Background: Adductor canal block is a new and promising approach for providing postoperative pain relief in arthroscopic knee surgery. Aim: The aim is to compare the postoperative analgesic efficacy of adductor canal block and intravenous (i.v.) diclofenac in patients undergoing knee arthroscopic surgeries. Set and Design: This was a prospective, randomized double-blinded comparative study comprising 60 American Society of Anesthesiologists Physical status Classes I and II patients posted for unilateral knee arthroscopic surgery. Materials and Methods: Patients were randomized into two groups of 30 patients each. Patients were given general anaesthesia with fentanyl, propofol, and vecuronium. Ultrasound (USG) guided adductor canal block with 30 ml of 0.5% ropivacaine was given in Group A patients and patients in Group B received i.v. diclofenac before extubation. After adequate recovery, patients were shifted to postanesthetic care unit. Visual Analogue Scale score was assessed at rest, on standing and on walking 3 m. Statistical Analysis: Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever is appropriate, was applied for comparing categorical variables. Results: The mean duration of analgesia was longer in Group A as compared to Group B and mean consumption of rescue analgesic was lower in Group A. Both were statistically significant. No significant postoperative complications or local side effects related to the block were noted. Conclusions: Adductor canal block provides a longer duration of postoperative analgesia promotes early mobilization and has a good safety profile in unilateral knee arthroscopic surgeries.

Background: Caudal epidural block combined with general anesthesia remains a popular choice of anesthesia for both supraumbilical and infraumbilical surgeries. More recently transversus abdominis plane block performed under ultrasound guidance is being described as an effective technique for postoperative analgesia for lower abdominal surgeries. The present study aims to compare the efficacy of ultrasound –guided TAP block and caudal epidural for paediatric infraumbilical surgeries. Aims and Objectives: To compare the duration and efficacy of postoperative pain relief between TAP block and caudal epidural block in children undergoing lower abdominal surgeries. Methods: Fifty children of age group 2-7 years undergoing lower abdominal surgeries were randomized to groups T and C. All patients were given general anesthesia as per standardized anesthesia protocol. Group T were given ultrasound guided TAP block with 0.5 ml.kg-1 of 0.2% Ropivacaine. Group C were given 1 ml.kg-1 of 0.2% ropivacaine as caudal block. All the children were assessed using FLACC scale. Their vitals, pain scores, duration of postoperative analgesia and requirement of supplemental analgesics were noted. Results: Rescue analgesic requirement was significantly less in Group T compared to Group C. Mean postoperative analgesia time was significantly more in Group T (342 mins) as compared to Group C (198 mins). Conclusion: Ultrasound guided TAP block provides better postoperative analgesia after loer abdominal surgeries in children.

