Peripheral Nerve Blocks for the Lower Extremity

  • Sylvia H. WilsonEmail author
  • Anna Uskova


Certain steps must be taken before offering a peripheral nerve block to a patient: Surgeon and primary anesthesia care team aware and in agreement. Patient meets all criteria for surgery and anesthesia: NPO, cardiopulmonary status, etc. Patient evaluation is complete: laboratory values, EKG, and CXR. Paperwork is completed: patient identification, surgical consent, and laterality. Contraindications to block are not present: coagulopathy, refusal (see later section). Patient consents to block: risks, benefits, and options explained.


Anesthesia, regional Nerve block Sciatic nerve Femoral nerve Lumbar plexus Analgesia Anesthetics, local Lower extremity 


  1. 1.
    Hagon BS, Itani O, Bidgoli JH, et al. Parasacral sciatic nerve block: does the elicited motor response predict the success rate? Anesth Analg. 2007;150:163–266.Google Scholar
  2. 2.
    Taboada M, Atanassoff PG, Rodríguez J, et al. Plantar flexion seems more reliable than dorsiflexion with Labat’s sciatic nerve block: a prospective, randomized comparison. Anesth Analg. 2005;100(1):250–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Labat G. Its technique and unique applications. In:Regional anaesthesia. 2nd ed. Philadelphia: WB Saunders; 1924. p. 45–55.Google Scholar
  4. 4.
    Morris GF, Lang SA, Dust WN, Van der Wahl M. The parasacral sciatic nerve block. Reg Anesth. 1997;22:223–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Chelly JE, Delaunay L. A new anterior approach to the sciatic nerve block. Anesthesiology. 1999;91:1655–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Vloka JD, Hadzic A, April E, Thys DM. The dividsion of the sciatic nerve in the popliteal fossa: anatomical implication for popliteal nevre blockade. Anesth Analg. 2001;92:215–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Perlass A, Brull R, Chan VWS, et al. Ultrasound guidance improves the success of sciatic nerve block in the popliteal fossa. Reg Anesth Pain Med. 2008;33:259–65.CrossRefGoogle Scholar
  8. 8.
    Pacqueron X, Bouaziz H, Macalou D, et al. The lateral approach to the sciatic nerve at the popliteal fossa: one or two injection? Anesth Analg. 1999;89:1221–5.CrossRefGoogle Scholar
  9. 9.
    Vloka JD, Hadzic A, Singson R, et al. The popliteal nerve block revisited: results of an MRI study. Anesth Analg. 1997;84:S344.CrossRefGoogle Scholar
  10. 10.
    O’Neill T. Lateral popliteal sciatic-nerve block made easy. Reg Anesth Pain Med. 2007;32:93–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Parkinson SK, Mueller JB, Little WL, Bailey SL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989;68:243–8.PubMedGoogle Scholar
  12. 12.
    Turker G, Uckunkaya N, Yavascaglu B, et al. Comparision of catheter technique psoas compartment block and the epidural block for analgesia in partial hip replacement surgery. Acta Anesthesiol Scand. 2003;47:30–6.CrossRefGoogle Scholar
  13. 13.
    Capdevila X, Coimbra C, Choquet O. Approaches to the lumbar plexus: success, risks, and outcome. Reg Anesth Pain Med. 2005;30:150–62.PubMedGoogle Scholar
  14. 14.
    Macaire P, Dadure C, Choquet O, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606–13.CrossRefPubMedGoogle Scholar
  15. 15.
    Khoo ST, Brown TCK. Femoral nerve block—the anatomical basis for a single injection technique. Anaesth Intensive Care. 1983;11:40–2.PubMedGoogle Scholar
  16. 16.
    Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technique of lumbar plexus anesthesia: the “3-in-1 block”. Anesth Analg. 1973;52(6):989–96.PubMedGoogle Scholar
  17. 17.
    Lang SA, Yip RW, Chang PC, Gerard MA. The femoral 3-in-1 block revisited. J Clin Anesth. 1993;5(4):292–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Seeberger MD, Urwyler A. Paravascular lumbar plexus block: block extension after femoral nerve stimulation and injection of 20 vs. 40 ml mepivacaine 10 mg/ml. Acta Anaesthesiol Scand. 1995;39(6):769–73.CrossRefPubMedGoogle Scholar
  19. 19.
    Marhofer P, Nasel C, Sitzwohl C, Kapral S. Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block. Anesth Analg. 2000;90:119–24.CrossRefPubMedGoogle Scholar
  20. 20.
    Atanassoff PG, Weiss BM, Brull SJ, et al. Electromyographic comparison of obturator nerve block to three-in-one block. Anesth Analg. 1995;81:529–33.PubMedGoogle Scholar
  21. 21.
    Jæger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013;38(6):526–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, Patt ML, Goon AK, Lee YY, Ma Y, YaDeau JT. Adductor canal block versus femoral nerve block for total knee arthroplasty a prospective, randomized, controlled trial. Anesthesiology. 2014;120(3):540–50.Google Scholar
  23. 23.
    Kwofie MK, Shastri UD, Gadsden JC, Sinha SK, Abrams JH, Xu D, Salviz EA. The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers. Reg Anesth Pain Med. 2013;38(4):321–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study. Anesth Analg. 2017;125(1):303–312.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesia and Perioperative MedicineMedical University of South CarolinaCharlestonUSA
  2. 2.Department of AnesthesiologyUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations