Background: Spinal anesthesia has always had problems with the timing of the onset and the length of the motor and sensory block. By combining local anesthetics with an adjuvant, one can lengthen the block's effect and lessen its side effects. In this study, patients undergoing elective infra-umbilical surgeries were given 25mcg/50mcg of neostigmine in addition to bupivacaine and the efficacy was studied. Aims: The assessment and comparison of: Onset of the Sensory Blockade Duration of the Sensory Blockade, Onset of the motor blockade, Duration of the motor blockade, Adverse effects. Materials and Methods: About 60 patients scheduled for elective infra-umbilical surgeries under spinal anesthesia were enrolled in our study. One of the three groups (each with 20 patients) was randomly assigned to patients: Group BS: Hyperbaric 0.5% Bupivacaine 3ml+0.5mL Normal Saline, Group BN 25: Hyperbaric 0.5% Bupivacaine 3mL+25mcg Neostigmine (0.5 mL), Group BN 50: Hyperbaric 0.5% Bupivacaine 3mL+50mcg Neostigmine (0.5 mL). The onset of anesthesia, duration of postoperative analgesia, time to use first rescue analgesia, overall, 24-hr VAS pain scores, are recorded for 24-hr post drug administration. Intra operative and postoperative blood pressure, heart rate, oxygen saturation, incidence of adverse effects and the total amount of analgesic consumed in overall 24-hr were recorded. Results: The duration of sensory and motor block was significantly prolonged with addition of 25mcg/50 mcg neostigmine to Bupivacaine for patients undergoing infra-umbilical surgeries under spinal anesthesia. It might cause a delay in attaining the discharge criteria in day care surgeries and there was a dose-dependent increase in the severity of nausea, vomiting with the highest PONV score in the group of patients who received 50mcg of neostigmine along with Bupivacaine intrathecally. Conclusion: Intrathecally administered doses of 25mcg or 50mcg neostigmine and Bupivacaine increased the duration of sensory and motor block, reduced the need for rescue analgesia and delayed postoperative pain for 5–6hours.Hense we recommend the addition of 25mcg of Neostigmine to Bupivacaine for Spinal anesthesia with minimal adverse effects.

Introduction: Laryngoscopy and tracheal intubation is a noxious stimulus, leading to a marked sympathetic response. Patients with cardiovascular or cerebral disease are at increased risk. Various drugs and laryngoscopy methods are used to effectively attenuate this response. The aim of the study was comparing the clinical efficiency in attenuation of hemodynamic response provided by Tab pregabalin 200mg given 2 hours pre-emptively with that of IV lignocaine given 90 seconds prior to intubation and to study the side effects of the drug if any.  Materials and Methods: After Ethical Committee Clearence from the institute and written informed consent. 30 patients, aged 18–60years, ASA grade I and II, of both genders were randomized into two groups of 15 each. Group I received Tab pregabalin 200mg 2 hours prior to surgery, Group II received Inj lignocaine 1.5mg/kg IV 90 seconds prior to intubation. Anaesthetic technique was standardized to both the groups. The statistical software namely SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. Hemodynamic parameters were observed at baseline, pre-induction and 1,2,4,6,8,10 and 15 minutes after laryngoscopy and intubation along with sedation score and post-operative side effects. Results: The mean basal and pre-induction heart rate, systolic, diastolic and mean arterial pressure was comparable between 2 groups (p-value >0.05). The patients had significant attenuation in heart rate with (p-value <0.05) at 1,2,4,6, and (p-value <0.01) at 8,10,15 minutes in pregabalin group compared to lignocaine group, systolic, diastolic and mean arterial pressures were too significantly lower at 1,2,4,6,8,10 and 15minutes in pregabalin group. Conclusion: Pregabalin 200mg as premedication is more effective in attenuating hemodynamic response to laryngoscopy compared to IV lignocaine with no significant side effects.

Introduction: This study aims to evaluate the safety and the efficacy of Nalbuphine with fentanyl as an intrathecal adjuvant to hyperbaric bupivacaine. The objective to study the onset and duration of sensory blockage; time to two segment regression; hemodynamic changes. Materials and Methods: Two groups of thirty ASA Gr I and II patients of either gender were randomly assigned. Group I patients will get 0.8 mg (1 mL) of nalbuphine and 12.5 mg (2.5 mL) of 0.5 percent hyperbaric bupivacaine. Group II patients will receive 12.5 mg and 25 μg of Fentanyl (1 mL). Hemodynamics, sensory and motor block, early postoperative analgesia and side effects were examined. The study included 18–55-year-old male and female patients. The study excluded patients with cardiac arrhythmias, heart blocks, or bradycardia; a known allergy to the test drug; a gross spinal abnormality, localized skin sepsis, haemorrhagic diathesis, neurological involvement/diseases; head injuries or raised intracranial pressure; and hemodynamic instability. Results: Number of rescue analgesia in 24 hrs was significantly less needed among Hyperbaric bupivacaine with nalbuphine group. Systolic blood pressure fluctuation was high among hyperbaric bupivacaine with fentanyl than Hyperbaric bupivacaine with nalbuphine group. Diastolic blood pressure fluctuation was relatively greater among hyperbaric bupivacaine with fentanyl than nalbuphine group. SPO2 saturation fluctuation was almost similar in both the groups. The fluctuation between the groups was not statistically significant. Among hyperbaric bupivacaine with nalbuphine group 4 reported sedation and two reported nauseas. Among hyperbaric bupivacaine with fentanyl group two had chest pain. Conclusion: In this clinical study, nalbuphine added to hyperbaric bupivacaine at 0.5 percent was more efficient than fentanyl at enhancing postoperative analgesia and extending sensory motor blockade without increasing unpleasant effects.