The anterior branch of the femoral nerve gives off the intermediate and the medial cutaneous nerves of the thigh
– the intermediate cutaneous nerve of the thigh innervates the skin of the
anterior thigh
– the medial cutaneous nerve of the thigh innervates the skin of the medial
thigh and knee
The posterior branch of the femoral nerve gives off the saphenous nerve, which is a sensory nerve innervating the antero-medial parts of the knee and the leg – sometimes as far distal as the big toe
Surgery and analgesia of
– the hip joint
– the shaft of the femoral bone
– the anterior thigh
– the knee joint
– the medial leg including the medial and anterior side of the ankle joint
and the subtalar joints
The ultrasound guided femoral nerve block is a basic level block
Colour Doppler can be used to visualise the proxy marker – the axillary artery – and blood vessels that you do not want to perforate with the needle
It is also possible to use colour Doppler to visualise the injection of local anaesthetic
In that case it is an advantage to lower the PRF (Pulse Repetition Frequency) in order to enhance the visibility of the injectate
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The medial cord is located between the axillary artery and vein around the two o’clock position of the artery
The local anaesthetic does not always spread around the artery to the two o’clock position from a seven o’clock point of injection
In that case the needle tip should be repositioned in front of the axillary artery to the interspace between the axillary artery and vein and local anaesthetic should be injected periarterially
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Before inserting the needle through the skin, the hose and the needle should be filled with saline or local anaesthetic
Just after insertion of the needle 1/2 ml of fluid should be flushed through the hose and needle to make sure that no air is contained in the “system”
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The femoral nerve runs below the iliacus fascia and on top of the iliacus muscle
The lumbar part of the lumbosacral plexus emerges from five spinal nerves: T12, L1, L2, L3 and L4
It gives origin to three important nerves in lower limb innervation: The femoral, the obturator and the lateral femoral cutaneous nerves
The most important lumbar plexus nerve concerning basic peripheral nerve blockade is the femoral nerve
It originates from the L2, L3, and L4 spinal nerves of the lumbar plexus
In the inguinal region the femoral nerve (FN) runs lateral to the femoral vessels and on top of the iliopsoas muscle
The femoral nerve runs below the iliacus fascia
To reach the nerve with your needle you have to penetrate two fascia: fascia lata and the iliacus fascia
Surgery and analgesia of the upper limb distal to the shoulder level
The ultrasound guided infraclavicular brachial plexus block is a basic level block
Select a linear high-frequency probe. Adjust gain, focus and depth 3-4 cm
Turn the orientation mark on the probe cranially. Place the probe below the clavicle, medial to the coracoid process in the parasagittal plane
Locate the black, pulsatile axillary artery (AA) and align it to the centre of the monitor. Seeing AA as a clock face the lateral cord is located at nine o’clock, the posterior cord at six o’clock and the medial cord at two o’clock. Often the cords are not sonographically visible
Insert the needle below the clavicle and advance it in-plane aiming periarterially at seven o’clock. Empty the needle of air by injecting 1/2 mL local anaesthetic subcutaneously
Avoid piercing any vessels or nerves
The endpoint of injection is periarterially from two o’clock to ten o’clock. Reposition the needle tip as necessary to reach the endpoint
(B) Look for the axillary artery (A); lateral cord (L); medial cord (M); posterior cord (P). Anterior (ant), posterior (post)
