effectiveness in elderly patients.

Background:  Levobupivacaine is an optical isomer of bupivacaine of the amide class and is linked to a decreased risk of toxicity than either the dextro-enantiomer itself or the racemic bupivacaine Levobupivacaine slows the transmission of the action potential in neurons that regulate sensory Aim: The present study aims at finding suitable adjuvant to Levobupivacaine for controlling of post-operative pain under epidural technique in surgical intensive care units of Nalanda Medical College and Hospital, Patna, Bihar, India  Methods: This was a Randomized double blinded controlled trial conducted at Department of Anaesthesia & Intensive Care, for the period of 24 months. However, this study was restricted only to the elective lower limb orthopaedic surgeries. Total number of patients seen at our Institute during the study period was 60 with 30 patients in each group. 60 healthy patients of ASA physical status I and II who undergone lower limb orthopaedic surgery were included in our study. After completion of the surgical procedure patients were shifted to post-operative care unit. They were divided into two groups -Group I and Group II and postoperative analgesia were maintained with the study drug according to the drug schedule: Group I: Received 10 ml injection of Levobupivacaine .125% with .5 mcg/kg Dexmedetomidine via epidural route. Group II: Received 10 ml injection of Levobupivacaine .125% with 1 mcg/kg Fentanyl via epidural route. Results: Observation showed that dexmedetomidine was better adjuvant to levobupivacaine as compared to fentanyl group. Number of top-ups required were significantly greater in fentanyl group in 24 hours. At the end of 24 hours majority of patients with Dexmedetomidine were pain free and satisfied with postoperative analgesia. Degree of complications (respiratory depression, nausea & vomiting) were observed more with the Fentanyl group in comparison to Dexmedetomidine group. Conclusion: In this randomised controlled trial, dexmedetomidine was found to be superior than fentanyl with better post-operative analgesia and less requirement of additional analgesics, less respiratory depression, less incidence of nausea or vomiting, urinary retention and low level of sedation. However, patients in fentanyl were more haemodynamically stable as compared to dexmedetomidine group. In this clinical trial, it can be concluded that the use of dexmedetomidine as an adjuvant to the local anaesthetic agent during epidural block hastens the onset of sensory and motor blockade, provides a longer duration of analgesia, decreases the total analgesic requirement, and is not associated with nausea like fentanyl and tramadol, which cause clinically significant and unmanageable side effects.

Background & Aims: Post-thoracotomy pain in pediatric patients is challenging to manage, affecting postoperative recovery, ventilation, and opioid consumption. Caudal Epidural (CE) has been a traditional approach, but Serratus Anterior Plane Block (SAPB) has gained attention as a viable alternative. This study compares the efficacy, opioid requirements, and safety of SAPB vs. CE in pediatric thoracotomy patients. Methods: This randomized controlled trial was conducted at a tertiary care hospital on 32 pediatric patients (6 months–7 years) undergoing thoracotomy. Patients were randomized into: SAPB Group (n=16): Ultrasound-guided SAPB using 0.125% Bupivacaine (0.4 ml/kg) + Dexmedetomidine (2 μg/kg), CE Group (n=16): Caudal Epidural using 0.125% Bupivacaine (1.25 ml/kg) + Dexmedetomidine (2 μg/kg). Primary Objectives: Total fentanyl consumption (24 hours), Time to first rescue analgesia. Secondary Objectives: Intraoperative fentanyl requirement, FLACC pain scores, Hemodynamic stability & complications Results:  SAPB significantly reduced fentanyl consumption (1.81±0.48 µg/kg) compared to CE (3.38±0.70 µg/kg, p=0.001). Time to first rescue analgesia was prolonged in SAPB (237.88±62.68 min) vs. CE (126.69±20.65 min, p=0.001). No major complications were reported in either group. Conclusion: SAPB is a safe and effective alternative to CE for post-thoracotomy pain in pediatric patients, providing longer-lasting analgesia and reduced opioid consumption.

