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.
Three-in-One Block
Procedure
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
the anesthetic.
