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Femoral Nerve Block
Kimberly Ting, MD; Nicole Z. Spence, MD; Jason M. Lewis, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Abbreviations

            • Femoral nerve (FN)
            • Femoral vein (FV)
            • Femoral nerve block (FNB)
            • Saphenous nerve (SN)
          • Definitions

            • FN: Largest branch of lumbar plexus and is derived from anterior rami of L2, L3, L4
            • FN is motor and sensory nerve
              • Motor: Contributes to hip flexion by innervating pectineus, iliacus, sartorius muscles; responsible for knee extension by innervating vastus medialis, vastus lateralis, vastus intermedius
              • Sensory: Anterior cutaneous branches of FN (sensory to anteromedial thigh) and terminal cutaneous branch of FN is SN (sensory to medial leg and foot)
              • FN osteotome
                • FN and its distal branch is responsible for sensory innervation (osteotome) of medial and anterior distal portion of femur
                • In addition, FN provides sensation to anteromedial tibia and medial malleolus
            • FNB can be performed by landmark technique with nerve stimulator or ultrasound-guided technique after FN courses underneath inguinal ligament to enter femoral triangle
            • Femoral triangle borders
              • Superior (base): Inguinal ligament
              • Lateral: Sartorius muscle (medial margin)
              • Medial: Adductor longus muscle (lateral margin)
              • Apex: Sartorius muscle and adductor magnus muscle
              • Floor: Iliopsoas, pectineus, adductor longus muscle
              • Anterior: Fascia iliaca
            • FNB (combined with sciatic nerve block) can provide complete anesthesia and analgesia for procedures of ipsilateral lower extremity

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things To Do

                                • Things To Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Angers M et al: Negative influence of femoral nerve block on quadriceps strength recovery following total knee replacement: a prospective randomized trial. Orthop Traumatol Surg Res. 105(4):633-7, 2019
                                      2. Dimaculangan D et al: Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial. J Clin Orthop Trauma. 10(1):81-6, 2019
                                      3. Li J et al: A practical analgesia approach to fragility hip fracture: a single-center, retrospective, cohort study on femoral nerve block. J Orthop Trauma. 33(4):175-9, 2019
                                      4. Lynch JR et al: Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med. 47(2):355-63, 2019
                                      5. Ohgoshi Y et al: Use of IPACK block with continuous femoral triangle block for total knee arthroplasty: a clinical experience. J Clin Anesth. 54:52-4, 2019
                                      6. Zhao XY et al: Ultrasound-guided continuous femoral nerve block with dexmedetomidine combined with low concentrations of ropivacaine for postoperative analgesia in elderly knee arthroplasty. Med Princ Pract. 28(5):457-62, 2019
                                      7. Bolarinwa SA et al: Reducing costly falls after total knee arthroplasty. World J Orthop. 9(10):198-202, 2018
                                      8. Büttner B et al: Paths of femoral nerve catheters placed using ultrasound-guided in plane vs out of plane techniques: a randomized controlled clinical trial. Medicine (Baltimore). 97(43):e12958, 2018
                                      9. Fenten MGE et al: Femoral nerve catheter vs local infiltration for analgesia in fast track total knee arthroplasty: short-term and long-term outcomes. Br J Anaesth. 121(4):850-8, 2018
                                      10. Talmo CT et al: Prospective randomized trial comparing femoral nerve block with intraoperative local anesthetic injection of liposomal bupivacaine in total knee arthroplasty. J Arthroplasty. 33(11):3474-8, 2018
                                      11. Zhang X et al: Efficacy and safety of lower extremity nerve blocks for postoperative analgesia at free fibular flap donor sites. Head Neck. 40(12):2670-6, 2018
                                      12. Paul JE et al: Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 113(5):1144-62, 2010
                                      13. Kandasami M et al: Femoral nerve block for total knee replacement - a word of caution. Knee. 16(2):98-100, 2009
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Outcomes

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Femoral nerve (FN)
                                                • Femoral vein (FV)
                                                • Femoral nerve block (FNB)
                                                • Saphenous nerve (SN)
                                              • Definitions

