الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Total joint arthroplasty is a major treatment option for pain and physical disabilities, and it can improve the patient’s quality of life. Patients undergoing total hip and knee replacement surgery especially, experience significant postoperative pain; as severe pain is reported in 60% of the patients and moderate pain is reported in up to 30% of patients undergoing total knee arthroplasty.
This overwhelming fear of severe postoperative pain and a prolonged recovery have made the arthroplasty procedures still underused despite the incredible impact.these procedures have on the quality of life of people with degenerative joint disease of the hip and knee.
The importance of pain extends far beyond the humanitarian and ethical aspects of inadequate pain control. Acute pain results in various physiologic changes that have important effects on the patient’s clinical course. Unrelieved pain is likely to cause adverse effects on more than one body system, particularly in high-risk surgical patients, that makes the surgical stress of total joint arthroplasty too great for the patients, and even threatened his life.
On the other hand unrelieved acute pain leads to the development of chronic pain. It is also generally believed that joint splinting and relative immobilization lead to joint stiffness. Moreover, severe postoperative pain is a common reason for delays in hospital discharge and unanticipated hospital admissions. So the target is always effective pain relief after surgery or acute injury that increases mobility and expedite a patient’s return to normal function with earlier return to work and better psychological benefits.
Regional anesthesia as pain management for total knee arthroplasty was considered as an adequate modalities for controlling post-operative pain but the contradicting issues about the prophylactic anticoagulation as a mandatory treatment in patient electively undergo knee arthroplasty, making the decision of which regional technique could be used; is challenging.; so an alternative regional anesthesia technique was considered as peripheral nerve blockade (PNB) of one or more major nerves supplying the lower limb. PNB may provide effective unilateral analgesia with a lower incidence of opioid-related and autonomic side-effects, less motor block, and fewer serious neurological complications compared with epidural analgesia.
Regarding the knee joint, is supplied by the femoral, obturator, and sciatic nerves, The femoral, obturator and lateral femoral cutaneous nerve are the most important branches of the lumbar plexus which forms within the Psoas muscle from the anterior rami of T12-L4, the femoral nerve is a mixed sensory and motor nerve. The motor fibers supply the quadriceps femoris, sartorius, and pectineus muscles, while the sensory fibers innervate the anterior thigh and medial aspect of the knee and lower leg. Femoral nerve block is a relatively safe and easy block as well as Adductor canal block.
The use of postoperative continuous femoral infusion or Adductor canal infusions is associated with a decrease in morphine consumption by up to 70%. This technique permits more rapid postoperative functional recovery, better functional outcomes, and a reduction in length of hospital stay. Advances in nerve localization such as ultrasound imaging and continuous catheter technology have also helped to increase interest in PNB for lower limb surgery.
The adductor canal block (ACB), or more precisely the