Tramadol Versus Midazolam In Psoas Compartment Block (Lumbar Plexus Block) With Bupivacaine For Lower Limb Surgeries

lumbar plexus anesthesia for major hip and knee surgery is becoming a standard technique.A posterior approach to the lumbar plexus was first described by Winnie and colleagues. Psoas compartment block is a deep block of the lumbar plexus from a posterior approach and it has been shown to achieve more consistent blockade of the obturator nerve.Psoas compartment block has been used to provide anesthesia for thigh surgery, for analgesia after total hip arthroplasty or total knee arthroplasty as well as in the treatment of chronic hip pain.Tramadol hydrochloride is a synthetic opioid analgesic with a relatively weak affinity to opioid receptors. It is a synthetic 4-phenyl-piperidine analog of codeine. Not only does tramadol display central analgesic effects as the result of its monoaminergic and mu-receptor agonistic activity, it also exhibits a non central analgesic effect that has led to its use as an adjunct to local anesthetics in the peripheral nervous system.Midazolam is a water-soluble benzodiazepine with a rapid onset and imidazole ring in its structure that account for stability in aqueous solutions and rapid metabolism.Midazolam produces this effect by its action on gamma aminobutyric acid-A (GABA-A) receptors. GABA receptors have also been found in peripheral nerves.