Background
hypotension
Surgical patients require effective intraoperative anesthesia and postoperative analgesia. Both spinal and epidural neuraxial blocks are widely used. Spinal anesthesia with a small dose of local anesthetic agent gives immediate and effective sensory and motor block, but its major side effects are hypotension and difficulty in controlling the level of the block [Hence, we hypothesized that the addition of either nalbuphine or DEX to epidural bupivacaine could be effective in prolonging the duration of postoperative analgesia for patients undergoing lower limb orthopedic surgeries.This study aimed to compare the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine for the achievement of adequate postoperative analgesia in patients undergoing lower limb surgeries under combined spinal-epidural anesthesia.