Impact of Enhanced Recovery Protocols on Short-Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India.

OBJECTIVE: Surgery for esophageal cancer is associated with high mortality and morbidity, especially in low and middle-income countries. The recent enhanced recovery after surgery guidelines for esophagectomy (2018) which attempt to reduce complications and length of stay (LOS) have rarely been validated in these settings. This study aimed to analyse the effect of this protocol on short-term outcomes in our subset of patients. METHODS: A retrospective review was conducted to investigate the outcomes of enhanced recovery protocol (ERP) compared to standard pre-protocol care (PP) in patients who underwent esophagectomy for cancer (31 in ERP vs 61 in PP group) at Cancer Research Institute, Uttarakhand, India. The main outcomes measured were 30-day mortality, morbidity and LOS. Risk assessment was stratified as per Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) systems while complications were classified as per the Clavien-Dindo scale. RESULTS: Preoperative clinical characteristics were similar between groups. Though the predicted POSSUM mortality and morbidity were significantly higher in the ERP group (p = 0.007), 30-day morbidity (19.35% vs 42.62%, p = 0.027) as well as median LOS (12 vs 15 days, p < 0.001) was significantly lower in ERP group. The PP group reported 4 deaths within 30 days as compared to none in the ERP group (p = 0.296). Furthermore, the ERP group reported lower occurrence of pulmonary complications (6.4%vs24.6%,p = 0.046), hemodynamic instability (0%vs14.75%,p = 0.026) as well as need for prolonged postoperative ventilation (> 24 h; 0% vs 11.48%, p = 0.004). Both minor and major complications as assessed by the Clavien-Dindo scale were lower in the group ERP though these differences were not statistically significant (0.059). CONCLUSIONS: Implementation of ERP improved short-term outcomes; hence can be strongly recommended in patients undergoing esophagectomy.

Outcome of perioperative 24-hour infusion of intravenous lignocaine on pain and QoR-15 scores after breast cancer surgery-A randomised controlled trial.

Background and Aims: Despite many analgesic modalities available, postoperative pain management after breast cancer surgery remains a challenge, which translates into poor quality of recovery, if untreated. Intravenous lignocaine with its anti-inflammatory, antihyperalgesic, and analgesic properties could provide a good option for these patients. The aim of this study was to evaluate the effect of intravenous lignocaine on postoperative pain relief and quality of recovery in patients undergoing surgery for breast cancer. Methods: In this prospective double-blind placebo-controlled randomised study, sixty-six patients undergoing breast cancer surgery were assigned 1:1 to placebo or intravenous lignocaine (Group L). Group L received an intravenous 1.5 mg/kg of lignocaine bolus at induction, followed by an intravenous infusion of 1 mg/kg/h for 24 hours intravenously, while the control group was given equal volume of normal saline. Pain scores, opioid utilisation, and quality of recovery (QoR-15) at 24 hours and on the day of suture removal were compared. Results: Statistically significant reduction was observed in both static (P = 0.01, 6 hours) and dynamic postoperative pain (P = 0.030, 24 hours), with consequential delay in the need for the first dose of opioid (P = 0.014) as well as decreased 24-hour postoperative opioid consumption (P < 0.001) and decreased post-operative nausea and vomiting (PONV) (P < 0.05) in the lignocaine group. Global QoR-15 was significantly better at 24 -hours in group L on postoperative day 1 (P < 0.001), albeit there was no significant difference at suture removal. No lignocaine related side effects were observed. Conclusion: Intravenous lignocaine can be safely used as an alternative perioperative non-opioid analgesic for early postoperative pain and recovery.

Self-Immolative System for Disclosure of Reactive Electrophilic Alkylating Agents: Understanding the Role of the Reporter Group.

