Contraindications

There are only a few true contraindications to lower extremity nerve blocks.[1,17] They may include infection at the puncture site and true allergy to local anesthetics (a very rare condi-tion, especially with aminoamides). Bleeding disorders or anticoagulant therapy are relative contra-indications and apply mainly for deep block procedures and perhaps insertion of indwel-ling catheters.

Degenerative axonal diseases have long been considered as contraindications to any regional anesthesia. However, there are no data to support the hypothesis that a conduction block could aggravate the disease, or data suggesting to the contrary. Regardless, it may be prefe-rable to avoid regional procedure in these patients unless a clear indication has been estab-lished, written informed consent obtained and a complete and well documented neurological examination is performed. If adequate monitoring of patients at risk of compartment syndrome cannot be guaranteed, performing a regional block would be imprudent and should be avoided. Obviously, parental refusal and severe psychoneurotic disorders should also be considered as contraindications.