Antifungal Susceptibility Profile of Clinical and Environmental Isolates of Aspergillus Species From a Tertiary Care Center in North India.

INTRODUCTION: Aspergillus species are ubiquitously found in the environment worldwide and are important causative agents for infection. Drug resistance among Aspergillus species is emerging, hence the present study was undertaken to look for antifungal susceptibility profiles of clinical and environmental isolates of Aspergillus species. MATERIALS AND METHODS: During the period from January 2018 to June 2019, a total of 102 Aspergillus isolates (40 clinical, 40 hospital, and 22 community environment) were tested for antifungal susceptibility testing for determination of minimum inhibitory concentration (MIC)/minimum effective concentration (MEC) as per Clinical and Laboratory Standards Institute (CLSI) M38-A3 method for itraconazole, voriconazole, amphotericin B, and caspofungin. RESULTS: Out of these 102 Aspergillus isolates, A. flavus was the most common species present. Aspergillus species were found to have low MIC values to azoles such as itraconazole and voriconazole except for one clinical isolate, which showed a MIC value of 2 µg/ml to voriconazole. Two isolates were non-wild-type for amphotericin B, but all isolates were wild-type for caspofungin. CONCLUSION: Antifungal susceptibility testing among clinical Aspergillus isolates and environmental surveillance studies in view of emerging drug resistance should be undertaken at a larger scale.

Comparison of APACHE II and APACHE IV score as predictors of mortality in patients with septic shock in intensive care unit: A prospective observational study.

Background and Aims: Prediction of outcome in intensive care unit (ICU) patients is of imperative importance. Our aim was to assess and compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE IV scores in predicting mortality in adult patients suffering from septic shock admitted to our ICU. Material and Methods: This was a prospective observational study conducted in a 14-bedded medical ICU of a tertiary care center from January 2019 to March 2020; 128 patients suffering from septic shock were included and APACHE II and IV scores were calculated. We also calculated the predicted and actual mortality rates and standardized mortality ratios. The receiver operating characteristic curves were used to assess discrimination. Results: Out of the 128 patients, 63 patients (49.21%) died. The mean (± standard deviation) admission APACHE II score was 16.7 ± 5.53, while the mean APACHE IV score was 67.25 ± 25.99. The non-survivors had significantly higher APACHE II and IV scores when compared to those who survived (P < 0.001). APACHE II had a slightly better discriminative power (with the area under the Receiver operating characteristic (ROC) curve of 0.78) than APACHE IV (with the area under the ROC curve of 0.74). The mean predicted mortality rate (PMR) of the patient population calculated on the basis of the APACHE II scoring system was 22.46 ± 15.76, and the mean PMR calculated as per the APACHE IV scoring system was 11.64 ± 15.59. Conclusion: Both APACHE II and APACHE IV underestimated mortality in septic shock patients. Both APACHE II and APACHE IV were comparable in differentiating survivors from non-survivors. However, there was a good correlation between the two models.

Ultrasound-guided erector spinae plane block compared to serratus anterior muscle block for postoperative analgesia in modified radical mastectomy surgeries: A randomized control trial.

Background and Objectives: The present study was undertaken to compare the analgesic efficacy of erector spinae plane (ESP) block with serratus anterior muscle (SAM) block in patients undergoing modified radical mastectomy (MRM). We hypothesized that ESP block would provide better postoperative pain relief than SAM block following MRM. Methods: Eighty American Society of Anaesthesiologists (ASA) I-II adult females, scheduled for MRM, were randomly allocated to receive either ultrasound-guided ipsilateral single-shot ESP or SAM block after induction in the respective planes, using 20 ml of 0.25% ropivacaine. Both the groups received postoperative intravenous patient-controlled analgesia (IV-PCA) (morphine) for 24 h. The primary outcome was to assess pain severity using a visual analogue scale (VAS) score. Postoperative 24-h opioid consumption, time to first opioid analgesia, hemodynamic variables, total dose of antiemetics, and safety profile of both the blocks were also evaluated. Data analysis was carried out using Statistical Package for the Social Sciences version 21.0 (SPSS Inc. Chicago, Illinois, USA). Results: VAS scores were lower in the ESP block group, at rest and on movement, and the difference was statistically significant (p < 0.05). Postoperative morphine consumption was also significantly less in patients receiving ESP block as compared to SAM block (3.13 ± 1.44 mg vs 4.33 ± 1.69 mg; P = 0.001). The time to first analgesia request was significantly prolonged in the ESP group as compared to the SAM group (9.58 ± 4.11 h vs 6.46 ± 2.95 h; P = 0.001). No major side effects were observed in any of the study groups. Conclusions: ESP block provides better analgesia as compared to SAM block after MRM. Clinical trial registration number: CTRI/2019/03/018067.