Opioids have traditionally been central to perioperative analgesia in major abdominal surgeries. However, opioid-related side effects such as respiratory depression, postoperative nausea and vomiting (PONV), ileus, and delayed recovery have prompted exploration of opioid-free anesthesia (OFA) as a safer, equally effective alternative. This study aimed to evaluate the impact of OFA on postoperative recovery outcomes compared to conventional opioid-based anesthesia (OA) in patients undergoing major abdominal surgeries. Materials and Methods: This prospective, comparative, observational study was conducted over six months at the Career Institute of Medical Sciences and Hospital, Lucknow. A total of 80 patients aged 18–65 years, classified as ASA physical status I–III and scheduled for elective major abdominal surgery, were randomized into two groups (n = 40 each): Group A (OFA) received opioid-free anesthesia using agents such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate, while Group B (OA) received standard opioid-based anesthesia with fentanyl. Postoperative pain scores (VAS at 2, 6, 12, and 24 hours), incidence of PONV, time to mobilization, return of bowel function, hospital stay duration, rescue analgesic requirement, and patient satisfaction were assessed. Data were analyzed using SPSS version 25 with a significance threshold of p < 0.05. Results: Baseline characteristics were comparable between groups. The OFA group demonstrated significantly lower postoperative pain scores at all time intervals (VAS at 2 hours: 2.8 ± 1.1 vs. 3.5 ± 1.3; p = 0.02). Time to first mobilization (18.5 ± 4.2 vs. 24.8 ± 5.6 hours; p < 0.01) and return of bowel function (36.2 ± 8.5 vs. 48.7 ± 10.2 hours; p < 0.01) were shorter in the OFA group. Additionally, OFA patients had reduced PONV incidence (15% vs. 35%; p = 0.04), required less rescue analgesia (tramadol 50.5 ± 20.1 mg vs. 80.3 ± 25.4 mg; p < 0.01), had shorter hospital stays (5.2 ± 1.3 vs. 6.5 ± 1.7 days; p < 0.01), and reported higher satisfaction scores (4.3 ± 0.6 vs. 3.8 ± 0.7; p = 0.01). No significant increase in adverse events was observed in the OFA group. Conclusion: Opioid-free anesthesia significantly improves postoperative recovery in major abdominal surgeries by enhancing analgesia, accelerating functional recovery, minimizing opioid-related side effects, and increasing patient satisfaction without compromising safety. OFA represents a promising component of multimodal enhanced recovery pathways and should be considered for broader implementation.

Background: For brachial plexus block, when local anaesthetics are used along with adjuvants result in extension of duration, longer analgesia with lesser side effects. In this study, we have compared effect of Dexmedetomidine and Fentanyl as an adjuvant with Lignocaine and Bupivacaine combination using Peripheral Nerve Stimulator for Supraclavicular block. Material And Method: In tertiary care medical college and hospital, this cross sectional and observational comparative study was conducted in 80 patients who were having elective forearm orthopedic surgeries. Patients were allotted in 2 groups with computer based random method. Same anesthetist has administered Inj. Lignocaine 2% 10 ml + Inj. Bupivacaine 0.5% 20 ml along with Inj. Dexmedetomidine 1µg/kg in Group D and Inj. Fentanyl 1µg/kg in Group F. In both groups, onset and duration of sensory and motor block, hemodynamic and respiratory parameters, sedation score, rescue analgesia and complication were compared. Result: The demographic characteristics of the two groups were not statistically significant.  The mean onset of sensory and motor block was faster in group D (5.5 ± 0.93 min, 7.58 ± 0 .9 mins respectively) compared to Group F (9.83 ± 2.24 mins,15.43 ± 1.96 mins, p < 0.001) . the mean duration of sensory block was longer in Group D (13.60 ± 0.67 hours) compared to Group F (11.14 ± 0.81 hours, p < 0.001) During intraoperative period in 60 to 120 mins, heart rate was lower in Group D (60 to 67 per min) compared to Group F. Mean sedation score was higher , time of rescue analgesia was longer in Group D. Conclusion: Dexmedetomidine shortens the onset time and prolongs the duration of sensory and motor block with better post operative analgesia without any significant side effects compared with Fentanyl when used in an adjuvant to Lignocaine and Bupivacaine combination in Supraclavicular brachial plexus block.

