II. Indications
- Regional Anesthesia covering proximal femur to knee
- Mid-shaft Femur Fracture
III. Anatomy: Landmarks
- Palpate femoral artery
- Femoral nerve lies lateral to the artery (NAVL)
- Injection site is 1-2 cm below the inguinal ligament, lateral to the femoral nerve
- Consider Bedside Ultrasound to confirm needle placement (optional)
- Allows visualization of artery as well as fluid infiltrating and expanding the appropriate space
IV. Preparation
- Consider performing in conjunction with other procedures
- Consider prior to Hare Traction Splint application
- If applying splint under Conscious Sedation, consider simultaneously placing Femoral Nerve Block
-
Anesthetic block options
- Bupivacaine or Sensorcaine: 10-20 cc (max 2 to 2.5 mg/kg) or
- Ropivacaine: 10-20 cc (max 2 mg/kg)
- Syringe
- Draw 10-20 cc Bupivicaine or Ropivacaine without Epinephrine into a 20 cc syringe
- Attach 22 gauge 1" to 1.25" needle
V. Technique
- Prepare site
- Palpate the femoral artery
- Position the Ultrasound (if used)
- Linear vascular probe with indicator at 9:00
- Superior or cephalad to injection site
- Midline marker of probe lies over the femoral artery
- Mark injection site (inferior to inguinal ligament, and lateral to femoral artery)
- Betadine or Hibiclens prep of injection site
- Locally infitrate skin at injection site (e.g. Lidocaine 1% with Epinephrine)
- Femoral Nerve Block
- Insert needle perpendicular to skin (90 degrees)
- Advance needle until Paresthesias (withdraw until ceases) or approximate depth of femoral artery
- Aspirate to confirm not in vessel
- Inject 10-20 cc (fluid may be seen on Ultrasound infiltrating appropriate space)
VI. Pharmacokinetics
- Onset of action: Within 15 to 30 minutes
- Duration: Expect 3-8 hours of Regional Anesthesia with Bupivicaine (longer with Ropivicaine)
VII. References
- Roberts (1998) Clinical Procedures in Emergency Medicine, Saunders
- Sacchetti in Majoewsky (2012) EM:RAP 12(2): 4