Pregabalin Versus Duloxetine on Postoperative Analgesic Requirement Following Lower Extremity Trauma Surgeries: A randomised, Clinical Trial.

OBJECTIVE: The use of pregabalin versus duloxetine in postoperative lower limb traumatic pain has not been compared. The aim of this study was to evaluate the response rate of rescue analgesic requirement with perioperative pregabalin versus duloxetine in lower limb trauma surgeries. METHODS: In this randomised, clinical trial, 60 patients of American Society of Anesthesiologists physical status I-II undergoing lower limb trauma surgery were randomised to receive oral pregabalin 150 mg day-1 or duloxetine 60 mg day-1, 2 hours prior to surgery and then once daily for next 2 days postoperatively. The surgery was performed under standardised spinal anaesthesia technique. The investigator was blinded to the study drug, oral paracetamol 1 g every 6 hours and intravenous diclofenac 75 mg was a rescue analgesic. The primary outcome of the study was response rate in terms of rescue analgesia requirement. Secondary outcomes included total rescue analgesia, visual analogue scale at rest and on movement, haemodynamics, anxiety depression score, and patient satisfaction score and adverse effects. RESULTS: In group pregabalin, 60% of patients required the first dose of rescue analgesia versus 50% in group duloxetine for 72 hours postoperatively. In group pregabalin, 6.6% of patients required the second dose of rescue analgesia after a mean duration of 24 hours, and 10% of patients in group duloxetine required the second dose after a mean duration of 40 hours. The visual analogue scale scores, time to first rescue, and cumulative rescue analgesic were comparable in both the groups. CONCLUSION: Equivalent rate-responsive rescue analgesia was required in patients receiving pregabalin or duloxetine following lower limb trauma surgery.

Evaluation of analgesic efficacy of superficial cervical plexus block in patients undergoing modified radical mastoidectomy: A randomised controlled trial.

BACKGROUND AND AIMS: Intravenous analgesics and local infiltration are used for postoperative analgesia in patients undergoing mastoidectomy. No randomised controlled trial (RCT) has so far determined response rates of pain reduction after ultrasound-guided superficial cervical plexus block (SCPB) in adult patients undergoing modified radical mastoidectomy. METHODS: This double-blind RCT was conducted in 30 adult patients of the American Society of Anesthesiologists (ASA) grade I/II undergoing modified radical mastoidectomy. The primary outcome was a reduction in the visual analogue scale (VAS) score. Secondary outcomes were postoperative diclofenac consumption, haemodynamics, and occurrence of any adverse events. All patients received general anaesthesia. At the end of the surgery, patients were randomised to either Group 'Block' (n = 15) ultrasound guided SCPB with 5 mL ropivacaine 0.5% or Group 'No block' (n = 15). All patients received intravenous (IV) paracetamol 1 g every 6 hourly and rescue analgesic IV diclofenac 75 mg if VAS score >4. RESULTS: Patients in Group 'Block' reported lower VAS score at rest versus Group 'No block' at 1 h postoperatively (P = 0.012). VAS score on movement was lower in patients of Group 'Block' compared to Group 'No block' at 1 h (P = 0.010), 4 h (P = 0.035), 8 h (P = 0.027), and 12 h (*P = 0.003) postoperatively. Diclofenac consumption was lower in patients of Group 'Block' (P = 0.041). No adverse effects were reported. CONCLUSION: Postoperative ultrasound-guided SCPB produced higher response rates in terms of reduction in VAS score in patients undergoing modified radical mastoidectomy.

