Anesthesia of all three nerves can be achieved in the same procedure by spreading the local anesthetic more proximally and using a larger total volume mL. To spread the anesthetic, have an assistant apply downward pressure a few centimeters distal to the site of injection. Pressure is sustained for seconds after the injection is completed to ensure proximal spread.
Though rare, potential complications include infection, nerve injury, bleeding or hematoma formation, and intravascular injection.
Using sterile technique and ultrasound guidance can minimize these risks. What's the evidence? The argument for using a femoral nerve block to provide analgesia to patients with hip fractures derives from its relative ease and efficacy in providing high-quality pain control, as well as lack of adverse effects commonly seen with opioid pain medications.
A randomized controlled trial published in Academic Emergency Medicine in evaluated the use of the femoral nerve block as an adjunct to opioid analgesics. Thirty-six patients were randomized, and a physician co-investigator performed ultrasound-guided injection of either bupivacaine or normal saline.
Both the patient and the emergency physician caring for the patient were blinded to the treatment arm, and additional analgesia administration was at the discretion of the treating physician over the four-hour study period. Results showed a significant decrease in pain intensity, less parenteral opioid administration, and no difference in adverse effects in the femoral nerve block group compared to the standard care group.
Another study, published in Annals of Emergency Medicine in , also compared the femoral nerve block to standard care IV opioids , extending the study time period to 24 hours from the time of block, or to the time of surgery, whichever came first. Multiple physicians at different levels of training administered the nerve blocks, and no adverse effects were identified. A femoral nerve block is feasible to perform, even in a busy emergency department.
A prospective observational study published in the American Journal of Emergency Medicine in demonstrated a median time of 8 minutes to perform the procedure. Included in this time was five minutes of manual pressure to achieve 3-in-1 block, making the actual procedure time even shorter. All procedures required only one attempt, and there were no complications. Though larger randomized controlled studies are required to confirm these findings, the literature suggests that after a short training session, EM residents can become proficient at ultrasound-guided femoral nerve blocks.
With a low complication rate and minimal side effects, a nerve block is ideal for patients with persistent pain or borderline low blood pressure. So the next time you see that year-old lady, just remember, a little procedure can save a lot of pain. After a nerve block, the part of your body that will be operated on will be numb.
Many times it is your choice to be as awake or asleep as you want. You never get to see the surgery itself because a large sterile drape is always placed between you and the surgeon.
Most patient prefer to be asleep during surgery then heavy sedation or general anesthesia will be used. This depends on the type of block performed and the type of numbing medication used.
For example, nerve blocks for hand surgery usually last for hours, but a nerve block for pain after total knee replacement can last for hours.
Medication continuously delivered through a tiny plastic tube nerve catheter placed next to the nerve can last for days. The nerve block is done predominantly under ultrasound guidance, which is the most modern technique. Usually a nerve block procedure takes minutes but the part with the needle last about 1 minute. It takes another minutes to start working fully depending on the area numb, the medication used and your personal response to the medication.
We always make sure the block is working before you go into the operating room. Again, you will be given some sedation medicine to help you relax when we do the block. We will use IV and oral medications to control your pain during and after surgery. These drugs may have side effects and may or may not be as effective as a nerve block. IV and oral Pain medications will be available to you to add to the nerve block and to use as needed. The shot will leave your leg partly or totally numb for a while.
Your doctor will tell you how long. You will need someone to drive you home. As the block wears off, you will start to feel some pain from the surgery. Be sure to take your pain medicines before the pain gets bad.
Problems from a nerve block are rare. There is a small risk of problems like seizures, heart problems, damage to nerves, infection, or bleeding. The benefits usually outweigh these risks. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Author: Healthwise Staff. Freedman MD - Anesthesiology.
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