Femoral Nerve Block

Femoral nerve block is perhaps the simplest peripheral nerve block of the lower extremity. With the child lying supine, the block needle is inserted vertically through the skin 0.5 to 1 cm both below the inguinal ligament and lateral to the femoral artery until twitches of the quadriceps muscle are elici-ted (Figure 2). The technique is particularly suitable for providing intra and post-operative pain relief in children with a femoral shaft fracture or children undergoing elective surgery in areas supplied by the femoral nerve. Long-lasting analgesia is easily obtained by placing a catheter along the nerve path and injecting a local anesthetic, either continuously or on-demand.[45,46] Typical infusion rates used by this author can be seen in Table 3. Although clinical infections are very rare, bacterial contamination of the catheter is frequent and requires that strict antibacterial precautions be taken on insertion of such devices and that the catheters be removed when adequate pain relief can be obtained by oral analgesics.[30]

                    Figure 2. Femoral nerve and fascia iliaca compartment block
                    A. Fascia iliaca compartment block
                    B. Femoral nerve block
                    1. Lateral cutaneous nerve of the thigh
                    2. Fascia iliaca
                    3. Femoral nerve
                    4. Femoral vessels sheath
                    5. Fascia lata








                                        Table 3. Suggested infusion rates for continuous techniques of lower extremity
                                                      nerve blocks (personal data)