compare unilateral epidural anesthesia versus femoral/sciatic nerve block by ultrasound guided as anesthetic technique for cases with low ejection fraction undergoing insertion of nail tibia for fixation of fracture shaft tibia.

Group A ;( Unilateral epidural anesthesia group) Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia using unilateral epidural anesthesia.

Group B;;( Ultrasound guided femoro/ sciatic nerve block group) Forty patients with low ejection fraction (30-40%) will do elective insertion of nail tibia for fixation of fracture shaft tibia by femoral/sciatic nerve block using ultrasound guidance.

For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the epidural group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request will be recorded.

Inclusion Criteria:

• Age 18 to 60 years old.
• Patients scheduled for elective insertion of nail tibia for fixation of fracture shaft tibia.
• Patients with low ejection fraction (30-40%).

Exclusion Criteria:

• Patient refusal
• Uncooperative patient
• Unconscious patients
• Cases with head trauma
• History of relevant drug allergy to local anesthetics
• Local infection at the site of the block
• Patients with coagulopathies and impaired platelet functions
• Patients with hemodynamic instability
• Previous neurological deficit in lower limb and previous femoral artery grafts or injuries.