Unilateral Block Research Articles

External auditory canal osteoma with coexisting canal wall cholesteatoma: a case report and review of literature

BackgroundThough rare, benign lesions that usually do not necessitate active intervention, osteomas of the external auditory canal, can be troublesome when they start to produce mass effect and severe obstruction to the external auditory canal. Even more insidious is the rarer phenomenon of canal wall cholesteatomas, which have been known to cause significant canal erosion and if left unchecked and spontaneous destruction of the adjacent anatomical structures, including the facial nerve, temporomandibular joint, sigmoid sinus, and skull base. The occurrence of both these exceptionally uncommon findings in the same canal is an unusual finding and may point to an undetermined interplay in pathogenesis.Case presentationHere, we describe one such case in a 39-year-old gentleman hailing from South India who presented with complaint of unilateral ear block and decreased hearing and how it was managed.ConclusionsWhile osteomas are usually incidental findings in asymptomatic patients, the potential for mass effect and canal obstruction must be kept in mind and patients must be evaluated for development of the more sinister cholesteatoma in the deeper canal.

Evaluation of the Rostral Inferior Alveolar Nerve Block via the Mental Foramen in Equids: In Vivo Efficacy Testing.

The use of proper sedative and regional anesthetic protocols is essential when performing equine dental surgical procedures under standing sedation. The efficacy of the rostral inferior alveolar nerve block via the mental foramen has not been previously studied. Aims of this study included determining the efficacy of the block, investigating whether any region (labial mucosa, alveolar mucosa, or teeth) was more reliably anesthetized, and if differences in efficacy existed between bilateral and unilateral blocks. In this blinded trial, 10 horses each were randomly assigned to receive a left unilateral block, right unilateral block or bilateral blocks and 5 horses were bilateral controls. For unilateral groups, the contralateral side of the horse acted as its own unilateral control. Mechanical nociceptive stimulus methods were used to determine response to stimulus at time points pre-sedation, post-sedation, and post-injection at 10, 30, 60, and 90 min. Results were evaluated in 4 groups: unilateral blocks, unilateral controls, bilateral blocks and bilateral controls. Overall, all groups were significantly less likely to respond to stimulus at time points post-sedation, T10, and T30, whereas only blocked sites were less likely to respond at T60 and T90 compared to pre-sedation. There was no significant difference in response to stimuli of blocked sites between the 3 regions at all time points. Overall, at T60 and T90, blocks produced regional anesthesia in 73% and 55% of sites, respectively. This study demonstrated the equine mental foramen regional nerve block has varied efficacy, producing partial or incomplete regional anesthesia in some cases.

An interventional prospective cohort study of efficacy of unilateral vs bilateral percutaneous posterior approach neurolytic celiac plexus blocks

Background: The neurolytic celiac plexus block (NCPB) has been a valuable intervention for managing upper abdominal cancer pain. However, the optimal approach for performing a NCPB remains a topic of debate. We conducted this study to establish the efficacy of unilateral vs bilateral percutaneous posterior approach NCPB. Methodology: This prospective, interventional study includes a cohort of individuals through chronic abdominal pain related to malignancies who were scheduled to undergo NCPB. Patients were divided into two groups, one group received the unilateral percutaneous posterior approach NCPB, and the other group received the bilateral NCPB by percutaneous posterior. Pain scores and adverse events at multiple time points post-procedure were recorded. Statistical analysis was conducted to compare pain score and adverse events between the two groups and evaluate the impact of the chosen approach on pain management. Results: Bilateral percutaneous posterior approach provides slightly better pain relief compared to the unilateral approach in the early post-procedure period which is not statistically significant. Complication rates appear to be comparable between the two approaches, with no major safety concerns identified. Conclusion: While the bilateral approach initially offers more effective pain relief, the long-term benefits and safety profiles of both methods are comparable. Clinical decision-making should consider these findings and prioritize individualized patient care. Abbreviations: CPB - Celiac Plexus Block; NCPB - neurolytic celiac plexus block; PACU - post-anesthesia care unit; VAS - visual analogue scale Keywords: Neurolytic celiac plexus block, Pancreatic cancer pain, upper abdominal malignancy Citation: Abbas MQ, Abbas SM, Farooq MF, Siddique M, Malik S. An interventional prospective cohort study of efficacy of unilateral vs bilateral percutaneous posterior approach neurolytic celiac plexus blocks. Anaesth. pain intensive care 2024;28(5): 798−803; DOI: 10.35975/apic.v28i5.2559 Received: March 24, 2024; Reviewed: August 05, 2024; Accepted: August 08, 2024

Complete anesthesia after unilateral sacral ESP block.