The development of stable, efficient chemoselective self-immolative systems, for use in applications such as sensors, requires the optimization of the reactivity and degradation characteristics of the self-immolative unit. In this paper, we describe the effect that the structure of the reporter group has upon the self-immolative efficacy of a prototype system designed for the disclosure of electrophilic alkylating agents. The amine of the reporter group (a nitroaniline unit) was a constituent part of a carbamate that functioned as the self-immolative unit. The number and position of substituents on the nitroaniline unit were found to play a key role in the rate of self-immolative degradation and release of the reporter group. The position of the nitro substituent (meta- vs para-) and the methyl groups in the ortho-position relative to the carbamate exhibited an influence on the rate of elimination and stability of the self-immolative system. The ortho-methyl substituents imparted a twist on the N-C (aromatic) bond leading to increased resonance of the amine nitrogen's lone pair into the carbonyl moiety and a decrease of the leaving character of the carbamate group; concomitantly, this may also make it a less electron-withdrawing group and lead to less acidification of the eliminated ß-hydrogen.

Effect of Fentanyl and Nalbuphine for Prevention of Etomidate-Induced Myoclonus.

BACKGROUND: Etomidate is a potent intravenous inducing agent with known undesirable side effects such as myoclonus and pain on injection in nonpremedicated patients. AIMS: The aim of this study is to compare the effect of fentanyl and nalbuphine in the prevention of etomidate-induced myoclonus. SETTINGS AND DESIGN: Randomized double-blind, placebo-controlled, and prospective comparative study. MATERIALS AND METHODS: A total of 120 patients were randomly allocated to one of the three groups containing 40 patients each for intravenous administration of fentanyl 2 µg/kg diluted in 10 mL normal saline (NS) (Group 1), nalbuphine 0.3 mg/kg diluted in 10 mL NS (Group 2), and only 10 mL NS (Group 3) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous bolus injection over 15-20 s and were assessed for the severity of pain using Grade IV pain scale and observed for myoclonus for 2 min and graded according to clinical severity. Serum creatinine phosphokinase (CPK) levels were obtained prior and postetomidate injection. STATISTICAL ANALYSIS: Statistical analysis was performed by the SPSS program version 17.0 for Windows. Tests used are Shaipro-Wilk test, ANOVA, Tukey's multiple comparison test, Tamhane's T2, and the Chi-square test. For all statistical tests, P < 0.05 was considered statistically significant with 5% level of significance (α). RESULTS: The incidence of myoclonus in Group 1 and 2 was 52.5% and 17.5%, respectively, whereas it was 92.45% in Group 3. There was no pain observed in 70%, 92.5%, and 50% of patients in Group 1, 2, and 3, respectively. There was a statistically significant difference in mean CPK level after induction among three groups (P < 0.001). CONCLUSION: Nalbuphine is more effective than fentanyl in the prevention of etomidate-induced myoclonus and pain with the minimum rise in CPK levels.

Comparison of Postoperative Quality of Recovery and Pain Relief with Preoperative Single-Dose Dexamethasone and Lignocaine after Laparoscopic Cholecystectomy.

AIM: To compare the role of single intravenous (IV) bolus of lignocaine and dexamethasone on pain score and quality of recovery score (QoR40) after laparoscopic cholecystectomy. SETTING AND DESIGN: The study was conducted at the postoperative recovery area, This was a double-blind randomized controlled study. MATERIALS AND METHODS: Seventy patients 18-60 years of age, American Society of Anesthesiologists physical status Class I and II, who underwent elective laparoscopic cholecystectomy, were enrolled in this study after approval from the Institutional Ethics Committee. Patients were randomly allocated to two groups. Group 1 received: 2 mg/kg lignocaine diluted to 10 ml with normal saline, and Group 2 received 0.1 mg/kg IV dexamethasone diluted to 10 ml with normal saline. Global QoR-40 is a 40-item questionnaire that provides a global score and subscores across five dimensions: psychological support, comfort, independence, pain, and emotions. It was assessed on a preoperative day as baseline to assess patient's basic quality of life and at 24 h postoperative. Visual analog scale (VAS) static and dynamic, total analgesic consumption in a day, nausea and vomiting, and antiemetic per day were assessed. STATISTICAL ANALYSIS USED: Student's t-test, Chi-square test, Fisher's exact, Levene's test were used for statistical analysis. RESULTS: Dexamethasone group had higher Global QoR-40 than lignocaine group 187.94 versus 182.85. Among dimensions of QoR-40, dexamethasone had statistically better physical comfort, physical independence, and pain relief as compared to lignocaine. Dexamethasone group had lower VAS compared to lignocaine group. Similarly, there was less fentanyl consumption in dexamethasone group (364.08 ± 127.31) in the postoperative period when compared to the lignocaine group (412.31 ± 147.8). CONCLUSIONS: Preoperative administration of a single dose of dexamethasone enhanced QoR after laparoscopic cholecystectomy as compared to lignocaine bolus dose.

