The LSUHSC New Orleans
Emergency Medicine Interest Group
The Student Procedure Manual
Nerve Blocks to the Lower Extremity
by Matthew Williams
- 2% Lidocaine with epinephrine
- 25% bupivicaine with epinephrine
Femoral Nerve Block
- Femoral nerve blocks are sufficient analgesia for femoral shaft fractures.
- Palpate the femoral artery I to 2 cm below the inguinal ligament.
- Raise a wheal of anesthesia just lateral to the artery.
- Apply firm pressure to the femoral artery with the non-dominant hand.
- Using a 22 gauge needle and a 20-ml syringe, insert the needle adjacent to the
artery perpendicular to the skin.
- The needle should be advanced until paresthesia is elicited or until the needle
pulsates laterally. Needle movement will indicate that you are immediately adjacent
to the artery.
- Slowly inject 10 to 20 ml of .25% bupivacaine with epinephrine.
- Caution: this block is located in an area of large nerves and vessels. Precautions
should be taken to avoid intravascular and intraneuronal injection.
- Designed to provide anesthesia to the Femoral, Obturator, and Lateral Femoral
Cutaneous Nerves with a single injection.
- The procedure for needle placement is the same for the Femoral Nerve block;
however, for the Three-in-One block to be effective the needle must be located
within the femoral nerve sheath.
- Once the needle is in place, apply pressure just distal to the injection site
and inject 20 to 30 ml of .25% bupivacaine with epinephrine.
- Compression should be held for 5 minutes to allow for proper distribution of
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