Complete anesthesia after unilateral sacral ESP block.

A Retrospective Study of Leparoscopic Evaluation of Tubal Factors in Case of Infertility

Background: Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The aim of this study was to determine the role of leparoscopic evaluation of Tubal factors in case of infertility. Methods: A retrospective study was carried out at Department of Gynae and Obstetrics UHC, Dhamrai, Dhaka, Bangladesh from January to December 2023. 55 patients were selected for laparoscopic evaluation. Inclusion criteria were patients with no prior pelvic surgery, normal bimanual pelvic examination, normal semen parameters of partner and no ovulatory dysfunction. After obtaining thorough history & detailed examination, patients were informed about the procedure and written informed consent was taken. Results: 55 patients underwent laparoscopy during the study period. Most patients 10 were in the age group of ˂20 yr, 15 were between 21-30 yr & 20 were 31- 40 yr of age and 10 were between 36 – 40 yrs of age. Among these 55 patients 24 patients had primary infertility while 31 had presented with secondary infertility. Diagnostic laparoscopy revealed normal pelvic organs in 9 (16.3%) cases, Chronic pelvic inflammatory disease in 3 (5.4%), endometriosis in 13 (23.6%) and congenital anomalies of uterus in 1(1.8%) cases. 7.2% cases had bilateral tubal block, 27.3% had unilateral block and in 7.2% cases though the tubes were found patent significant peritubal adhesions were noted. Tubal pathology was detected in 55.5% cases of primary infertility and 42.1% cases of secondary infertility. Among those who had tubal pathology, nonspecific pelvic inflammatory disease was noted in 33.3% and genital tuberculosis was diagnosed in 2.7% cases. The most common complications were pyrexia, shoulder tip pain, nausea and vomiting. Conclusion: Laparoscopy is a safe and effective diagnostic tool in evaluating tubal status of infertile patients. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor.

Anterior quadratus lumborum block for analgesia after living-donor renal transplantation: a double-blinded randomized controlled trial

IntroductionLimited non-opioid analgesic options are available for managing postoperative pain after renal transplantation. We aimed to investigate whether the unilateral anterior quadratus lumborum (QL) block would reduce postoperative opioid consumption...

Three-point Method Nerve Block for Relieving Pain of Microbotox Injection in Middle and Upper Face.

With the popularity of microbotox, pain caused by multiple microdroplets and subcutaneous injection of botulinum toxin is increasing. This study presents a new, refined, three-point nerve block technique that provides effective pain relief during minimally invasive injection therapy targeting the middle and upper face. Fifty volunteers underwent facial ultrasonography to measure the locations of the supraorbital and infraorbital foramen. Following microdrop Botox injection of the middle and upper face, 100 patients underwent a self-controlled study to analyze whether a three-point nerve block surpasses topical anesthesia for reducing injection pain. The visual analog scale pain score, the time of the three-point method and botulinum toxin injection, and side effects were recorded. Among the volunteers, the location of the supraorbital and infraorbital foramen showed no statistical difference between the left and right sides. For the 100 patients (13 men, 87 women) who underwent the three-point nerve block, the visual analog scale pain scores on the experimental side were significantly lower than those on the control side, except in the frontotemporal region (2.46 ± 0.50, 2.42 ± 0.47, P > 0.05). The duration of the unilateral three-point nerve block was 74.8 ± 5.64 seconds. The total injection time was 189.86 ± 26.79 seconds (range 148-286 s). The three-point method exerted prominent analgesic effects during middle and upper facial treatments, with benefits including a precise block region, high satisfaction, and simple operation technique. Therefore, clinicians can easily master and apply this method.

