Unilateral Epidural Block Versus Ultrasound Guided Combined Femoro-sciatic Nerves Block for Patients With Low Ejection Fraction

Study Overview
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Brief Summary
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compare unilateral epidural anesthesia versus femoral/sciatic nerve block by ultrasound guided as anesthetic technique for cases with low ejection fraction undergoing insertion of nail tibia for fixation of fracture shaft tibia.

Detailed Description
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Group A ;( Unilateral epidural anesthesia group) Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia using unilateral epidural anesthesia. Group B;;( Ultrasound guided femoro/ sciatic nerve block group) Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia by femoral/sciatic nerve block using ultrasound guidance. For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the epidural group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request will be recorded.

Official Title
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Comparative Study Between Intentional Unilateral Epidural Block Versus Ultrasound Guided Combined Femoro-sciatic Nerves Block for Patients With Low Ejection Fraction Undergoing Insertion of Nail Tibia for Fixation of Fracture Shaft Tibia

Conditions
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Low Ejection Fraction Patients, Fracture Tibia

Intervention / Treatment
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* Procedure: unilateral epidural anesthesia
* Procedure: Ultrasound guided femoro/ sciatic nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 to 60 years old. Patients scheduled for elective insertion of nail tibia for fixation of fracture shaft tibia. Patients with low ejection fraction (30-40%). Exclusion Criteria: Patient refusal Uncooperative patient Unconscious patients Cases with head trauma History of relevant drug allergy to local anesthetics Local infection at the site of the block Patients with coagulopathies and impaired platelet functions Patients with hemodynamic instability Previous neurological deficit in lower limb and previous femoral artery grafts or injuries.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Unilateral epidural anesthesia group<br>Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia using unilateral epidural anesthesia. | Procedure: unilateral epidural anesthesia<br>* Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia using unilateral epidural anesthesia.<br>* Other names: Ultrasound guided femoro/ sciatic nerve block;|
| Active Comparator: Ultrasound guided femoro/ sciatic nerve block group<br>Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia by femoral/sciatic nerve block using ultrasound guidance. | Procedure: Ultrasound guided femoro/ sciatic nerve block<br>* Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia by femoral/sciatic nerve block using ultrasound guidance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean blood pressure |  | 20 minutes after anesthesia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| adequate sensory block |  | 20 minutes after the block | 
| adequate motor block |  | 15 minutes after the block | 
| time of first analgesic request |  | within 24 hours after the block |