Context: Propofol induction is associated with hypotension due to changes in intravascular volume, tone of vessels and cardiac output. Plethysmograph variability index (PVI) and perfusion index (PI) are derived indices from pulse oximeter, used for assessing fluid responsiveness and vessel tone, respectively. We studied the utility of these indices in predicting hypotension due to propofol. Aims: The aim of the study is to test the baseline cutoff values of PVI > 15% and PI <1.05 in predicting hypotension with propofol induction. Settings and Design: This is a prospective double-blind observational study in tertiary care hospital. Methods: Institutional ethical committee approval was obtained. 106 surgical in-patients as per inclusion and exclusion criteria were randomly allotted by computer-generated random numbers. All patients were nil by mouth for 6 h. Injection midazolam and fentanyl were used as premedicants. Propofol at dose of 2 mg.kg⁻¹ was used for induction. Masimo Radical 7^® monitor was used for recording of PVI and PI from the upper limb. Baseline values of PVI and PI were recorded every minute from preinduction period till intubation. Standard monitors of noninvasive blood pressure, pulse oximeter, and electrocardiography were used. As per the occurrence of hypotension, patients were grouped as Group H (hypotension) and Group NH (no hypotension). Statistical Analysis: Data were analyzed with SPSS version 20. Quantitative data were analyzed using mean, standard deviation, interquartile range as per distribution. Shapiro–Wilk test with P < 0001 was used descriptive parameters. Scatter plot and Spearman correlation were used to find correlation between the two variables. Mann–Whitney U test was used to compare the two groups in terms of PVI and PI at different time points. Receiver operator characteristic curve was plotted for PI and PVI against hypotension, and cutoff value was calculated. Sensitivity, specificity, positive predictive value, negative value, and diagnostic accuracy of PI and PVI were calculated. P <0.05 was considered statistically significant. Results: Eighty-one patients (76.4%) who had hypotension were grouped into Group H and 25 patients (23.6%) without hypotension as Group NH. There was no difference between groups with respect to doses of midazolam (P = 0.28), fentanyl (P = 0.54), and propofol (P = 0.28). Baseline cutoff of PVI >15 had sensitivity of 58% and specificity of 56%, respectively. PI cutoff value of < 1.05 had sensitivity of 30.9% and specificity of 48%. The risk ratio of PVI cutoff and PI cutoff were 1.41 and 0.43, respectively. There was poor agreement between mean arterial blood pressure (MAP) estimation and prediction of hypotension by PVI (Cohen's kappa = 0.106, P = 0.218) and PI values (Cohen's kappa = −0.133, P = 0.054). Area under the receiver operator curve was 0.596 and 0.511 for PVI >15% and PI < 1.05, respectively. New cutoff values PVI >17.5% and PI > 0.76 were found. PVI and PI had poor diagnostic performance. There was no significant correlation of PVI and PI with hemodynamic variables such as heart rate, MAP, SBP, DBP, and PP. Conclusion: Baseline values of PVI >15% and PI < 1.05 are not good tools for predicting hypotension with propofol induction. New values of baseline cutoff of PVI >17.5% have high specificity, and PI > 0.76 has high sensitivity and positive predictive value.

Background: Recent studies have supported the use of quadratus lumborum block (QLB) for postoperative analgesia for patients undergoing renal surgery. Aims: The aim was to study the efficacy of posterior QLB for postoperative analgesia in patients undergoing percutaneous nephrolithotomy (PCNL). Settings and Design: This trial was a hospital-based, randomized, double-blind, controlled, prospective study. Materials and Methods: Forty patients aged from 18 to 60 years, belonging to the American Society of Anesthesiologists physical status I–III and scheduled for unilateral PCNL under spinal anesthesia were administered ultrasound-guided posterior QLB with 30 ml of either 0.2% ropivacaine (Group Q) or normal saline (Group C) after the subarachnoid block. Duration of analgesia was the primary outcome variable. Statistical Analysis Used: Data were compiled in Microsoft Excel, and analyses were performed in SPSS (version 24.0.0.0; IBM, Armonk, New York, USA). Unpaired t-test, Mann–Whitney U test, and Fisher's exact test were used for the comparison of continuous, ordinal, and categorical data, respectively. Results: Duration of analgesia was significantly longer in Group Q (1167.10 ± 89.74 vs. 290.25 ± 47.38 min), as compared to Group C. Except at the end of the surgery, visual analog scale at rest and on movement was significantly lower till 20^th h in Group Q. Patient satisfaction was better, and analgesic consumption was lower in Group Q. Side effects were similar in both groups. Conclusions: QLB provides good quality, and prolonged duration of postoperative analgesia compared to placebo for PCNL, but more large-scale studies are needed to recommend it for routine use.

