Femoral Block

13 Femoral Block



David L. Brown, with contributions from Brian D. Sites, Brian C. Spence




Perspective


This block is useful for surgical procedures carried out on the anterior thigh, both superficial and deep. It is most frequently combined with other lower extremity peripheral blocks to provide anesthesia for operations on the lower leg and foot. As an analgesic technique, it is used for femoral fracture analgesia or for prolonged continuous catheter analgesia after surgery on the knee or femur.




Patient Selection


Because the patient is supine when this block is carried out, virtually any patient undergoing a surgical procedure of the lower extremity is a candidate. Because elicitation of paresthesia is not necessary to carry out femoral block, even anesthetized patients are candidates.



Pharmacologic Choice


As with all lower extremity blocks, a decision must be made about the extent of sensory and motor blockade desired. If motor blockade is necessary, higher concentrations of local anesthetic are needed. As with concerns about local anesthetic use in the sciatic block, the desire for motor blockade must be balanced against the volume of local anesthetic necessary if femoral, sciatic, lateral femoral cutaneous, and obturator blocks are combined. Approximately 20 mL of local anesthetic should be adequate to produce femoral block. With continuous catheter techniques used for postoperative analgesia, 0.25% bupivacaine or 0.2% ropivacaine may be used, and even lower concentrations of these drugs may be useful after a trial. With this technique, a rate of 8 to 10 mL per hour usually suffices.



Traditional Block Technique



Placement




Anatomy


The femoral nerve travels through the pelvis in the groove between the psoas and the iliacus muscles, as illustrated in Figure 13-1. It emerges beneath the inguinal ligament, posterolateral to the femoral vessels, as illustrated in Figure 13-2. It frequently divides into its branches at or above the level of the inguinal ligament.


image

Figure 13-1. Femoral nerve anatomy: anterior oblique view.


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Figure 13-2. Femoral nerve anatomy: at inguinal ligament.



Position


The patient is in a supine position, and the anesthesiologist should stand at the patient’s side to allow easy palpation of the femoral artery.



Needle Puncture


A line is drawn connecting the anterior superior iliac spine and the pubic tubercle, as illustrated in Figure 13-3

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May 31, 2016 | Posted by in ANESTHESIA | Comments Off on Femoral Block

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