Background: The induction of anaesthesia, laryngoscopy, tracheal intubation and surgical stimulation evoke cardiovascular responses leading to alteration in heart rate, cardiac rhythm and blood pressure. The response starts in 5 seconds, peaks within 1-2 minutes and returns to baseline in 5 minutes. The goal is to compare the effectiveness of Esmolol and Magnesium Sulphate for attenuation of haemodynamic stress response to laryngoscopy and intubation. Materials and Methods: After approval from the ASRAMS Institutional Ethics Committee, the procedure was clearly explained to patients and informed written consent was obtained. The study was conducted during the period, April 2024- March 2025 at ASRAM General and Super-Specialty Hospital, Eluru, Andhra Pradesh. 90 patients of age group 15 to 60 yrs of ASA physical status I and II who underwent elective ENT surgery under general anesthesia were selected and randomly allocated into 3 groups. Baseline heart rate and blood pressure was measured. They were premedicated with Inj. Glycopyrrolate 0.2mg and Inj. Midazolam 0.04mg/kg intramuscular 45 minutes before surgery. Patients were then shifted into the theatre. Inj. Fentanyl 2µg/kg was given 5 minutes before intubation to all patients. They were induced with Inj. Propofol 2mg/kg and Vecuronium 0.1mg/kg. Group M received Inj. Magnesium Sulphate 50mg/kg in 100ml of normal saline infusion over 10 minutes before induction. Group P received 15ml of normal saline 5 minutes before induction. Group E received Esmolol 1.5mg/kg in 15ml normal saline over 15-20 seconds one minute after vecuronium and intubation was done after 2 minutes.  Group P received 15ml of normal saline 5 minutes before induction. The heart rate, systolic and diastolic blood pressure and mean arterial pressure were recorded baseline, after premedication, one min after test drug, after induction, immediately after intubation, thereafter 1, 3 and 5 minutes following intubation. Laryngoscopy duration was noted. Results: 1) Group E showed maximum attenuation of heart rate and blood pressure. 2) Group M also showed significant attenuation of blood pressure response but produced tachycardia on infusion of the drug. Heart rate response was not statistically significant compared to group E. 3) All patients recovered well.  4) Incidence of side effects was not significant between the groups. Conclusion: From this study, it is concluded that hemodynamic changes to laryngoscopy and intubation can be attenuated by giving intravenous Esmolol 1.5mg/kg. Esmolol is effective in blunting the response followed by Magnesium Sulphate which blunts the hypertensive response but produces tachycardia during infusion of the drug. Placebo was ineffective in blunting hemodynamic stress response to laryngoscopy and intubation..

Background: Maxillofacial cancer surgery constitutes a large part of surgical oncology practice in India. The combined utilization of opioids and NSAIDs result in additive or synergistic analgesia by acting through different mechanisms. Present study was aimed to compare the analgesic efficacy between intravenous fentanyl and intravenous fentanyl with diclofenac sodium infusion during mandibular surgeries in a tertiary care cancer centre. Material and Methods: The present study was a Prospective, Randomized Control study conducted in 246 ASA I and II patients aged between 18-65 years, undergoing elective mandibular surgeries under general anaesthesia. Patients were randomly assigned to 2 groups with 123 patients in each group. Group 1 received 100ml normal saline after induction of anaesthesia and Group 2 received Inj. diclofenac sodium 1mg/kg in 100ml normal saline after induction of anaesthesia. Results: The study populations were similar and comparable in terms of demographic parameters such as Age, Gender and ASA physical status. In our study, baseline mean values of heart rate, systolic blood pressure, diastolic blood pressure and Mean Arterial Blood Pressure were comparable. Even though the values of SBP, DBP, MAP in the intraoperative and postoperative period and VAS score in the postoperative period in study group were statistically higher compared to the control group at few time intervals, they were within <20% of the baseline values and <4 for VAS and hence there was no need of any rescue analgesics in the study group both intraoperatively and postoperatively. IV Diclofenac Sodium 1mg/kg when given as an infusion effectively reduced the requirement of Fentanyl as a rescue analgesic when compared to control group. Conclusion: Administration of single dose of intravenous Diclofenac sodium post induction augments the intraoperative as well as postoperative analgesic effect of Fentanyl without any added morbidity in patients subjected to mandibular surgeries.