Background and Aim: Bilevel positive airway pressure (BIPAP) is emerging as a useful modality in prevention as well as the management of postoperative respiratory dysfunction in patients undergoing coronary artery bypass graft (CABG). Materials and Methods: A total of 50 patients who underwent CABG were managed using BIPAP during postoperative period. Acid–base gas parameters, electrolyte levels, respiratory and hemodynamic parameters, and 24 h urine output before and after BIPAP application were measured. Data were analyzed using SPSS 21.0 version. Paired “t”-test was used to compare the changes in different parameters. Results: The mean age of patients was 57.72 ± 9.67 years (range: 36–85 years), majority were males (84%). Mean body mass index and mean left ventricular ejection fraction of patients were 24.26 ± 3.74 kg.m ⁻² and 52.77 ± 10.26%, respectively. Mean pO₂, pCO_2, and respiratory rate before BIPAP application were 90.62 ± 12.90 torr, 40.26 ± 5.39 torr, and 25.64 ± 6.21/min, respectively, which became 158.52 ± 50.43 torr, 37.77 ± 6.98 torr, and 21.78 ± 4.79/min, respectively, after BIPAP application, thus showing a significant change (P < 0.05). No significant change in other parameters was observed. No other adverse effect was noted. Conclusion: BIPAP application helped in improving ventilatory parameters without any adverse impact on hemodynamics and other parameters. Its application was a safe method to prevent respiratory disturbances following cardiac surgery.

Background: ProSeal insertion is usually more time-consuming with lower first-attempt success. Aim of the Study: We aimed to compare the incidence of successful placement of ProSeal laryngeal mask airway (PLMA) in the first attempt by railroading it over soft gum-elastic bougie introduced into esophagus versus traditional digital insertion technique. Time taken and ease of securing airway, associated hemodynamic responses, and trauma were also assessed. Settings and Design: This was a prospective randomized study conducted in a tertiary care institute. Subjects and Methods: Forty patients were recruited into two groups. Following induction in Group P, PLMA was introduced using digital technique, whereas in Group B, a soft gum-elastic bougie was introduced into esophagus and then PLMA was railroaded over the bougie. Correct placement was confirmed with end-tidal carbon dioxide waveform. Statistical Tests Used: Fisher's exact test and independent samples t-test were used for statistical analysis. Results: Successful first-attempt insertion was significantly higher in Group B compared to Group P (100% vs. 70%). Percentage of easy insertion was also significantly higher in Group B (95% vs. 65%). Time taken to insert ProSeal was significantly shorter in Group B (30.8 ± 7.8 vs. 59.5 ± 44.6 s). No patient in Group B had blood-stained secretion versus 70% in Group P. Mean arterial pressures at and after ProSeal insertion were significantly higher in Group P. However, heart rate remained comparable in both the groups. Conclusion: Bougie-guided ProSeal insertions had significantly higher first-attempt insertion success rates and were significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

Introduction: Various adjuvants to local anesthetics are used in spinal anesthesia for improving the quality and prolonging postoperative analgesia. We aim to compare the analgesic efficacy of morphine or dexmedetomidine given intrathecally as adjuvants to isobaric levobupivacaine. Materials and Methods: Seventy patients of age group 18–60 years, American Society of Anesthesiologists 1 and 2 undergoing elective abdominal hysterectomy, were randomized into two groups. Group M received spinal anesthesia with 3 mL of 0.5% isobaric levobupivacaine with 250 μg of preservative-free morphine. Group D received 3 mL of 0.5% isobaric levobupivacaine with 5 μg of dexmedetomidine. Quality of anesthesia, sensory and motor block characteristics, duration of effective analgesia, and incidence of side effects were compared. Results: The time for the first analgesic request was 320.80 ± 41.75 min in the dexmedetomidine group as compared to the morphine group (451.63 ± 38.55 min), P = 0.000. The analgesic requirement in the first 24 h was significantly higher in Group D as compared to Group M, P = 0.000. Adverse effects were similar in both the groups, except pruritus which was seen only in Group M. Conclusion: Our study shows that the use of intrathecal morphine as an adjuvant to isobaric levobupivacaine provides better analgesia than intrathecal dexmedetomidine; however, adverse effects such as nausea and pruritus may be seen.