Vitamin D levels of anesthesiologists working in tertiary care hospital of South Asian country: An observational study.

BACKGROUND AND AIMS: Vitamin D deficiency is now emerging as a major global health problem. Doctors spend most of their time indoors and hence, have very low sun exposure. With limited studies on vitamin D levels of anesthesiologists and no published study from South Asian countries, we planned to determine vitamin D levels in anesthesiologists. MATERIAL AND METHODS: One hundred twenty anesthesiologists, working in two tertiary care hospitals, were enrolled in this study. The participants were asked to complete the questionnaire and blood samples were drawn at the same sitting for measuring serum 25(OH) D and serum calcium levels. A subgroup analysis of anesthesiologists was done based on vitamin D status levels defined as per Endocrine society clinical practice guidelines 2011 on vitamin D deficiency. Vitamin D deficiency: 25(OH) D <20 ng/ml (<50 nmol/l), Vitamin D insufficiency: 25(OH) D of 21-29 ng/ml (52.5-72.5 nmol/l), Vitamin D sufficiency: 25(OH) D of ≥30 ng/ml (≥75 nmol/l). RESULTS: The mean working hours in a day [mean ± standard deviation (SD)] were 10.70 ± 1.56 hours with a range of 8-15 hours. The mean ± SD level of vitamin D in anesthesiologists was 14.56 ± 9.39 ng/ml with a range of 5.30-58.00 ng/ml. Out of 120 anesthesiologists, 101 (84.2%) anesthesiologists had deficient levels of vitamin D, 10 (8.3%) had insufficient levels, and 9 (7.5%) anesthesiologists had sufficient levels of vitamin D. Majority of the anesthesiologists had normal serum calcium levels. A total of 91.5% of doctors had vitamin D deficiency who were not taking vitamin D supplement groups as compared to 28.6% in doctors who had taken vitamin D supplements in the past. CONCLUSION: Prevalence of vitamin D deficiency/insufficiency was high among anesthesiologists. However, levels were optimal in professionals taking vitamin D supplements.

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India.

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial.

BACKGROUND AND AIMS: An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients. METHODS: This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I-II of both sexes aged 18-80 years with body mass index (BMI) ≥20 to ≤35 kg/m2 undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group (n = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group (n = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively. RESULTS: The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37-99.63 (20-160)] mg versus 93.60 ± 34.99 [79.16-108.04 (20-160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported. CONCLUSION: A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.

Acute normovolemic hemodilution in major orthopedic surgery.

BACKGROUND: With increasing concerns regarding the newer emerging pathogens, alternatives to allogeneic blood transfusion are being explored and acute normovolemic hemodilution (ANH) is one of them. METHODS: A prospective study was conducted in patients aged 18-65 years with preoperative hemoglobin >12 g/dl undergoing total knee replacement or total hip replacement. Patients in whom hemodilution was performed were included in the ANH group whereas patients undergoing treatment as per the routine hospital protocol were included in the control group. RESULTS: Preoperative hemoglobin was similar in both ANH and control groups (12.7 ± 0.7 vs 12.6 ± 0.6, p = 0.56). Allogeneic blood requirement was significantly less in the ANH group as compared to the control group (4 vs 15, p = 0.001). Postoperative complications were significantly lower in ANH group as compared to control group (7 vs 16, p = 0.01). CONCLUSIONS: ANH can be an alternative approach to meet the need of safe blood especially in resource constrained countries, like India where risk of transfusion transmitted infections are still high and where there is high demand of blood and acute shortage of blood in hospitals.

Dihydrotestosterone in Amyotrophic lateral sclerosis-The missing link?