Are Female Children More Likely to be Born to Indian Anesthesiologists? - A Nationwide Survey.

CONTEXT: Exposure to medications (prescribed or over-the-counter) or exposure to chemicals (unintentional or occupational) during pregnancy have always been of great scientific concerns. AIMS: This study aims to ascertain whether the recently documented offspring sex ratio (OSR) skew in medical literature is reproducible among our respondent population and how our respondents' characteristics relate to the OSR skew (if any) in our respondent population. SETTINGS AND DESIGN: A survey questionnaire uploaded on the SurveyMonkey® Online Portal. SUBJECTS AND METHODS: The survey was completed by the Indian anesthesiologists about themselves and their spouses during the periconceptional periods of their offspring. STATISTICAL ANALYSIS USED: Analysis of variance for means and Chi-square test for proportions with P < 0.05 as statistically significant. RESULTS: Respondents (irrespective of gender) who sired first-born or second-born male children were anyway more likely to sire male children as reflected in the personal sex ratios among all offspring sired by them, and similarly respondents (irrespective of gender) who sired first-born or second-born female children were anyway more likely to sire female children. Male parents were significantly more common to have worked in operating rooms around the time of conception of first-born or second-born children. As compared to female anesthesiologists, male anesthesiologists significantly reported that they were practicing inhalational induction of anesthesia more often around the conception of their second-born female children as compared to around the conception of their second-born male children. CONCLUSIONS: Practice of inhalational induction of anesthesia was reportedly more common among Indian male anesthesiologists during periconceptional period of their second-born female children.

Post-operative effectiveness of continuous wound infiltration, continuous epidural infusion and intravenous patient-controlled analgesia on post-operative pain management in patients undergoing spinal surgery.

BACKGROUND AND AIMS: Very few studies have compared continuous wound infiltration (CWI), continuous epidural infusion (CEI) and intravenous Patient Controlled Analgesia (PCA) with morphine in spine surgery. This study compared these modalities in patients undergoing microdissectomy. METHODS: This prospective, randomized control trial was conducted on 75 patients of American Society of Anesthesiologists' physical status I or II undergoing microdiscectomy. Patients in all the three groups received morphine 1 mg IV, with a lockout period of 10 min after each bolus, and the maximum allowed dose was 15 mg/5 h postoperatively. Patients in Group A received CWI with 0.25% levobupivacaine 20 mL as bolus after extubation followed by infusion at 5 mL/h. Group B received CEI with 0.25% levobupivacaine at 5 mL/h. Patients in Group C received intravenous (IV) morphine by PCA pump only. The primary end points were static and dynamic visual analogue scores (VAS) and postoperative pain scores. Secondary observations were postoperative morphine consumption at 8 h, 24 h and 48 h, and patient satisfaction. RESULTS: Group A showed greater analgesic effects at 12 h (P < 0.02), 24 h (P < 0.03), 36 h (P < 0.008) and 48 h (P < 0.007) when compared to the other two techniques, as pain scores were less in group A as compared to group B and C. The requirement of postoperative intravenous morphine (mg) was 18 ± 12.82, 22.92 ± 9.88, 41.56 ± 8.83 for groups A, B and C after 48 h (P < 0.001). CONCLUSION: Continuous wound infiltration is an effective postoperative pain control technique with minimal side effects, after spinal surgery.

The opinion of post graduate students on objective structured clinical examination in Anaesthesiology: A preliminary report.

