الفهرس 
Physiology of Pain
Cardiovascular effectsOnly 14 pages are availabe for public view
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Abstract
When a noxious stimulus produces tissue injury, chemical mediators are released and activate nociceptors which in turn generate nerve impulses. Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, restriction of mobility, nausea and vomiting, increase in the systemic vascular resistance, cardiac work, and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response.
Orthopedic surgeries are associated with moderate to severe postoperative pain, so these procedures are better to be done under regional anesthetic techniques which reduce neuro-endocrinal stress responses, central sensitization of the nervous system and muscle spasms which occur in response to painful stimuli.
Treating postoperative pain in patients using opioids is an enduring challenge for health care providers and should be targeted to provide adequate analgesia for increased pain sensitivity of opioid-induced hyperalgesia, prevent withdrawal that might produces sympathetic over-stimulation and heightens stress responses, and finally to avoid triggering a relapse or worsening of the addiction disorder.Recently, among these regional anesthetic techniques PNB are gaining popularity because they reduce the possibility of complications and side effects associated with the central blocks. Continuous femoral and sciatic nerves block provides effective analgesia and anesthesia with potentially fewer complications and side effects than epidural blocks in lower limbs orthopedic surgeries.
The purpose of this study was to compare between epidural analgesia and continuous femoral and sciatic nerves block in adult drug-abuser patients undergoing orthopedic surgeries including comparison of analgesic efficacy, side-effects, and complications.
The study was performed upon 60 patients, aging 20-60 years, and randomly distributed among two groups:
group A:
30 patients received lumbar epidural analgesia followed by general anesthesia.
group B:
30 patients received continuous femoral and sciatic nerves block followed by general anesthesia.
For each patient, the following data were collected: age, gender, weight, height, ASA, duration of surgery, hemodynamic changes, incidence of postoperative complications, pain scores, morphine consumption, rehabilitation indices and duration of hospital stay.
The results showed that performing continuous femoral and sciatic nerves blocks provided effective analgesia, equivalent rehabilitation and duration of hospital stay in addition to fewer complications in comparison to continuous epidural analgesia such as hypotension, postoperative vomiting and urinary retention.