Published July 18, 2017 v 9:03 am | category  Print

By Dr Jacinth Tan

  • Fast, safe and effective procedure.
  • In patients undergoing surgery: Reduces the amount of general anaesthetic and opioid analgesics needed intraoperatively1, reduces post-operative pain and analgesic consumption1, 2, and may even reduce the length of hospital stay2.
  • In patients not undergoing surgery: Reduces the pain from hip fractures, provides longer duration of analgesia, reduces the analgesic doses needed and reduces the number of nursing interventions3.

Indications:

Surgical procedures to:

  • Hip joint.
  • Femur (e.g. femoral fractures)4.
  • Knee (e.g. knee arthroscopies, ACL reconstructions, patella ligament realignment)4:
  • For anterior knee procedures: A femoral nerve block alone may suffice4
  • For coverage of the medial aspect of the knee: Obturator nerve block should be added4
  • For coverage of the lateral aspect of the knee: Lateral femoral cutaneous nerve block should be added4
  • For coverage of the posterior aspect of the knee: Sciatic nerve block should be added4
  • Anterior thigh (e.g. skin graft from the anterior aspect of the thigh) 5.
  • Medial aspect of the leg (by blocking the saphenous nerve—a terminal cutaneous branch of the femoral nerve).
  • In combination with a popliteal block, analgesia can be provided for any procedure on the lower leg and foot5.
  • In combination with a high sciatic block and an obturator nerve block, analgesia can be provided for the entire lower extremity5.

Contraindications:

  • Local infection at the proposed needle insertion point.
  • Situations where dense sensory block may mask the onset of lower extremity compartment syndrome (especially if combined with a sciatic block). E.g. Fresh fractures of the tibia/ fibula, or extensive and traumatic elective orthopaedic procedures to the tibia and fibula. Best practice will be to consult with one’s surgical colleagues as to the likelihood of compartment syndrome.6


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