Comparison of ultrasound-guided rhomboid intercostal and subserratus plane block versus thoracic paravertebral block for analgesia in thoracoscopic surgery: a randomized, controlled, non-inferiority trial.

To investigate the non-inferiority of ultrasound-guided rhomboid intercostal and subserratus plane (RISS) block compared to thoracic paravertebral block (TPVB) in postoperative analgesia for thoracoscopic surgeries. This study consecutively enrolled 50 patients undergoing elective thoracoscopic surgery. Following general anesthesia, the RISS group received a unilateral block with 40 mL of 0.25% ropivacaine, while the TPVB group received with 30 mL of 0.33% ropivacaine. The primary outcome measure was the 24-hour postoperative resting VAS score. Secondary outcome measures included nerve block operation time for two groups, postoperative 1, 2, 4, 8, 48-hour resting VAS scores, and different time points coughing VAS scores, time to first postoperative ambulation, total intravenous analgesic consumption at different time points postoperatively, complications related to the block. There were no significant statistical differences between the two groups in terms of postoperative rest and cough VAS scores at each time (P>0.05), and the mean difference in rest VAS scores did not exceed the non-inferiority margin in 95% CI. There were no significant differences in total intraoperative and postoperative analgesic consumption at different time points (P>0.05), and no significant differences in time to first postoperative ambulation (P>0.05). Compared to the TPVB group, the RISS group had a shorter nerve block operation time (259.43±30.11 vs. 335.23±30.96 s, P<0.001) and fewer instances of intraoperative hypotension (two vs. seven cases, P=0.022), bleeding at the puncture site, pneumothorax, and arrhythmia. In thoracoscopic surgeries, the postoperative analgesic efficacy of ultrasound-guided RISS block is not inferior to TPVB. Compared to TPVB, RISS block is simpler, quicker, and associated with fewer puncture-related complications.

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study.

This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25mg pethidine as a rescue analgesic to patients with VAS ≥4. Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

No quadriceps muscle weakness following anterior quadratus lumborum block compared with placebo: a randomized, non-inferiority, blinded, volunteer trial

Background and aimsAnterior quadratus lumborum block is a truncal block, applied in close proximity to the lumbar plexus, potentially causing lower limb weakness. This trial aimed to evaluate whether a...

Comparison of midpoint transverse process to pleura (MTP) block and erector spinae plane block (ESP) for postoperative analgesia in modified radical mastectomy patients: A double-blinded, randomized control trial.

Modified radical mastectomy (MRM) is associated with moderate severity of postoperative pain. Besides intravenous (IV) analgesics, various nerve blocks are being described for pain relief of MRM patients. We compared erector spinae plane (ESP) block with midpoint transverse process to pleura (MTP) block in these patients for postoperative analgesia. After receiving ethical committee approval from the institutional ethics committee (AIIMS, Jodhpur) and written informed consent from study participants, 66 patients who were assigned American Society of Anesthesiologists (ASA) physical status I and II, aged 18-75 years, and were scheduled to undergo MRM were enrolled and randomly allocated into two groups. Unilateral block was given before surgery at T3 or T4 level and with 15 ml of 0.5% ropivacaine in both the groups. Infusion of 0.5% ropivacaine (Neon laboratories limited, Mumbai, India) and 0.2% ropivacaine at a rate of 5 ml/h was maintained intraoperatively and postoperatively, respectively. Pain was assessed using the Visual Analogue Scale (VAS) for the next 24 hours. The total number of patients needing rescue analgesia, the total amount of rescue analgesics consumed in the next 24 hours, and patient satisfaction score were also compared between groups. Demographics and baseline vitals were comparable in the groups. On comparing VAS scores in both the groups during rest and movement at different time intervals, there was no difference in pain scores during the initial two hours. From the third hour, there was a statistically significant difference (P < 0.001) in pain VAS scores in both groups. The ESP group had lower VAS scores compared to the MTP group when followed for the next 24 hours. There was a statistically significant difference in patient satisfaction. ESP block is more efficacious when compared to MTP block for postoperative analgesia in MRM patients.

