Tips for a Femoral Nerve Block - NYSORA

Explore NYSORA knowledge base for free:

Tips for a Femoral Nerve Block

March 26, 2024

The femoral nerve block is one of the most clinically applicable nerve block techniques with a high success rate. The ultrasound-guided technique allows the practitioner to monitor the spread of local anesthetic and needle placement, make adjustments, and reduce the risk of femoral artery puncture. 

As opposed to more distal techniques, such as a femoral triangle block or adductor canal block, a femoral nerve block can provide complete anesthesia for knee surgery.

In contrast to more distal techniques, such as the femoral triangle block or adductor canal block, the femoral nerve block can provide complete anesthesia for various procedures, including knee surgery, making it a crucial tool in surgical and emergency settings. In geriatric patients with hip fractures, the use of ultrasound-guided femoral nerve blocks offers a safer, more effective alternative to opioids for pain management.

Importance of pain management in geriatric hip fractures

Hip fractures are a leading cause of emergency surgeries in elderly patients, often resulting in prolonged recovery times, high morbidity, and significant mortality rates. Managing acute pain effectively in this population is critical yet challenging due to multiple factors, including:

  • Opioid-related risks: Elderly patients are more susceptible to adverse effects such as sedation, nausea, respiratory depression, and cognitive impairment when opioids are used for pain relief.
  • Comorbidities: Many geriatric patients have underlying health issues, such as kidney disease or gastrointestinal conditions, which limit the use of NSAIDs.
  • Opioid misuse: The global opioid crisis has led to increased efforts to minimize opioid use, particularly in vulnerable populations like the elderly.

A study by Tsai et al. 2022 published in the Journal of Clinical Medicine focused on the use of lidocaine-based single-shot ultrasound-guided femoral nerve block (USFNB) in geriatric patients with traumatic hip fractures. The researchers found that this technique not only significantly reduced opioid consumption but also led to faster and more effective pain relief compared to standard care.

Key findings

  1. Reduced opioid use: Patients who received USFNB required 80% less opioids than those who were treated with systemic analgesics.
  2. Faster pain relief: The time for meaningful pain relief was significantly shorter in the USFNB group (96 minutes) compared to the standard care group (185 minutes).
  3. Safety: The study found no significant complications associated with USFNB, making it a safe option for managing acute pain in elderly patients​.

Benefits of ultrasound-guided femoral nerve block in hip fracture management

The benefits of USFNB in the emergency management of geriatric hip fractures are clear. It offers targeted, effective pain relief with minimal systemic side effects. Key advantages include:

  • Opioid reduction: By providing localized pain relief, USFNB decreases the need for opioids, reducing the risk of adverse effects and potential addiction.
  • Faster recovery: Improved pain management enables earlier mobilization and rehabilitation, accelerating recovery and reducing complications.
  • Minimal complications: With ultrasound guidance, practitioners can ensure accurate needle placement, reducing the risk of complications such as vascular puncture or nerve injury.

Best practices for a successful femoral nerve block

Adhering to best practices is crucial for ensuring the success of a femoral nerve block. Below are three essential tips for performing a successful ultrasound-guided femoral nerve block:

  1. Use real-time ultrasound guidance
    • Ultrasound allows for precise needle placement and real-time visualization of the femoral nerve and surrounding structures. This minimizes the risk of complications, such as femoral artery puncture, and improves the accuracy of anesthetic delivery.
  2. Optimize patient positioning
    • Ensure the patient is supine with the leg slightly abducted to expose the inguinal area. Proper positioning facilitates better access to the femoral nerve and ensures an accurate block.
  3. Monitor the spread of local anesthetic
    • Continuous monitoring of the anesthetic’s spread under ultrasound ensures complete coverage of the femoral nerve. If the anesthetic does not fully surround the nerve, adjustments can be made immediately, improving the block’s effectiveness​.

Clinical application: femoral nerve block in emergency settings

The ultrasound-guided femoral nerve block is especially beneficial in emergency settings, such as managing acute pain in geriatric hip fractures. The technique can be performed quickly by trained emergency physicians, providing rapid pain relief and reducing the need for systemic analgesics.

By adhering to the above tips, clinicians can ensure the safe and effective administration of the block, improving outcomes for patients while minimizing the risk of opioid-related complications.

Conclusion

Ultrasound-guided femoral nerve blocks offer a highly effective and safe method for managing acute pain in elderly patients with hip fractures. By reducing opioid use and providing faster pain relief, this technique aligns with modern efforts to improve patient care while addressing the challenges associated with opioid overuse. Incorporating Ultrasound-guided femoral nerve blocks into clinical practice enhances pain management and contributes to better overall patient outcomes. Following best practices—such as using real-time ultrasound guidance, optimizing patient positioning, and carefully monitoring anesthetic spread—can ensure the success of this technique in both emergency and surgical settings​.

For more detailed information, refer to the full article in the Journal of Clinical Medicine

Tsai TY, Cheong KM, Su YC, et al. Ultrasound-Guided Femoral Nerve Block in Geriatric Patients with Hip Fracture in the Emergency Department. J Clin Med. 2022;11(10):2778. Published 2022 May 14.

Adhere to these 3 essential tips for a successful femoral nerve block:

  1. Place the transducer transversely over the femoral crease.
  2. Identify the femoral artery with the femoral vein medial to it.
  3. Insert the needle in-plane, from lateral to medial, to pierce the fascia iliaca lateral to the femoral nerve and inject 10-15 mL of local anesthetic.

Watch the video below to get a better picture of the process and see how the NYSORA Nerve Blocks App brings these instructions to life: 

For more tips like these and the complete guide to the 60 most frequently used nerve blocks, download the Nerve Blocks App HERE. Don’t miss the chance to get the bestselling NYSORA Nerve Blocks App also in book format – the perfect study companion with the Nerve Blocks app!

More news