BACKGROUND AND AIMS: The scenario in medical education is changing with objective structured clinical examination (OSCE) being introduced as an assessment tool. Its successful implementation in anaesthesiology postgraduate evaluation process is still limited. We decided to to evaluate the effectiveness of OSCE and compare it to conventional examinations as formative assessment tools in anaesthesiology. METHODS: We conducted a cross-sectional comparative study in defined population of anaesthesiology postgraduate students to evaluate the effectiveness of OSCE as compared to conventional examination as formative assessment tool in anaesthesiology. Thirty-five students appeared for the conventional examination on the 1(st) day and viva voce on the 2(nd) day and OSCE on the last day. At the conclusion of the assessment, all the students were asked to respond to the perception evaluation questionnaire. We analysed the perception of OSCE among the students. RESULTS: Results showed a positive perception of the objective structured physical examination (OSCE) as well as structured 9 (25.7%), fair 19 (54.2%) and unbiased 13 (37.1%) with more standardised scoring 9 (25.7%). The students perceived OSCE to be less stressful than other examination. Thirty-one (88.5%) students agreed that OSCE is easier to pass than conventional method and 29 (82.5%) commented that the degree of emotional stress is less in OSCE than traditional methods. CONCLUSION: OSCE is better evaluation tool when compared to conventional examination.

Cervical Spine Movement and Ease of Intubation Using Truview or McCoy Laryngoscope in Difficult Intubation.

STUDY DESIGN: Prospective, observational, analytical, randomized control trial. OBJECTIVE: To compare cervical spine movement for best laryngoscopic view and ease of intubation using Truview or McCoy laryngoscope in anticipated difficult intubation. SUMMARY OF BACKGROUND DATA: The addition of modified laryngoscope blade to the anesthesiologist's armamentarium adds flexibility and improves the skill of the anesthetist, which benefits the patients. METHODS: One hundred patients of American Society of Anesthesiologists status I and II with predicted difficult intubation score ≥5 were divided into two groups: Group A (n = 50): intubation done with McCoy laryngoscope and Group B (n = 50): intubation done with Truview laryngoscope and compared for the ease of intubation using intubation difficulty scale (IDS), cervical spine movement, and hemodynamic alterations. RESULTS: The total IDS determining the ease of tracheal intubation was better in Group B than Group A. On comparing the variables of IDS score, there was no difference between the two groups except 14 (28%) patients in Group A required application of external laryngeal pressure, whereas only five (10%) patients had this difficulty in Group B. It was seen that craniocervical extension was significantly less (2.5 times) in Group B as compared to Group A. CONCLUSION: In anticipated difficult intubation, Truview improves the laryngeal view, causes less movement at cervical spine, which could be more helpful in patients with restricted neck mobility, and has lesser complications. LEVEL OF EVIDENCE: 2.

A comparison of granisetron and nitroglycerine for attenuating rocuronium pain: A double-blinded randomized, placebo controlled trial.

BACKGROUND: The incidence of pain reported in literature after IV administration of rocuronium is 50-80%. The aim of our study was to determine whether pre-treatment with intravenous granisetron and nitroglycerine would reduce rocuronium-induced pain. METHODS: One hundred fifty patients of either sex, aged 18-65 years, American society of Anaesthesiologist grading (ASA) I-II, scheduled for various surgeries under general anesthesia were randomly assigned to one of the groups. Group G: received 2 granisetron (1mg/ml) diluted with 3 ml of 0.9% normal saline) while the Group C: received 5 ml of 0.9% normal saline. Group N: received 200΅g of nitroglycerine diluted to a total of 5 ml(with 0.9% normal saline). It was accompanied by manual venous occlusion for 20 seconds. Then 0.06mg/kg of rocuronium was injected through same cannula over 10-15 sec. Patients were asked by a blinded investigator to score the pain on injection of rocuronium using visual analogue scale (0-10) with 0-no pain,1-3 mild pain, 4-6 moderate and >=7 severe pain. At the same time discomfort in the form of patient's movement, such as no movement (grade 0), movement only wrist (grade 1), movement to the upper arm and shoulder of injected arm (grade 2) or generalized movements (grade3) was observed. Statistical analysis using independent t test, Mann-Whitney test and reverse ANOVA was done. RESULTS: 1. At 0 seconds, in group G number of patients who experienced withdrawl score of 0-1 were 92%,group N were 82% while only 26% of patients in group C had favourable withdrawl score.74% of patients in group C had score of 2-3 at same time. 2. At 0 sec, in group G number of patients who experienced VAS score of 0-3 were 96%, group N 72%. At same time Group C 48 % of patients had VAS score of 2-3. CONCLUSION: We conclude that pre-treatment with granisetron or nitroglycerine both are highly effective in attenuation of rocuronium induced pain.