OBJECTIVE: Testosterone has been postulated to be involved in ALS causation. MATERIALS AND METHODS: CSF levels of free testosterone and dihydrotestosterone were measured in 13 ALS patients [7 males, 6 females] and 22 controls [12 males, 10 females]. RESULTS: CSF free testosterone levels did not show any significant differences but CSF dihydrotestosterone levels were significantly decreased in all male and female ALS patients. CONCLUSIONS: DHT is probably integral to survival of motor neurons. In patients predisposed to develop ALS, there is possibly a sort of "testosterone resistance" at level of blood-brain barrier [BBB] existing right from birth and is likely the result of dysfunctional transport protein involved in testosterone transfer across the BBB. In these patients, lesser amount of testosterone is able to breach the BBB and enter the central neural axis. Lesser amount of testosterone is available to 5 α reductase in the anterior pituitary to be converted to DHT and lesser amount of DHT is generated. There is inadequate negative feedback suppression of LH at the level of anterior pituitary by DHT. As a result of higher LH levels, testosterone levels rise in the peripheral testosterone fraction [the fraction outside the BBB] and this explains the various physical attributes of ALS patients like lower Ratio of the index and ring finger lengths (2D:4D ratio), increased incidence of early onset alopecia etc. This deficiency of DHT leads to motor neuron death causing ALS.

Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial.

BACKGROUND: The effect of dexmedetomidine as an adjuvant in the adductor canal block (ACB) and sciatic popliteal block (SPB) on the postoperative tramadol-sparing effect following spinal anesthesia has not been evaluated. METHODS: In this randomized, placebo-controlled study, ninety patients undergoing below knee trauma surgery were randomized to either the control group, using ropivacaine in the ACB + SPB; the block Dex group, using dexmedetomidine + ropivacaine in the ACB + SPB; or the systemic Dex group, using ropivacaine in the ACB + SPB + intravenous dexmedetomidine. The primary outcome was a comparison of postoperative cumulative tramadol patient-controlled analgesia (PCA) consumption at 48 hours. Secondary outcomes included time to first PCA bolus, pain score, neurological assessment, sedation score, and adverse effects at 0, 5, 10, 15, and 60 minutes, as well as 4, 6, 12, 18, 24, 30, 36, 42, and 48 hours after the block. RESULTS: The mean ± standard deviation of cumulative tramadol consumption at 48 hours was 64.83 ± 51.17 mg in the control group and 41.33 ± 38.57 mg in the block Dex group (P = 0.008), using Mann-Whitney U-test. Time to first tramadol PCA bolus was earlier in the control group versus the block Dex group (P = 0.04). Other secondary outcomes were comparable. CONCLUSIONS: Postoperative tramadol consumption was reduced at 48 hours in patients receiving perineural or systemic dexmedetomidine with ACB and SPB in below knee trauma surgery.

Serotonin Syndrome in ICU-A Road Less Traveled.

A potentially life-threatening adverse drug reaction, serotonin syndrome (SS) may occur in patients on serotonin agonist medications. Medications responsible for SS include commonly prescribed antidepressants, anxiolytics, analgesics and antiemetics. This syndrome has been mentioned in various scenarios in perioperative setting but rarely acknowledged in intensive care unit (ICU) setting. Multiple comorbities leading to polypharmacy and serotoninergic medications place elderly patients, particularly at higher risk of SS. We wish to report a case of SS in an elderly male with depression who developed SS and required ICU admission. Most crucial point is to be able to recognize this entity whenever a patient on multiple drugs with altered sensorium is admitted to ICU. HOW TO CITE THIS ARTICLE: Jindal S, Gombar S, Jain K. Serotonin Syndrome in ICU-A Road Less Traveled. Indian J Crit Care Med 2019;23(8):376-377.

GlideScope versus D-blade for tracheal intubation in cervical spine patients: A randomised controlled trial.