Background: Liver produces most of the blood coagulation factors, so it is not surprising to see a deranged coagulation profile in patients receiving liver transplants. Besides standard laboratory methods to evaluate coagulation profile, point-of-care assays are being used regularly since their results are rapidly available. However, sparse information is available on the comparability of point-of-care coagulation assays with laboratory coagulation assays in this special setting. In this study, our aim is to observe the changing hemostatic profile during different stages of liver transplant surgery using laboratory-based tests and thromboelastography (TEG). Methods: Fifty patients undergoing living donor liver transplantation surgery were selected. Coagulation tests (prothrombin time [PT], activated partial thromboplastin time [APTT], platelet count, and fibrinogen) and TEG were performed at various intervals during liver transplant surgeries – before induction of anesthesia, 2 h into dissection phase, 30 min into anhepatic phase, 30 min after reperfusion of homograft, postoperative – at closure of surgery, 12 h postoperative, and 24 h postoperative. Statistical analysis and Pearson correlation were performed between laboratory-based coagulation tests and TEG, and their pattern through various stages of the surgery analyzed. Results: Platelet count and fibrinogen have a significant positive correlation with TEG in almost all phases of liver transplant. PT and APTT have a positive correlation with TEG until uptake of new liver and predominantly negative correlation after that. However, this correlation is significant only before induction of anesthesia and anhepatic phase. Conclusions: TEG can be used to estimate platelet count and fibrinogen concentrations in all phases but PT and APTT only before induction and anhepatic phase of liver transplant surgery. The decision regarding transfusion of blood products should be based on a combination of the clinical assessment of surgeon and anesthesia personnel combined with results from laboratory and TEG.

Background: Volume deficit is one of the predictors of hypotension. Inferior venacaval collapsibility index (IVCCI) can detect volume deficit and aids volume resuscitation in patients of intensive care unit. Aims: The primary aim was to compare the incidence of postspinal anesthesia hypotension (PSAH) in IVCCI measured and nonmeasured groups. The secondary aim was to determine IVCCI association with PSAH within IVCCI measured group in spite of fluid bolus. Settings and Designs: This was a prospective, randomized, controlled, single-blinded study. Methodology: One hundred patients posted for orthopedic surgery under spinal anesthesia (SA) were randomly divided as IVCCI measured (CI) and non-IVCCI measured (NCI) groups before SA. If IVCCI was more than 40% fluid bolus was given. Intraoperative hemodynamics was monitored. PSAH managed with fluids and vasopressors which were noted. Data collected were analyzed with unpaired t-test, Z-test, logistic regression test, and Pearson's correlation. Results: PSAH incidence was 18% in group (CI) whereas 38% in group (NCI), and the difference was statistically significant. Vasopressors given were higher in group NCI. Perioperative fluids were more in group CI, but the intraoperative fluids were more in group NCI. There was no statistically significant association between PSAH after fluid preloading and IVCCI within the IVCCI measured group. Conclusion: Prespinal anesthesia evaluation of IVCCI to optimize fluid therapy can reduce the incidence of PSAH in orthopedic surgeries and the vasopressor requirement, and hence, the association of IVCCI of more than 40% with PSAH.

Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by using several techniques such as intravenous analgesia, epidural analgesia, and peripheral nerve blocks that include femoral nerve and saphenous nerve. Several authors recommended intra-articular injection of local anesthetic (IALA) as a part of multimodal analgesia regimens for TKA instead of other techniques. Aims: The present study compares IALA technique efficacy with single-shot femoral nerve block (FNB) as part of multimodal analgesia regimen in TKA patients for postoperative pain management. Setting and Design: Perioperative care, randomized double-blind comparative study. Subjects and Methods: We recruited a total of 60 patients scheduled for unilateral total knee replacement under spinal anesthesia. Subjects were allocated randomly into two groups FNB and IALA receiving ultrasound-guided FNB and Intra-articular local anesthesia and morphine mix infiltration, respectively. Twenty-four hour postoperative morphine consumption through patient-controlled analgesia was the primary outcome measure in our study. Secondary outcome measures were pain scores, nausea and vomiting. Statistical Analysis: Chi-square test, Mann–Whitney test. Results: The amount of morphine consumed at the end of 24 h was noted to be higher in IALA group as compared to FNB (FNB − 16.03 ± 9.37 mgs; IALA − 23.60 ± 13.73 mgs P = 0.03). Visual analog score at 24 h with knee flexion was better in FNB group (FNB − 1.27 ± 1.43; IALA 2.42 ± 2.54, P = 0.04). Conclusion: FNB technique provides better analgesia in comparison to IALA for postoperative pain management in terms of PCA morphine consumption.