Postoperative pain and long-term functional outcome after administration of gabapentin and pregabalin in patients undergoing spinal surgery.

STUDY DESIGN: Prospective, double-blind study, randomized control trial. OBJECTIVE: To evaluate and compare the analgesic efficacy, adverse effects, and clinical utility of gabapentin and pregabalin in postoperative pain management, long-term functional outcome, and quality of life in patients undergoing spinal surgery. SUMMARY OF BACKGROUND DATA: Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. The most common persistent symptoms are pain, motor deficit, and decreased functional status. METHODS: This study was conducted in 90 patients belonging to the 18 to 75 age group of either sex undergoing spinal surgery under general anesthesia. Group A received 300 mg of gabapentin, group B received 75 mg of pregabalin, whereas group C received placebo 1 dose 1 hour before surgery and 8 hourly for 7 days, thereafter. The outcome of postoperative static and dynamic pain and functional outcome was recorded using 3 questionnaires-visual analogue scale, Prolo functional and economic score, Oswestry Disability Index score from preoperative period to 3 months postoperatively. RESULTS: Among the 3 groups, subjects receiving pregabalin showed consistently reduced static and dynamic pain intensity and also required lesser amount of rescue drug throughout the postoperative period. There was statistically significant difference (P < 0.05) in the Prolo score and Oswestry Disability Index score at all time intervals between group B and group C. Although, significant difference in the functional outcome between group A and group B was seen at 3 months. CONCLUSION: Preoperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy followed by gabapentin and then placebo. LEVEL OF EVIDENCE: 2.

Addition of clonidine or lignocaine to ropivacaine for supraclavicular brachial plexus block: a comparative study

<p><b>INTRODUCTION</b>Clonidine is used with local anaesthetics to improve analgesia. However, the improvement conferred when clonidine is used together with ropivacaine is controversial. Thus, the present study aimed to evaluate the improvement in analgesia when clonidine is used together with ropivacaine for supraclavicular brachial plexus block.</p><p><b>METHODS</b>This was a prospective, randomised, double-blind controlled study. A total of 75 patients who were scheduled to undergo supraclavicular block were randomly assigned into three groups (i.e. clonidine, lignocaine and control groups) of 25. Patients in all three groups received 20 mL of 0.75% ropivacaine. In addition to that, patients in the clonidine group received 1 mL of clonidine (150 μg) plus 9 mL of saline, patients in the lignocaine group received 10 mL of 2% lignocaine with adrenaline (1:200,000), and patients in the control group received 10 mL of saline. The characteristics of anaesthesia and analgesia for these three groups were assessed.</p><p><b>RESULTS</b>The addition of 2% lignocaine with adrenaline to ropivacaine led to earlier onset of the sensory block (by 4.88 mins), but no increase in the duration of analgesia when compared to analgesia using ropivacaine alone. The addition of clonidine to ropivacaine led to earlier onset of sensory and motor blocks (by 2.88 mins and 3.28 mins, respectively), as well as an increased duration of sensory and motor blocks (by 222.64 mins and 192.92 mins, respectively) when compared to analgesia using ropivacaine alone. The total duration of analgesia was increased by 208.24 mins with clonidine when compared to analgesia using ropivacaine alone. There were no significant differences in sedation score and no side effects in all three groups.</p><p><b>CONCLUSION</b>When compared to the use of ropivacaine alone, the addition of 150 μg clonidine to ropivacaine for brachial plexus block achieved earlier analgesic onset and improved duration of analgesia, without unwanted side effects.</p>

Anesthesia for opioid addict: Challenges for perioperative physician.

Opioid addiction is on a rise globally. Such a patient presents to an anesthesiologist as well as to the surgeon with an array of challenges. We present the case of an opioid addict (pentazocine) who presented for debridement and grafting of eschars and old healed scars. Initially he was medically managed for opioid addiction followed by a planned anesthesia. We hereby discuss the challenges faced during perioperative period.

