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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 13 – Femoral Block

PERSPECTIVE

The femoral block is useful for surgical procedures carried out on the anterior thigh, both superficial and deep. It is most frequently combined with other lower extremity peripheral blocks to provide anesthesia for operations on the lower leg and foot. As an analgesic technique, it is used for femoral fracture analgesia or for prolonged continuous catheter analgesia after surgery on the knee or femur.

Patient Selection.

Because the patient is in the supine position when this block is carried out, virtually any patient undergoing a surgical procedure of the lower extremity is a candidate for this block. Paresthesias are not necessary, so even anesthetized patients are candidates for femoral block.

Pharmacologic Choice.

As with all lower extremity blocks, a decision must be made about the extent of the sensory and motor blockade desired. If motor blockade is necessary, higher concentrations of local anesthetic are needed. As with concerns about local anesthetic use in the sciatic block, the desire for motor blockade must be considered in light of the volume of local anesthetic necessary if femoral, sciatic, lateral femoral cutaneous, and obturator blocks are combined. Approximately 20 mL of local anesthetic should be adequate to produce femoral block. With continuous catheter techniques used for postoperative analgesia, 0.25% bupivacaine or 0.2% ropivacaine may be used, and even lower concentrations of these drugs may be useful after a trial. With this technique, a rate of 8 to 10 mL per hour usually suffices.

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