BACKGROUND AND AIMS: Airway management in patients with cervical spine pathology is challenging. The aim of the study was to evaluate GlideScope (GVL) and D blade of C-MAC (CMAC-D) using manual inline axial stabilisation (MIAS) for tracheal intubation in patients with cervical spine injury/pathology. METHODS: This is a randomised, single-blind, hospital-based study. After obtaining informed consent, 54 patients with cervical spine pathology/injury were grouped into GVL group or CMAC-D group, (n = 27 each) based on computer-generated random number table. Preoperative airway difficulty score (ADS) was calculated. The primary outcome of the study was intubation difficulty score (IDS) and the secondary outcomes included total time taken to secure airway, failure to intubate, haemodynamic parameters and adverse events. Data was represented in the form of number (%) or mean and standard deviation and median and interquartile range as appropriate. Chi square test was used for analysing IDS. RESULTS: The mean ± SD of IDS of the CMAC-D and GVL groups were 0.04 ± 0.2 (0.04-0.11) and 0.19 ± 0.40 (0.03-0.34), respectively, (P value = 0.096). The number (%) of patients with IDS > 0 was 1 (3.7) in CMAC-D and 5 (18.5) in GVL group, (P value = 0.192). Demographic data, ADS, Cormack-Lehane grading, success rate, time of tracheal intubation, type of surgeries, haemodynamic parameters and post-operative complications were similar in both the groups. CONCLUSION: Both GVL and CMAC-D with MIAS are equally efficacious in tracheal intubation in cervical spine injury/pathology patients without other difficult airway management criteria.

Evaluation of analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound-guided adductor canal block in patients following anterior cruciate ligament reconstruction surgeries.

INTRODUCTION: Local anaesthetic (LA) with highly selective alpha-2 agonist dexmedetomidine has not been evaluated in adductor canal block (ACB) for arthroscopic anterior cruciate ligament (ACL) reconstruction surgeries. The study evaluates postoperative analgesic effect of ropivacaine with adjuvant dexmedetomidine following postoperative ultrasound-guided ACB. METHODS: 105 randomized subjects received ultrasound-guided ACB using 15 mL of 0.5% ropivacaine, with 0.5 µg kg-1 of dexmedetomidine administered perineurally (Group II), intravenously (Group III) or none (Group I). Primary outcome included 24 hours' total morphine consumption postoperatively. Secondary outcomes included haemodynamics and adverse effects. RESULTS: The postoperative total morphine consumption was significantly reduced till 4 hours in II 0.57 mg (0.98 (0-3)) (p = 0.011) and up to 6 hours in Group III 0.77 mg (1.00 (0-4)) (p = 0.004) compared to Group I. The postoperative total morphine consumption was comparable at 24 hours in Group III 3.57 mg (1.73 (0-8)) and Group II 3.34 mg (1.92 (07)) (p = 1.000). The visual analogue scale (VAS) scores were comparable in all the three groups at all the time intervals studied (p > 0.05). There were no adverse effects observed during the study. CONCLUSION: Use of perineural dexmedetomidine with LA for ACB in the postoperative period resulted in significant reduction in total morphine consumption in initial 4 hours as compared to 6 hours with intravenous (IV) dexmedetomidine.

Recovery Profile After General Anaesthesia in Paediatric Ambulatory Surgeries: Desflurane Versus Propofol.

OBJECTIVE: Paediatric ambulatory surgeries warrant a speedy recovery of patients without compromising their safety. Short-acting agents such as propofol and desflurane help facilitate these objectives. In this prospective, randomised study we compared the recovery profile in paediatric patients undergoing ambulatory surgeries who received entropy guided general anaesthesia (GA) using desflurane and propofol as maintenance anaesthetics. METHODS: We enrolled 80 children (3-10 years of age), ASA I and II, scheduled for elective surgeries of <60 minutes duration requiring GA between March 2015 and June 2016. We used entropy to monitor adequate depth of anaesthesia and to ensure equipotency of anaesthetic administration in both groups. The state and response entropy was maintained between 40 and 60 by titrating the anaesthetic agents and opioid analgesics. The time of awakening, perioperative haemodynamics, postoperative recovery profile, adverse events and comparative cost of anaesthetic agents were analysed. RESULTS: The mean heart rate in the desflurane group was significantly higher. There was no difference between the blood pressure, end tidal carbon dioxide, or oxygen saturation in the two groups. There was a trend towards faster awakening, spontaneous respiration and extubation, quicker time to achieve a fast track score >12 and shift out of the post-anaesthesia care unit in the desflurane group, but the difference was not statistically significant. There were no serious adverse events. The mean cost of desflurane was significantly higher than propofol. CONCLUSION: Desflurane and propofol provided similar recovery profiles in children receiving GA for ambulatory surgeries. However, propofol was more cost effective compared to desflurane.