Current understanding of the literate versus illiterate patient's knowledge about anesthesiologists: A comparative study.

CONTEXT: There is a widespread ignorance among the public about the role of anesthesiologists and their responsibilities inside or outside the operating room both in developed and developing countries. AIMS: The present study was conducted to assess the knowledge of literate and illiterate patient about the role of anesthesiologists and their concerns regarding anesthesiology. SETTING AND DESIGN: This is a prospective study conducted in a preoperative anesthetic clinic of a large tertiary care hospital. The study consisted of a standard preanesthetic interview and questionnaire. MATERIALS AND METHODS: After obtaining permission from the Ethics committee, patients in the age group 18-75 years of either sex undergoing elective surgery were included. The patients were divided into two groups on the basis of their education: Group A: included patient who are illiterate; Group B: included patients who are literate, completed a questionnaire, which was later evaluated. STATISTICAL ANALYSIS USED: Unpaired t test and correlation r test were used. RESULTS: There was limited knowledge among both literates and illiterates regarding the perioperative role of anesthesiologists. They wanted to be fully explained about the anesthesiology technique and were keen to meet their anesthesiologist both before and after the surgery. CONCLUSION: To eliminate the ignorance among general public regarding the role of anesthesiologists, efforts must be made to educate and generate awareness among the population.

A retrospective analysis of anesthetic experience in 2917 patients posted for cleft lip and palate repair.

CONTEXT: Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children. AIM: to study the perioperative anesthetic complications in poor children with cleft abnormalities. SETTINGS AND DESIGN: Retrospective analysis. MATERIALS AND METHODS: This retrospective audit was conducted on 2917 patients of smile train project under going general anesthesia for cleft lip and palate from January 2007 to December 2010. Demographic, pre-anesthetic status, anesthetic management and anesthesia complications were recorded. Chi-square test was used to assess the relation between patient factors and occurrence of complications. RESULTS: Of the 3044, we were able to procure complete data of 2917 patients. Most of children presented with anemia 251 (35%), 202 (29%) had eosinophilia while 184 (26%) had upper respiratory tract infection. The incidence of perioperative complications was 8.19% of which 33.7% critical incidents occurred during the induction time. The most common complication was laryngospasm 77 (40.9%) followed by difficult intubation 64 (30.9%). There was no mortality. CONCLUSION: Since these procedures do not characterize an emergency, most of the perioperative complications can be prevented by following the routine installed by the institute and smile train protocols.

Recovery profile and emergence delirium following sevoflurane and isoflurane anesthesia in children posted for cleft lip surgery.

UNLABELLED: This prospective, randomized, double control study was carried out in 84 children aged 2-24 months posted for elective cleft lip surgery. METHODS: Patients were randomally divided into 2 groups of 42 patients each. In Group A patients were induced and maintained on sevoflurane while in Group B patients were induced with sevoflurane and maintained on isoflurane. Standardized anesthesia technique was used. Recovery milestones and post operative complications were recorded. RESULTS: Incidence of emergence delirium in sevoflurane group was 11.9% while in isoflurane group is 2.38%. The overall incidence of emergence delirium in the study was 7.14%. There was no significant difference (p > 0.05) in the incidence of emergence delirium between the two groups. There was no effect of duration of exposure of sevoflurane and time taken for achievement of recovery milestones while we observed a positive correlation with isoflurane. In sevoflurane the recovery endpoint first reached was limb movement > spontaneous respiration > spontaneous eye opening. In isoflurane group the recovery end point first reached was spontaneous respiration > limb movement = spontaneous eye opening. CONCLUSION: Our study confirms that the recovery profile of sevoflurane in children less the two years is superior compared to isoflurane.

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery.

UNLABELLED: AIMS AND CONTEXT: To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively SETTING AND DESIGN: Prospective, randomized, double-blind study. METHODS: Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine (1 µg/kg) and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. STATISTICAL ANALYSIS: Two sample unpaired t-test and the correlation r test. RESULTS: The duration of analgesia from the time of administration of block in group A was 667.72 ± 210.74 min compared to 558.48 ± 150.28 min in group B (P<0.05). CONCLUSION: Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects.