ABSTRACT
Introduction: Tonsillectomy is one of the most commonly performed procedures in Otolaryngology. Nowadays tonsillectomy is carried out more as a day care surgery and this trend is increasing, Discharge from day case surgery may not be possible in some of the patients.The factors responsible for this include post-tonsillectomy pain, Bupivacaine when used topically for post tonsillectomy pain relief in children, has been shown to be safe with no complications. This study aims to determine effective dose of 0.5% bupivacaine and 0.25% Bupivacaine topically applied in reducing post tonsillectomy pain. Material and methods: This is a prospective randomized, double blind study of sixty patients ASA I and II patients aged between 5 to 12 years scheduled for ambulatory tonsillectomy. Anaesthesia was standardized for all patients fentanyl 1µ/kg was used as intra operative analgesia, patients were randomized into group A, who received 0.5% Bupivacaine and group B received 0.25% Bupivacaine both solutions were prepared and labeled by the research assistant who is in custody of the envelopes. After haemostasis was achieved, group A patients had both sides of their tonsillar fossae tightly packed for 5 minutes with a standard gauze of 10cm dimension folded twice to make it 2.5 by 2.5cm and fully soaked with 5ml of 0.5% bupivacaine. Group B patients received 5mls of 0.25% of bupivacaine soaked gauze was applied for 5 minutes as applied in group A. In both groups both the patients/parents or guardian and the researcher were blinded to the agent being used. Results: There was significant reduction in pain intensity among patients that received topical application of 0.5% bupivacaine 1.46(±1.17) & 2.80(±0.81) compare to those received 0.25% bupivacaine 3.16(±1.38) & 3.02(±1.62), time to first analgesic request (TFA) was longer in group A 8.84 (3.24) hours, when compared to group B which had a mean duration of 6.72(1.56) hours, with a p-value of 0.036. The cumulative dose of paracetamo

ABSTRACT
Introduction: Surgery is a stressful situation which affects the metabolic and hormonal changes. Apart from surgical stress, anesthesia related procedures like Tracheal intubation, recovery from anesthesia, and post-operative pain can increase the stress induced hormonal changes. This study aims to find out the pattern of postoperative blood glucose response among non-diabetes patients receiving either general anesthesia or spinal anesthesia for their surgeries. Materials & Methods: An institution based, observational, cross-sectional study was conducted among 147 non diabetes patients who received either general or spinal anesthesia for their surgery. Data was analyzed using SPSS, version 20.0 for windows. Chi-Square test was used to show association between categorical variables and independent sample t-test was used to show mean difference among normally distributed continuous variables. All statistical tests were 2-tailed and a p-value of <0.05 was considered significant. Results: 66.0% of study population received general anesthesia and 34.0% received spinal anesthesia. In postoperative period, 41.5% of study population had their plasma glucose in pre diabetes range and 20.4% had their plasma glucose in diabetes range. Frequency of postoperative hyperglycemia (IFG + Diabetes) was 61.9%. Mean postoperative plasma glucose was significantly higher among study population who received general anesthesia. Increasing age, female gender, overweight, obesity, hypertension and hypothyroidism was significantly associated with high risk of postoperative hyperglycemia. Conclusion:There is high prevalence of postoperative hyperglycemia. The frequency of postoperative hyperglycemia was significantly high among those who received general anesthesia than those who received spinal anesthesia.

ABSTRACT
Background and Aims: To compare the efficacy and safety of intrathecal hyperbaric Ropivacaine without adjuvant and with adjuvant Dexmedetomidine for lower abdominal surgeries. Methods: This was a prospective, randomized, double-blind, comparative study conducted among the patients who were ASA grade I or II, age 18 to 60 years planned for lower abdomen surgeries under spinal anaesthesia. Patients were randomly allocated to two groups (30 in each): Ropivacaine Group (control group or R group): spinal anesthesia with 3ml of 0.6% hyperbaric Ropivacaine (18mg) + 0.5ml NS. Dexmedetomidine Group (R+D or D group): spinal anesthesia with 3ml of 0.6% hyperbaric Ropivacaine (18mg) + 0.5ml Dexmedetomidine (5 mcg). All patients scheduled for operation were given oral tablets ranitidine 150 mg and Alprazolam 0.25mg in the night before surgery. Results: There was no significant difference in the basic characteristics between the groups. Heart rate, MAP and SpO2 were similar between the groups across time. The onset sensory levels and bromage were significantly (p=0.0001) higher among the patients of Group R compared with R+D. The 2 segment sensory regression (min), sensory regression S2 (hr), motor recovery (hrs), long term mobilization after spinal anesthesia, total amount of vasopressor given and total amount of Atropine given were significantly (p<0.05) lower among the patients of Group R compared with R+D. The percentage of complications was almost low in both the groups. Conclusion: Dexmedetomidine may be more suitable drug in surgeries in which muscle relaxation has greater value in lower abdominal surgeries.

ABSTRACT
Aim: The aim of the study is to evaluate the effect of mechanical temporal summation on prediction of postoperative pain in open inguinal hernia repair patients. Methods: Twenty five male subjects undergoing open hernia repair were included in this prospective study. Vonfrey filament (#6.45) 180G was used to elicit mechanical temporal summation on volar aspect of the dominant forearm of all the patients preoperatively. First and last stimuli pain rating was assessed using 101 point numerical pain scale. mTs was presumed to be present if the value of the last stimuli is higher than the first (mTs >0). VAS for anxiety is used to assess the level of anxiety. Postoperatively, vas scores for pain and analgesic consumption were recorded. Results: Out of 25 patients, 20% showed mTs more than ‘0’ (>0). Their pain scores both at rest and sitting and analgesic consumption are greater than the mTs (=0) no change patients which is statistically significant. Conclusion: Assessment of preoperative mechanical temporal summation is significantly correlated with the level of VAS scores both at rest and sitting. Analgesic consumption also considerably increased. Thus vonfrey filament is a simple, bedside tool for predicting postoperative pain and analgesic consumption.