الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Pain relief is a primary therapeutic objective in traumatic injuries. Many strategies to control post traumatic pain have been described Aim of the work : This study was designed to investigate the effect of lower limb trauma on hemodynamic and plasma stress markers level and the effect of early administration of different analgesic modalities on the hemodynamic and stress markers level in stressfully traumatized lower limb fracture patients. Study design :The current study was carried on fifty patients of either sex with age ranging from 20 <U+2013> 60 years presented with lower limb fractures in Mansoura Emergency Hospital. Patients were allocated into five groups according to the analgesic technique that was adopted either iv tramadol or epidural local anesthetic Results and conclusion : the result of current study proved that epidural analgesia anesthesia with local anesthetic provided good pain control with greater attenuation of the neuroendocrine stress response manifested by decrease in the level of stress markers level (cortisol, adrenaline, noradrenaline and blood glucose) with high degree of hemodynamic stability . Inhibition of stress response is greater after continuous epidural analgesia with local anesthetic than continuous iv infusion of tramadol .The profile of block with the low dose of ropivacaine infusion in term of its greater sensory motor separation in addition to its more greater attenuation of stress response makes it suitable for continuous epidural analgesic infusion and provided a better balance between analgesia and motor block.