July 18, 2017
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