The femoral nerve block is considered one of the basic nerve block
techniques because it is relatively simple to perform, carries a low risk of
complications, and results in a high success rate. When used alone, femoral
nerve block is well suited for surgery on the anterior aspect of the thigh
and for postoperative pain management after femur and knee surgery. However,
when combined with a sciatic block, anesthesia of almost the entire lower
limb from the mid-thigh level can be achieved.
When used alone, a femoral nerve block is well suited for surgery on
the anterior aspect of the thigh and for superficial surgery on the medial
aspect of the leg below the knee. Some examples include repair of the
quadriceps tendon or quadriceps muscle biopsy, long saphenous vein
stripping, and postoperative pain management after femur and knee surgery.
Femoral nerve block significantly improves postoperative analgesia after
knee surgery during the first 8–12 hours postoperatively.1–5
However, when combined with a sciatic or popliteal block, femoral
block provides anesthesia for entire lower leg or ankle surgery.
The primary indication of continuous femoral nerve block is pain
management after major femur or knee surgery.6–22 In
addition, when compared with a single dose technique or placebo, continuous
femoral nerve block significantly reduces postoperative morphine consumption
in patients after total hip replacement.23,24 For this
application, the technique is as efficient as IV patient-controlled
analgesia (PCA) with morphine or patient-controlled epidural analgesia, and
it results in fewer technical problems and side effects.13
Continuous femoral nerve block provides excellent analgesia in patients
with femoral shaft or femoral neck fractures.14,15,21,25
Its relative simplicity makes it uniquely suitable for
analgesia in the emergency room and facilitate physical and radiologic
examinations as well as manipulations of the fractured femur or hip.
After major knee surgery, continuous femoral nerve block provides better
pain relief than parenteral administration of opioids (IV PCA,
intramuscular)7,12,16,17,20 or intraarticular
analgesia.18,26 For knee surgery, continuous femoral block
is as effective as continuous lumbar plexus block27 or
continuous epidural analgesia,12,20 with fewer risks
of complications. Because this technique results in faster postoperative
knee rehabilitation than IV PCA with morphine and fewer side effects than
epidural analgesia, continuous femoral nerve block is probably the analgesic technique of
choice in patients after total knee
Relative contraindications for femoral nerve block may include previous
ilioinguinal surgery (femoral vascular graft, kidney transplantation), large
inguinal lymph nodes or tumor, local infection, peritoneal infection, and
preexisting femoral neuropathy.
The femoral nerve is the largest nerve of the ...