II. Indications

  1. Regional Anesthesia covering proximal femur to knee
  2. Mid-shaft Femur Fracture

III. Anatomy: Landmarks

  1. Palpate femoral artery
  2. Femoral nerve lies lateral to the artery (NAVL)
  3. Injection site is 1-2 cm below the inguinal ligament, lateral to the femoral nerve
  4. Consider Bedside Ultrasound to confirm needle placement (optional)
    1. Allows visualization of artery as well as fluid infiltrating and expanding the appropriate space

IV. Preparation

  1. Consider performing in conjunction with other procedures
    1. Consider prior to Hare Traction Splint application
    2. If applying splint under Conscious Sedation, consider simultaneously placing Femoral Nerve Block
  2. Anesthetic block options
    1. Bupivacaine or Sensorcaine: 10-20 cc (max 2 to 2.5 mg/kg) or
    2. Ropivacaine: 10-20 cc (max 2 mg/kg)
  3. Syringe
    1. Draw 10-20 cc Bupivicaine or Ropivacaine without Epinephrine into a 20 cc syringe
    2. Attach 22 gauge 1" to 1.25" needle

V. Technique

  1. Prepare site
    1. Palpate the femoral artery
    2. Position the Ultrasound (if used)
      1. Linear vascular probe with indicator at 9:00
      2. Superior or cephalad to injection site
      3. Midline marker of probe lies over the femoral artery
    3. Mark injection site (inferior to inguinal ligament, and lateral to femoral artery)
    4. Betadine or Hibiclens prep of injection site
    5. Locally infitrate skin at injection site (e.g. Lidocaine 1% with Epinephrine)
  2. Femoral Nerve Block
    1. Insert needle perpendicular to skin (90 degrees)
    2. Advance needle until Paresthesias (withdraw until ceases) or approximate depth of femoral artery
    3. Aspirate to confirm not in vessel
    4. Inject 10-20 cc (fluid may be seen on Ultrasound infiltrating appropriate space)

VI. Pharmacokinetics

  1. Onset of action: Within 15 to 30 minutes
  2. Duration: Expect 3-8 hours of Regional Anesthesia with Bupivicaine (longer with Ropivicaine)

VII. References

  1. Roberts (1998) Clinical Procedures in Emergency Medicine, Saunders
  2. Sacchetti in Majoewsky (2012) EM:RAP 12(2): 4

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