الفهرس 
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Abstract
Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain.
Neuroaxial block is used for postoperative pain management and decrease analgesic use.
Many adjuvant drugs are added to bupivacaine to prolong the duration of sensory block like opioids and dexamethasone.
Clinically, Dexamethasone is a synthetic glucocorticoid with anti-inflammatory & immunosuppressant properties which has a rapid onset & long duration of action. Adverse effects are extremely rare and not reported for perineural injection however, minimal adverse effects were reported for systemic injection.
The aim of this thesis was to study the effect of adding both perineural & systemic dexamethasone as an adjuvant to bupivacaine in femoral and sciatic nerve block. The comparison included the effect on haemodynamics, postoperative pain & postoperative analgesic requirement.
In our study, 50 patients were randomly divided into two equal groups:
group A (Perineural Dexamethasone group) [n=25]
Those cases received 2ml volume of dexamethasone (8mg) combined with the 20 ml of bupivacaine of 0.5% concentration in each block, followed by injecting 5 ml saline intravenous.
group B (Systemic Dexamethasone group) [n=25]
Those cases received 2 ml of dexamethasone (8mg) diluted over 3 cm saline in a 5 ml syringe following injection of the perineural 20 ml bupivacaine (0.5%) combined with 2 ml saline to have the same syringe volume for each block.
Our study showed that addition of dexamethasone to bupivacaine in femoral and sciaticnerve block whether perineural or intravenous prolonged postoperative analgesia with negligible side effects & slightly better outcome to the perineural route.