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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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PLACEMENT

Anatomy.

As shown in Figure 14-1 , the lateral femoral cutaneous nerve emerges along the lateral border of the psoas muscle immediately caudad to the ilioinguinal nerve. It courses deep to the iliac fascia and anterior to the iliacus muscle to emerge from the fascia immediately inferior and medial to the anterosuperior iliac spine, as shown in Figure 14-2 . After passing underneath the inguinal ligament, it crosses or passes through the origin of the sartorius muscle and travels underneath the fascia lata, dividing into anterior and posterior branches at variable distances below the inguinal ligament. The anterior branch supplies the skin over the anterolateral thigh, whereas the posterior branch supplies the skin over the lateral thigh from the greater trochanter to the mid-thigh.

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Figure 14-1  Lateral femoral cutaneous nerve: anatomy.


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Figure 14-2  Lateral femoral cutaneous nerve block: technique.


Position.

The patient is in a supine position, with the anesthesiologist at the patient’s side, similar to the position taken for the femoral nerve block.

Needle Puncture.

The anterosuperior iliac spine is marked in the supine patient, and a 22-gauge, 4-cm needle is inserted at a site 2 cm medial and 2 cm caudal to the mark (see Fig. 14-2 ). As shown in Figure 14-3 , the needle is advanced until a pop is felt as the needle passes through the fascia lata. Local anesthetic is then injected in a fan-like manner above and below the fascia lata, from medial to lateral, as illustrated in Figure 14-3 .

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Figure 14-3  Lateral femoral cutaneous nerve block: cross-sectional technique for local anesthetic injection.


Potential Problems.

The superficial nature of this block allows one to avoid most problems associated with regional blocks.

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