Comparative Study between Bilateral and Unilateral Erector Spinae Plane Block in Managing Postoperative Pain in Laparoscopic Cholecystectomy

Background: Postoperative pain after laparoscopic cholecystectomy remains as an important problem, with two components: somatic and visceral. Surgical incisions lead to somatic pain, while abdominal inflation and diaphragm irritation leads to visceral pain. Erector spinae plane block is a newly described interfascial plane block. Aim: to compare bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy Patients and Methods: The study involved 50 patients scheduled for elective laparoscopic cholecystectomy. Patients were randomly assigned in to two equal groups each with 25 patients: unilateral and bilateral erector spinae plane block. Numerical Pain score and need for analgesia during all time points to 12 hr post recovery; hemodynamic indices at baseline, during all time poins from full recovery to 12 hr post recovery were recored. Results: there were no significant differences between the two groups in hemodynamic indices. At 12thhr post operation, 36%, 12% and 36% of patients in unilateral group demonstrated mild, moderate and required rescue analgesia, respectively compared with 28%, 8% and 20% of patients in bilateral group with a statistically significant difference. at 3rdhr post operation, 12% and 8% of patients in unilateral group need paracetamol and tramal, respectively, compared 4% and 0%, respectively in bilateral group, with a significant difference. Additionally, at 12thhr post operation, 34% and 12% of patients in unilateral group need paracetamol and tramal, respectively, compared 28% and 8%, respectively in bilateral group, with a significant difference. Conclusions: Unilateral and bilateral erector spinae plane block seem to have no serious impact hemodynamic indices. Bilateral block is associated with lower pain score and need for postoperative analgesia than unilateral block

Dissociation between Selecting and Orienting Attentional Reading Deficits: A Study in Adults with Epilepsy.

Word reading requires a range of spatial attention processes, such as orienting to a specific word and selecting it while ignoring other words. This study investigated whether deficits of these spatial attention processes can show dissociations after hemispheric lesions. Thirty-nine patients with left or right focal epilepsy and 66 healthy participants had to read aloud four-letter words presented in the left and right visual hemifields. There were three successive blocks of presentation: in the unilateral block, a single word was presented in one of the visual hemifields; in the bilateral block, two words were presented simultaneously, one in each visual hemifield; in the cued block, two words were also presented, but only the cued word had to be reported. Twenty-one patients, twelve with a left and nine with a right hemisphere lesion, showed a word reading deficit. Four had specific difficulties in the cued block, suggesting an attentional selection reading deficit. Twelve patients had an asymmetric reading deficit, suggesting an attention orientation or a visual field deficit. Five patients had more complex deficits. The visual field presentation procedure may help to reveal different types of reading disorders in patients with epilepsy and to dissociate orienting and selecting deficits.

ND YAG Capsulotomy-induced Acute non-pupillary Block Glaucoma in a Pseudophakic Patient

Secondary angle-closure glaucoma (ACG) due to pupillary block in pseudophakic patients has numerous reports in the literature. We report a 60-year-old pseudophakic patient with occurrence of unilateral non-pupillary block secondary ACG caused by vitreous prolapse after laser capsulotomy. He received topical and oral aqueous suppressants as treatment, and he underwent anterior vitrectomy with pars plana vitrectomy. This report aims to supplement the scant literature on this condition and to educate clinicians of the value of imaging in secondary ACG with non-pupillary block in pseudophakic patients to determine the cause and tailor treatment.

Is the application of subcostal transversus abdominis plane block effective for pain control in classical four-port laparoscopic cholecystectomy?