A prospective randomized controlled study to evaluate and compare GlideScope with Macintosh laryngoscope for ease of endotracheal intubation in adult patients undergoing elective surgery under general anesthesia.

BACKGROUND: The aim of the study was to compare the ease the intubation using GlideScope video laryngoscope and Macintosh laryngoscope in adult patients undergoing elective surgery under general anesthesia. MATERIALS AND METHODS: A total of 200 American Society of Anesthesiologists I-II patients of either sex, in the age group of 18-60 years were included in the study. Patients were randomly allocated to two groups. We assessed ease of intubation depending on time to tracheal intubation, number of attempts, glottic view (Cormack-Lehane grade [CL grade] and percentage of glottis opening [POGO]) and intubation difficulty score (IDS), hemodynamic variables and any intra- and post-operative adverse events. RESULTS: The rate of successful endotracheal intubation (ETI) in both groups was 100% in the first attempt. The time required for successful ETI was 24.89 ± 5.574 in Group G and 20.68 ± 3.637 in Group M (P < 0.001) found to be statistically significant. There was significant improvement in glottic view with GlideScope (as assessed by POGO score 66.71 ± 29.929 and 94.40 ± 10.476 in group G and 75.85 ± 26.969 and 74.20 ± 29.514 Group M and CL grading [P < 0.001]). A comparison of mean IDS between two groups revealed intubation was easier with the use of GlideScope. The hemodynamic response to intubation was significantly lesser with the use of GlideScope when compared with Macintosh laryngoscope. The incidence of adverse events, though minor like superficial lip or tongue bleed, was similar in two groups. CONCLUSIONS: GlideScope offers superiority over Macintosh laryngoscope in terms of laryngeal views and the difficulty encountered at ETI in an unselected population.

Tramadol sparing effect of dexmedetomidine as an adjuvant with lignocaine in preoperative stellate ganglion block for postoperative pain relief following upper limb surgeries.

BACKGROUND: Recent literature has established the role of stellate ganglion block (SGB) for management of acute postoperative pain. The effects of dexmedetomidine as an adjuvant to lignocaine in a preoperative SGB for postoperative pain relief have not been evaluated so far. METHODS: The following randomised, double-blinded, control trail included 54 patients scheduled for upper limb orthopaedic surgery under general anaesthesia. Preoperative ultrasound-guided (USG) SGB was performed in all patients. Group I (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 µg/kg dexmedetomidine for SGB) and 15 mL of intravenous (IV) normal saline (NS). Group II (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL NS for SGB) and 15 mL of IV NS. Group III (n = 18) received 3.5 mL of a solution (3 mL 2% lignocaine + 0.5 mL of NS for SGB) and 0.5 µg/kg dexmedetomidine in 15 mL of IV NS. Postoperatively tramadol consumption and Visual Analogue Scale (VAS) score were recorded up to 48 hours. RESULTS: The cumulative tramadol consumption at the end of 48 hours (p = 0.01) was significantly reduced in the group I as compared to group II. In group I, postoperative VAS at rest was significantly reduced up to 12 hours postoperatively as compared to group II (p = 0.05). The cumulative tramadol consumption was not reduced significantly in group III compared to group II (p = 0.51). CONCLUSION: Dexmedetomidine as an adjuvant to SGB along with lignocaine produced a significant tramadol sparing effect and superior analgesia as compared to IV dexmedetomidine and control group.1.