Background: Awake fiber-optic bronchoscopy-guided intubation is the method of choice in difficult airway which requires effective airway anesthesia to ensure patient comfort and acceptance. Aims: This study was conducted to assess the quality of airway anesthesia, patient comfort during intubation, and postoperative satisfaction of patients. Settings: Patients posted for surgeries under general anesthesia with Mallampati Grade I and II in a medical college. Patients were followed in the operation theater and postoperative ward. Study Design: This was a prospective randomized single-blind study. Materials and Methods: Group D received intravenous (i.v.) dexmedetomidine 1 μg.kg⁻¹ i.v. over 10 min and 3 ml of 4% lignocaine spray as you go (SAYGo). Group F received i.v. fentanyl 2 μg.kg⁻¹ over 10 min and transtracheal injection 3 ml of 4% lignocaine. Parameters assessed were endoscopic time, intubating condition, vocal cord position, cough severity, comfort during intubation, postoperative patient satisfaction, and any adverse effects such as sore throat, hoarseness, unpleasant memories, and hemodynamic response during intubation. Statistical Analysis: Independent Student's t-test, Mann–Whitney, Chi-squared test, or Fisher's exact test were used. P ≤ 0.05 was considered statistically significant. Results: Intubating conditions, vocal cord position, cough severity, comfort during intubation, and postoperative patient satisfaction were statistically significant (P ≤ 0.05) in favor of Group D though endoscopic time was longer. Conclusion: IV dexmedetomidine with SAYGo is effective than IV fentanyl with transtracheal block for awake fiber-optic videoscopic intubation in terms of intubating conditions, vocal cord position, cough severity, comfort during intubation, and postoperative satisfaction of patients with significant attenuation of postintubation hemodynamic response and better preservation of respiration though endoscopic time is more.

Background: Open inguinal hernia repair is one of the routine day-care procedures performed across the world. A multitude of anesthetic techniques have been outlined for painless inguinal hernia repair, comprising general anesthesia and regional anesthesia such as spinal, epidural, and nerve blocks; with regional anesthetic techniques often favored for uncomplicated open inguinal hernia repair. Ultrasound-guided peripheral nerve blocks have made rapid strides and are gaining popularity because of the reduced incidence of adverse events. Aims: We aim to compare the efficacy of two regional anesthesia techniques to compare the adequacy of surgical anesthesia and their efficacy to ease postoperative pain with least potential side effects. Settings and Design: This prospective, interventional, single-centric, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was registered with the Clinical Trial Registry of India (CTRI/2021/04/033109). It was conducted after obtaining written informed consent from all patients and approval from the institutional review board. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status classes I/II, in the age group of 18–60 years of either sex, scheduled for elective open inguinal hernia repair, were enrolled into two groups of 30 patients each according to the anesthetic technique used. Group T comprised patients receiving ultrasound-guided transversus abdominis plane block (TAP block), whereas the Group S comprised patients administered spinal anesthesia for elective open inguinal hernia repair. The primary end points of this study were to assess the adequacy of surgical anesthesia and duration of postoperative analgesia, whereas the secondary end points included assessment of patients' hemodynamic profile post institution of the block and comparing the incidence of adverse events associated with the two techniques. Statistical Analysis: SPSS version 20.0 was used for analysis. Frequency, mean distribution, standard deviation, Chi Square test and student t Test were calculated to p value. P < 0.05 was considered statistically significant. Continuous variables were expressed as mean + SD, whereas categorical variables were expressed as absolute numbers and percentages. Intergroup nominal categorical data were compared by Chi-square test. Results: The visual analog scale score was found significantly lower in Group T at all time points except immediate postsurgery (3, 6, 12, 24, and 48 h) as compared to Group S (0.357 ± 0.4880 vs. 1.393 ± 1.8527; P = 0.006, 1.393 ± 0.4973 vs. 2.893 ± 2.3148; P = 0.001, 2.429 ± 0.9201 vs. 3.321 ± 2.0377; P = 0.039, 1.214 ± 0.4179 vs. 2.286 ± 1.9217; P = 0.006, and 1.143 ± 0.3563 vs. 1.643 ± 1.5685; P = 0.106, respectively), and the duration of postoperative analgesia was highly significant (P < 0.001) in Group T (724.00 ± 103.2914 min) as compared to Group S (256.643 ± 73.4218 min). Difference in the number of rescue analgesics administered over the first 24 and 24–48 h was significantly higher in the spinal group which comprised patients administered with the TAP block. Conclusion: Ultrasound-guided TAP block provides better intra-operative and postoperative analgesia as compared to subarachnoid block especially in respiratory and cardiovascular cripples without any significant adverse events and hemodynamic changes.