The utilization of transversus abdominis plane (TAP) block for postoperative pain management has proven to be efficacious. The purpose of this inquiry is to evaluate the effectiveness of right-sided TAP blockade guided by ultrasonography (USG) in managing pain subsequent to laparoscopic cholecystectomy. A total of 60 patients were equallydistributed into two groups. The control group was comprised of patients who did not receive a TAP block, whereas the TAP block group consisted of patients who underwent an ultrasound-guided, right-sided unilateral subcostal TAP block with 20 mL of 0.25% bupivacaine. A Verbal Numerical Rating Scale was administered to all participants for pain assessment at postoperative intervals of 0th, 6th, 12th and 24th hours. Additionally, the overall amount of supplementary analgesic used after surgery, age distribution among each gender classification and body mass index range categories as well as operation time duration; use or non-use of drain; and incidence rate for postoperative complications were recorded for each patient individually. The mean age of participants was 47.72 ± 13.80 years, with a female-to-male ratio of 41/19. The control group exhibited significantly higher pain scale measurements than the block group at the postoperative 0th and the postoperative 24th hour. Drain replacement yielded notably higher pain scores for both TAP and control groups at the postoperative 0th hour. Neither BMI nor operation duration had significant effects on postsurgical pain in either patient group—whether or not they received a TAP block treatment. Our research shows that the implementation of a TAP block and exclusion of surgical area drainage placement yield favorable results in mitigating postoperative pain. Notably, BMI and procedure duration do not exhibit any discernible impact on postoperative pain management.

Complications profile following regional anesthesia: Comparative analysis between ankle and unilateral spinal blocks for foot surgery

Objectives This study aims to compare the complications profile between ankle block and unilateral spinal block for foot Surgeries. Ankle block is expected to provide minimal intraoperative and postoperative complications compared to unilateral spinal block following foot surgeries. Material and Methods Fifty adult patients scheduled for elective foot surgeries that met the inclusion criteria were enrolled in the study. They were assigned into two groups of 25 each as they came, group A (ankle block) and group S (unilateral spinal block). Group A had surgery under the ankle block using 4 ml of 0.5% plain bupivacaine to block each nerve. In contrast, group S had surgery under a unilateral spinal block using 3 ml of 0.5% heavy bupivacaine. The complications were observed and recorded. The data obtained were analyzed using Statistical Package for Social Sciences version 25.0 and were presented using relevant proportions, tables, and figures. Statistical association tests were performed with a confidence level of 95%, and a p-value of less than 0.05 was taken as significant. Results The intraoperative complications observed between the two groups; three patients (12%) had nausea for group S while two patients (8.7%) had nausea from group A, two patients (8%) had vomiting from group S while one patient (4%) from group A had vomiting, three patients (12%) had bradycardia from group S and one patient (4%) had bradycardia from group A, three patients (12%) from group S had hypotension while no patient had hypotension from group A. The postoperative complications between the two groups; 2 (8%) patients had nausea from group S while only one patient (4%) had nausea from group A, Only 1 (4%) patient had vomiting from group S and one patient (4%) had vomiting from group A. Only two patients (8%) had urinary retention from group S, while no patients from group A had urinary retention. No patient had a postural puncture headache or shivering from group S. Conclusion Ankle block is associated with minimal complications compared to unilateral spinal block.

Erector spinae plane block versus caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair: a randomized controlled trial

Background Erector spinae plane block is a promising strategy for pain management in some settings. However, the effectiveness of erector spinae plane block versus caudal block in pediatric inguinal hernia repair has yet to be formally investigated. Methods One hundred and two patients aged 2–5 years undergoing unilateral open inguinal hernia repair randomly received unilateral erector spinae plane block (0.2% ropivacaine 0.5 mL kg−1), caudal block (0.2% ropivacaine 1 mL kg−1), or no block. The primary outcome was time to the first rescue analgesia, defined as the interval from the end of surgery to the Face, Legs, Activity, Cry, and Consolability scale greater than three. Secondary outcomes included the number of patients requiring rescue analgesia, the area under the curve of pain scores over time, satisfaction of guardians, and adverse events. Results The median time to the first rescue analgesia was longer in the erector spinae plane block group than in the caudal block group [10.0 h (interquartile range, 6.6–24.0 h) vs. 5.0 h (interquartile range, 2.9–7.3 h); p < .001]. The Cox regression model demonstrated that the risk of postoperative rescue analgesia requirement was 0.38 in children receiving erector spinae plane block compared with caudal block (95% confidence interval 0.23–0.64; p < .001). Additionally, the area under the curve of the pain scores over time was lower in the erector spinae plane block group than in the caudal block group (44.3 [36.6–50.7] vs. 59.0 [47.1–64.5]; p < .001). Conclusions Erector spinae plane block provided superior postoperative analgesia compared to caudal block in children undergoing inguinal hernia repair. Trial registration: Chinese Clinical Trial Registry; ChiCTR2100048303

