Nerve Block: Femoral: Difference between revisions
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==Equipment Needed== | ==Equipment Needed== | ||
*Ultrasound with sterile probe cover | *Ultrasound (linear probe) with sterile probe cover | ||
*Syringe with 25-30ga needle | *Syringe with 25-30ga needle | ||
*Local anesthetic | *Syringe with 22ga noncutting spinal needle | ||
*Local anesthetic (bupivicaine preferred due to long duration of action) | |||
*Chlorhexidine or betadine | *Chlorhexidine or betadine | ||
*Sterile drape | *Sterile drape | ||
==Procedure== | ==Procedure<ref>Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91.</ref>== | ||
*Place patient supine | |||
*Cleanse skin with chlorhexidine or betadine and drape | |||
*Apply sterile ultrasound probe 1cm distal to inguinal ligament | |||
*Identify femoral nerve (hyperechoic structure lateral to the femoral artery) | |||
*Inject small amount of local anesthetic into skin and subcutaneous tissue overlying femoral nerve | |||
*Under ultrasound guidange, advance noncutting spinal needle to the femoral nerve sheath | |||
*Aspirate to ensure not in blood vessel | |||
*Inject local anesthetic along nerve sheath | |||
==Complications== | ==Complications== | ||
Revision as of 11:58, 9 August 2015
Background
- Found to be effective method of regional pain control in ED[1]
- Does not alter clinical presentation of developing compartment syndrome (compartments innervated by sciatic nerve)[2]
Indications
- Femur fracture
- Hip fracture
- Patella fracture
- Any other significant trauma or need to perform painful procedure in distribution of femoral nerve (anterior and lateral lower extremity)
Contraindications
- Infection overlying injection site
Equipment Needed
- Ultrasound (linear probe) with sterile probe cover
- Syringe with 25-30ga needle
- Syringe with 22ga noncutting spinal needle
- Local anesthetic (bupivicaine preferred due to long duration of action)
- Chlorhexidine or betadine
- Sterile drape
Procedure[3]
- Place patient supine
- Cleanse skin with chlorhexidine or betadine and drape
- Apply sterile ultrasound probe 1cm distal to inguinal ligament
- Identify femoral nerve (hyperechoic structure lateral to the femoral artery)
- Inject small amount of local anesthetic into skin and subcutaneous tissue overlying femoral nerve
- Under ultrasound guidange, advance noncutting spinal needle to the femoral nerve sheath
- Aspirate to ensure not in blood vessel
- Inject local anesthetic along nerve sheath
Complications
- Inadvertent intravascular injection
- Infection
- Bleeding/hematoma
See Also
External Links
References
- ↑ Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am. J. Emerg. Med. 2010;28(1):76-81.
- ↑ Karagiannis G, Hardern R. Best evidence topic report: No evidence found that a femoral nerve block in cases of femoral shaft fractures can delay the diagnosis of compartment syndrome of the thigh. EMJ 2005;22(11):814.
- ↑ Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91.