Background: Intraoperative fluid strategy may affect the graft viability in head-and-neck surgeries with free flap reconstruction (HNS-FFR). Studies to guide regarding association of intraoperative fluid with metabolic parameters during such surgeries are infrequent. Aim: This study aimed to compare plasmalyte (PL) and normal saline (NS) (0.9%) in terms of acid–base balance and electrolytes in the peri-operative period along with graft viability during above-mentioned surgeries. Settings and Design: Prospective, observational cohort study was conducted in patients, 18–65 years, undergoing HNS-FFR at a tertiary care center. Materials and Methods: The cohort was categorized into two groups based on the intraoperative fluid used, i.e., PL (Group A) and NS (Group B) group. The primary objective was to compare arterial blood gas parameters at seven time points till the 3^rd postoperative day. We studied the effect on graft viability and length of hospital stay. Statistical Analysis Used: The independent t-tests, Chi-square, or Fisher's exact test were used to evaluate the categorical variables with a repeated measures analysis of variance for inter-group comparison with P < 0.05 as significant. Results: Seventy-one (36 in Group A and 35 in Group B) patients were included in the study with comparable baseline characteristics. Group A had a better acid–base status, especially after the conclusion of vascular anastomosis (pH 7.37 ± 0.06 vs. 7.33 ± 0.04, P = 0.014) and in the postoperative period (pH 7.35 ± 0.07 vs. 7.31 ± 0.05, P = 0.013). No statistically significant difference was observed in outcome parameters between the groups. Conclusions: PL may be preferred over NS due to better metabolic milieu during HNS-FFR surgery.

Background: The incidence of postoperative recall under total intravenous anesthesia (TIVA) is not yet fully established. Avoidance of inhalational agent is a known risk factor for awareness. In addition, lack of reliable technique to monitor drug concentration needed for adequate depth of anesthesia makes TIVA challenging. Hence, we intend to evaluate our standard anesthesia practice for postoperative recall. Methodology: This questionnaire-based observational study was done over the period of 2 years. We enrolled 1080 adult (American Society of Anesthesiologists physical status Class I or II) patients undergoing TIVA for Endoscopic retrograde cholangiopancreatography (ERCP). All patients received fentanyl, midazolam and propofol-based anesthesia. Manual boluses of propofol were given to achieve adequate sedation. (Ramsay sedation scale of 5) in accordance with clinical signs as judged by the primary anesthesiologist. Postoperatively within 12–24 h, patients were assessed for recall using Brice questionnaire. Primary outcome was number of patients reporting postoperative recall in the Brice interview. Secondary outcome was the incidence of dreaming. Results: On postoperative interview, none of the patients reported awareness. 12.5% of patients had dreams which were pleasant. None of the dreams was unpleasant. The worst thing about surgery was pain. Conclusion: Our study suggests that if adequate doses of propofol are adhered to and necessary action is taken against responses indicating wakefulness, postoperative recall under TIVA is an uncommon occurrence.

