Dr. Hadzic will discuss the differences among the: (1) lumbar plexus block, (2) fascia iliaca block, (3) femoral triangle block, and (4) adductor canal block, because trainees and attendees to NYSORA workshops sometimes tend to be completely confused as to what each one of these blocks does. The lumbar plexus derives its branches or origins from the spinal segments of L1 through L5 and is a rather large entity. But, in essence, the most important three nerves are the femoral nerve, which is the biggest nerve of the lumbar plexus, the lateral femoral cutaneous nerve of the thigh, and the obturator nerve.  If you open the abdominal cavity and dissect the source muscle then this is the image that you are going to see. These are the roots of the lumbar plexus, and these roots combine inside the source muscle in order to create the lumbar plexus. So when we perform a lumbar plexus block, it is here that the local anesthetic injection takes place, and we want to fill this space with the local anesthetic in order to get a block of all of those three nerves that we just talked about.  One other way you can accomplish the lumbar plexus black is through the fascia iliaca by injecting the local anesthetic underneath the fascia iliaca, above the inguinal ligament which causes the local anesthetic to spread underneath the fascia iliaca and results in the block in most of these branches, particularly the femoral nerve. If you take a look at the illustration on the left that mimics the aforementioned situation, you can see how the femoral nerve, lateral femoral cutaneous nerve of the thigh, and the obturator nerve are all covered by the fascia iliaca. So, the goal of the fascia iliaca block is actually an injection of … Continue reading Best Nerve Block for Total Knee Replacement Pain: Crash Course with Dr. Hadzic