Best Nerve Block for Total Knee Replacement Pain

What is the difference between lumbar plexus, fascia iliaca, femoral nerve, femoral triangle, and adductor canal blocks? And which one is best for knee analgesia. In this short video, Dr Hadzic walks us from lumbar plexus proximally to the LIA infiltration, using a ruptured quadriceps tendon repair as an indication. He explains how the analgesic efficacy decreases from proximal to distal, while the muscle sparing increases. The femoral nerve can be blocked in multiple locations from the lumbar plexus (a), intra-pelvis under the fascia iliaca (b), to around inguinal area (c) to the femoral triangle (d), to its distal branches in the adductor canal (e). Although the locations from (b) to (d) are named as different techniques, they are simply blocks of the femoral nerve at different levels. Therefore, the choice of the block (a-d) depends on the desired extent of analgesia and motor blockade of the anterior thigh muscles.

 



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