The LSUHSC New Orleans
Emergency Medicine Interest Group


The Student Procedure Manual

Nerve Blocks to the Lower Extremity

by Matthew Williams

Recommended Anesthetics
Femoral Nerve Block
Three-in-One Block

Recommended Anesthetics

Femoral Nerve Block


  1. Femoral nerve blocks are sufficient analgesia for femoral shaft fractures.
  2. Palpate the femoral artery I to 2 cm below the inguinal ligament.
  3. Raise a wheal of anesthesia just lateral to the artery.
  4. Apply firm pressure to the femoral artery with the non-dominant hand.
  5. Using a 22 gauge needle and a 20-ml syringe, insert the needle adjacent to the artery perpendicular to the skin.
  6. 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.
  7. Slowly inject 10 to 20 ml of .25% bupivacaine with epinephrine.
  8. 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


  1. Designed to provide anesthesia to the Femoral, Obturator, and Lateral Femoral Cutaneous Nerves with a single injection.
  2. 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.
  3. 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.
  4. Compression should be held for 5 minutes to allow for proper distribution of the anesthetic.


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