Background: Labor pain is one of the most intense pains that a woman experiences. Almost 60% of primiparous women described the pain of uterine contractions as unbearable extremely severe or excruciating. Aims: Our study aimed to relieve pain suffering of mother and to decrease fetal acidosis to make the delivery process safer for mother and baby. Settings and Design: Thus, epidural labor analgesia was designed comparing ropivacaine-fentanyl (RF) and bupivacaine-fentanyl (BF) as intermittent bolus technique. Materials and Methods: Sixty women who requested epidural analgesia having ≥3 cm cervical dilatation were allocated in two groups, one group received RF and the other group received BF. Each group received study drug 16 mL with 50 μg fentanyl and top of 10 mL and 25 μg fentanyl when visual analog scale (VAS) ≥3. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes were compared. Statistical Analysis: For skewed data or ordered categorical data, nonparametric Mann–Whitney U-test was used for statistical analysis of two groups. For categorical data, comparisons were made by Pearson's Chi-square test or Fisher's exact test as appropriate (%). Results: Both groups were comparable in terms of demographic data and obstetric and neonatal parameters at the onset of labor Comparison of heart rate, systolic blood pressure (BP), diastolic BP, and saturation between Group RF and Group BF. It was found statistically not significant. VAS score before the epidural study drug was given, was 5 (4–5) in RF group, and was 5 (3–6) in BF group, and after 1 min, VAS score was 1 in both the groups thereafter. The score remained zero till at 100 min in both the groups till the time when the top-up dose was given. Bearing down reflex was present in all the patients as judged by the obstetrician. It was sluggish in 20% of patients in Group RF as compared to 10% in Group BF. Conclusions: From clinical and safety perspective, both RF and BF were reasonable choice for labor analgesia.

Background: Total knee replacement (TKR) surgeries are associated with significant postoperative pain. Ultrasound-guided adductor canal block is associated with better pain scores. The addition of Clonidine and Dexmedetomidine as additives to local anesthetics was the recent focus of interest. However, there are minimal studies comparing the duration of analgesia as additives to Ropivacaine in ultrasound-guided adductor canal block for TKRs. Materials and Methods: Prospective, randomized, double-blind design was followed. One hundred and two American Society of Anesthesiologists I to III patients undergoing unilateral TKR surgeries were included in the study and randomized into two groups. Group C received Clonidine 150 mcg and Group D received Dexmedetomidine 100 mcg as an add on to 30 mL of 0.2% ropivacaine for adductor canal block. Postoperatively, duration of analgesia, sedation score, rescue analgesic requirement, hemodynamics, and any other adverse effects were monitored. Results: The total duration of analgesia in Group D (16.01 h [standard deviation [S. D]-0.5]) was significantly higher as compared to Group C (13.02 h [S. D-0.5]) (P < 0.0001). The numerical rating score (NRS) was significantly lower in Group D compared to Group C (P < 0.05) at multiple postoperative timelines. Group D (2.25(S. D-0.44)) had better sedation scores as compared to Group C (2 [S. D-0]) (P = 0.001). Conclusion: Dexmedetomidine has longer duration, lower pain, and better sedation scores as compared to clonidine in adductor canal blocks for postoperative pain relief in TKR surgeries.

Cochlear implants are expensive surgeries. It was expected that by the end of the year 2021 about 80,000 cochlear implants will be shipped worldwide. Alone in India 500 cochlear implants are placed in a year. Patients for these procedures are mostly young children with prelingual deafness. They often pose challenges like anxiety, post operative nausea and vomiting, haemorrhage and CSF leak or flap necrosis. Parent child separation is another concern in a deaf paediatric patient. A meticulous anaesthetic management provides comfortable induction and a stable intra operative hemodynamics to give favourable outcomes.