Background: Aim: The study was conducted to find out the temporal relationship of administration of these two drugs to establish if there exists a significant reduction in required Propofol dose and if it further decreases the associated side effects of Propofol. Methods: This was a randomized prospective clinical study conducted on patients aged >18 and <60 years belonging to American Society of Anaesthesiologists (ASA) status 1 and 2 and undergoing elective oncosurgeries under general anaesthesia. After obtaining approval from the ethics committee, data was collected from patients who were admitted to Kidwai Memorial Institute of Oncology from February 2021 to December 2021.  Results: Most of the study subjects belonged to the age group of 51-60 years (45%). All 3 groups were comparable in terms of mean age and weight. The incidence of hypotension was compared between the 3 groups and it was found that hypotension was seen in the least in Group C with a statistical significance of p=0.048. Requirement of additional Propofol doses was found to be least among subjects of Group C (p<0.00001) which was a highly significant statistical finding. The baseline values between the three groups showed no statistical significance, compared to Group A and B, Group Chad least fluctuation in MAP with statistical significance (p values<0.05). The heart rate (HR) was also found to be comparable between the groups A and B in the induction period.  Conclusion: Our study found that Propofol administered 5 min after administering Fentanyl in a dose of 1 μg/kg was most effective in attenuating the hemodynamic response to laryngoscopy as well as skin incision. We also found that additional doses of Propofol required for induction of anaesthesia was significantly reduced when administered after Fentanyl. There was no significant respiratory depression, bradycardia, oxygen desaturation or respiratory complications in any of the groups. There were no serious complications encountered in our study.

Introduction: Awake fibreoptic intubation (AFOI) is a preferred method for managing anticipated difficult airways, particularly in patients with anatomical or physiological challenges. Sedation plays a critical role in ensuring patient comfort and procedural success, without compromising respiratory or cardiovascular stability. While midazolam-fentanyl is a commonly used sedative combination, dexmedetomidine has gained interest due to its sedative and sympatholytic properties with minimal respiratory depression. Aims and Objectives: This study aimed to compare dexmedetomidine versus midazolam-fentanyl for (1) hemodynamic stability, (2) sedation level, and (3) ease and comfort of intubation during AFOI. Materials and Methods: In this prospective, double-blinded, randomized study, 60 ASA I–II patients undergoing elective head and neck surgery were divided into two groups: Group D (dexmedetomidine 1 µg/kg loading + 0.7 µg/kg/hr infusion) and Group FM (fentanyl 2 µg/kg + midazolam 40 µg/kg over 10 minutes). Ramsay Sedation Scores, intubation time, COMFORT scale, and hemodynamic parameters were recorded and compared. Statistical analysis was conducted using t-tests and chi-square tests. Results: Group D had significantly better hemodynamic stability (p<0.001), shorter intubation time (15.4 vs. 20.6 seconds, p<0.001), and lower COMFORT scores indicating greater patient comfort (10.0 vs. 15.87, p<0.001). Sedation levels were also deeper in Group D (Ramsay score 2.87 vs. 1.70, p<0.001). Complication rates were similar across groups. Conclusion: Dexmedetomidine offers superior sedation, enhanced comfort, and better hemodynamic control compared to fentanyl-midazolam during AFOI, supporting its use as the preferred sedative agent in anticipated difficult airway management.