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Peripheral nerve blocks inhibit the propagation of impulses in nerve terminals to inhibit the perception of pain by the cerebral cortex. Local anesthetics will temporarily block the transmission of pain. The onset, duration, density, and spread of the nerve block may be influenced by the type of local anesthetic given, concentration, and volume. The femoral nerve block anesthetizes the femoral nerve distribution and is utilized for anterior thigh and knee procedures. It can provide effective analgesia with less opioid intake, which consequently reduces the adverse effects from opioid consumption, and promote earlier hospital discharge. This activity describes the technique of a femoral nerve block and highlights the role of the interprofessional team in the management of these patients. Objectives: Describe the technique of a femoral nerve block. Review the complications of a femoral nerve block. Summarize the indications of a femoral nerve block. Outline factors affecting the performance and improvement for outcomes of peripheral nerve blocks that require collaboration from all members of the medical team. Access free multiple choice questions on this topic.

Peripheral nerve blocks inhibit the propagation of impulses in nerve terminals to inhibit the perception of pain by the cerebral cortex. Local anesthetics will temporarily block the transmission of pain.[1] The type of local anesthetic given, concentration, and volume may affect the onset, duration, density, and spread of the nerve block. The femoral nerve block anesthetizes the femoral nerve distribution, and surgeons use it for anterior thigh and knee procedures. It can provide effective analgesia with less opioid intake, which consequently reduces the adverse effects from opioid consumption, and promote earlier hospital discharge.[2]

There are always risks involved when performing a peripheral nerve bock. The following are complications that can result: nerve injury, allergic reaction, hematoma, infection, and local anesthetic systemic toxicity.[7] Also, patients should understand the risk of the nerve block not working successfully, and other forms of analgesia should be available. There is a small risk of temporary or permanent nerve injury, which can be caused by direct needle injury or intraneural injection. Given the possibility of complications, resuscitation equipment must be nearby in the event of local anesthetic systemic toxicity.[13] A 20% lipid emulsion administration is effective for local anesthetic toxicity. A bolus dose of 1.5 mL/kg based on the lean body mass of lipid emulsion should be given over 1 minute and followed by an infusion of 0.25 mL/kg/min. This continuous infusion should continue until reaching hemodynamic stability. If hemodynamic stability is not obtained, then another bolus of 1.5 mL/kg (for a maximum of two total doses of 20% lipid emulsion), followed by a continuous infusion at the increased dose of 0.5 mL/kg/min should be considered.[14] The 10% lipid emulsion in propofol should never be used as an alternative source for lipid emulsion therapy.

The performance of peripheral nerve blocks requires collaboration from all members of the interprofessional medical team. The regionalist and nursing staff should work together to provide the highest level of care and benefit to the patient. Although a relatively safe procedure, preparation, proper monitoring, and immediate accessibility of emergency equipment and medications should be ready in the event of any adverse events;, if anesthesia is in use in any form, a nurse dedicated to the monitoring of the patient should be on the case. Also, resuscitative equipment should always be in the room, even before starting the procedure. The pharmacist should verify agent selection and dose for the procedure, as well as ensuring no drug-drug interactions by performing medication reconciliation, and reporting to the surgical team any concerns. Open interprofessional communication and collaboration between the staff is the optimal way to avoid morbidity and improve outcomes when performing femoral nerve block. [Level 5]