Combined Lumbar and Sacral Branches Block Through the Ilio-Psoas Muscle Spaces for Analgesia of Lower Limb Surgeries

Inclusion Criteria: * ASA I-II. * patients scheduled for unilateral femur or tibial surgery necessitate knee joint intervention * patients who have severe pain hindering changing their position or patients who have spinal fractures or refusing spinal anesthesia. * patients with the capability of communication Exclusion Criteria: * puncture site infection * patients with coagulation disorders * patients who refuse to participate or withdraw due to personal reasons * allergy to local anesthetics. * past surgery at the site of the block * hip ankylosis * drug abuse * Body mass index ≥ 35 kg/m2 * peripheral vascular insufficiency * use of alpha or beta blocker agents * Nerve injury or neuropathy of the affected lower limb * cardiovascular or respiratory decompansation