                                                • FN: Largest branch of lumbar plexus and is derived from anterior rami of L2, L3, L4
                                                • FN is motor and sensory nerve
                                                  • Motor: Contributes to hip flexion by innervating pectineus, iliacus, sartorius muscles; responsible for knee extension by innervating vastus medialis, vastus lateralis, vastus intermedius
                                                  • Sensory: Anterior cutaneous branches of FN (sensory to anteromedial thigh) and terminal cutaneous branch of FN is SN (sensory to medial leg and foot)
                                                  • FN osteotome
                                                    • FN and its distal branch is responsible for sensory innervation (osteotome) of medial and anterior distal portion of femur
                                                    • In addition, FN provides sensation to anteromedial tibia and medial malleolus
                                                • FNB can be performed by landmark technique with nerve stimulator or ultrasound-guided technique after FN courses underneath inguinal ligament to enter femoral triangle
                                                • Femoral triangle borders
                                                  • Superior (base): Inguinal ligament
                                                  • Lateral: Sartorius muscle (medial margin)
                                                  • Medial: Adductor longus muscle (lateral margin)
                                                  • Apex: Sartorius muscle and adductor magnus muscle
                                                  • Floor: Iliopsoas, pectineus, adductor longus muscle
                                                  • Anterior: Fascia iliaca
                                                • FNB (combined with sciatic nerve block) can provide complete anesthesia and analgesia for procedures of ipsilateral lower extremity

                                              PREPROCEDURE

                                              • Indications

                                                • Contraindications

                                                  • Preprocedure Imaging

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things To Do

                                                                    • Things To Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Angers M et al: Negative influence of femoral nerve block on quadriceps strength recovery following total knee replacement: a prospective randomized trial. Orthop Traumatol Surg Res. 105(4):633-7, 2019
                                                                          2. Dimaculangan D et al: Periarticular injection and continuous femoral nerve block versus continuous femoral nerve block alone on postoperative opioid consumption and pain control following total knee arthroplasty: Randomized controlled trial. J Clin Orthop Trauma. 10(1):81-6, 2019
                                                                          3. Li J et al: A practical analgesia approach to fragility hip fracture: a single-center, retrospective, cohort study on femoral nerve block. J Orthop Trauma. 33(4):175-9, 2019
                                                                          4. Lynch JR et al: Adductor canal block versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Am J Sports Med. 47(2):355-63, 2019
                                                                          5. Ohgoshi Y et al: Use of IPACK block with continuous femoral triangle block for total knee arthroplasty: a clinical experience. J Clin Anesth. 54:52-4, 2019
                                                                          6. Zhao XY et al: Ultrasound-guided continuous femoral nerve block with dexmedetomidine combined with low concentrations of ropivacaine for postoperative analgesia in elderly knee arthroplasty. Med Princ Pract. 28(5):457-62, 2019
                                                                          7. Bolarinwa SA et al: Reducing costly falls after total knee arthroplasty. World J Orthop. 9(10):198-202, 2018
                                                                          8. Büttner B et al: Paths of femoral nerve catheters placed using ultrasound-guided in plane vs out of plane techniques: a randomized controlled clinical trial. Medicine (Baltimore). 97(43):e12958, 2018
                                                                          9. Fenten MGE et al: Femoral nerve catheter vs local infiltration for analgesia in fast track total knee arthroplasty: short-term and long-term outcomes. Br J Anaesth. 121(4):850-8, 2018
                                                                          10. Talmo CT et al: Prospective randomized trial comparing femoral nerve block with intraoperative local anesthetic injection of liposomal bupivacaine in total knee arthroplasty. J Arthroplasty. 33(11):3474-8, 2018
                                                                          11. Zhang X et al: Efficacy and safety of lower extremity nerve blocks for postoperative analgesia at free fibular flap donor sites. Head Neck. 40(12):2670-6, 2018
                                                                          12. Paul JE et al: Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 113(5):1144-62, 2010
                                                                          13. Kandasami M et al: Femoral nerve block for total knee replacement - a word of caution. Knee. 16(2):98-100, 2009