Postoperative pain is often undertreated. Safe and effective pain management should be the primary goal to improve patient rehabilitation and satisfaction. Post operative pain relief can be achieved by a variety of techniques including parental NSAIDS (non-steroidal anti-inflammatory drugs), opioids, epidural analgesia, patient controlled analgesia and peripheral nerve blocks. Three in one femoral nerve block is relatively simple to perform, effective, low risk technique with a high success rate.

The 90 patients ASA grade I-II in age group 18-80 years undergoing fracture femur surgery at SGRD Amritsar will be studied with the aim of evaluating the effectiveness of addition of tramadol or butorphanol as adjuvants to levobupivacaine vs levobupivacaine and saline through 3 in 1 femoral nerve block randomly divided into 3 groups with 30 patients each receiving preemptive three in one nerve block either using 0.25% Levobupivacaine alone (Group I) or tramadol 1mg/kg (Group II) or butorphanol 0. 06mg/kg as adjuvant to 0.25% levobupivacaine (Group III). To every patient spinal anaesthesia using 0.5% heavy bupivacaine will be given. Ease of positioning, pain relief, and duration of post operative analgesia in all the three groups will be compared. In addition, post operative requirement of intravenous diclofenac 75 mg will be evaluated.