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 consumption^{1, 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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