Perioperative analgesic efficacy of lumbar erector spinae plane block in dogs undergoing hemilaminectomy: a randomized blinded clinical trial

ObjectiveTo evaluate the perioperative analgesic effect of the unilateral lumbar erector spinae plane block (ESPBL) in dogs undergoing hemilaminectomy. Study designRandomized, blinded clinical study. AnimalsA total of 30 client-owned dogs undergoing thoracolumbar or lumbar hemilaminectomy for intervertebral disc extrusion (IVDE). MethodsDogs were randomly assigned to receive a unilateral ESPBL, performed either with 0.4 mL kg−1 ropivacaine 0.5% [group ROPI (n = 15)] or with saline solution [CNT group (n = 15)]. Dogs were premedicated intravenously (IV) with acepromazine 5 μg kg−1 and methadone 0.2 mg kg−1, general anaesthesia was induced by administering IV midazolam 0.2 mg kg−1 and propofol to effect and maintained with isoflurane. Fentanyl was administered as rescue analgesia. Bradycardia [heart rate (HR) < 60 beats minute−1] with hypotension was treated with atropine IV. The Short-Form of the Glasgow Composite Pain Scale was used pre- and postoperatively at 1, 2, 4, 8, 12, 16, 20 and 24 hours after extubation, and methadone 0.2 mg kg−1 was administered IV when pain score was ≥ 5/20. HR and end-tidal concentration of isoflurane (Fe'Iso) were compared between groups with anova combined with a Dunnet’s post hoc test. Time to the first rescue methadone and total dose of fentanyl (FENtot, μg kg−1 hour−1) and methadone (METtot, mg kg−1) in the first 24 postoperative hours were compared using unpaired Student’s t test. Postoperative pain scores were compared with the Mann–Whitney test and atropine administration with a Fisher’s exact test; p < 0.05. ResultsHR, Fe'Iso, FENtot, METtot and atropine administration were significantly lower in group ROPI compared to CNT. Postoperative analgesic effect was significantly longer, and pain scores were significantly lower in group ROPI for all time points. Conclusions and clinical relevanceUnilateral ESPBL with ropivacaine reduced perioperative opioid consumption and the occurrence of bradycardia in dogs undergoing hemilaminectomy.

Transmedian overlap of sensory distribution is a possible cause of unilateral interfascial plane block failure.

Transmedian overlap of sensory distribution is a possible cause of unilateral interfascial plane block failure.

Study of Saline Infusion Sonography and Hysterosalpingography to See the Tubal Patency in the Infertile Women

Background: Infertility is a global issue in reproductive health. Etiology Of infertility is multifactorial and fallopian tube abnormality being one of the most important causes accounts for up to 40%of female infertility. Saline infusion sonography (SIS) is gaining popularity and being widely practiced and accepted as a screening tool in assessing tubal patency. Objectives: To compare the efficacy of tubal patency test with saline infusion sonography and hysterosalpingography in infertile women. Methods: It is a quasi-experimental study. 120 consecutive infertile women in 25-40 years, who are ovulating spontaneously or by ovulation induction who was needed tubal assessment included here. 60 patients went for saline infusion sonography, 60 went for hysterosalphingography which was allocated by lottery. Result: Main outcome was find out the diagnostic accuracy of saline infusion sonography over conventional hysterosalpingography for evaluation of tubal patency. Tubal patency confirmed by SIS 54(89.99%) had at least one tube patent. Tubal block 6(10.01%). HSG bilateral tubal patency 40(66.67%), bilateral tubal block 15(25.00%), unilateral block 5(8.33%). SIS had sensitivity 86% specificity 97%, positive predictive value 97% and negative predictive value 83% in tubal patency. Conclusion: SIS employed as a screening procedure to pick up subjects needing HSG and laparoscopy Low risk subjects for tubal factors in infertility, sonohysterosulphingography can be. It is simple, relatively less expensive, minimally invasive procedure. J Com Med Col Teachers Asso Jan 2023; 27(1): 27-33