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Lower extremity nerve blocks: Techniques

Authors
Christina L Jeng, MD
Meg A Rosenblatt, MD
Section Editor
Lisa Warren, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Peripheral nerve blocks of the lower extremity are used for operative anesthesia and/or postoperative analgesia for a variety of lower extremity surgeries.

This topic will discuss the innervation of the lower extremity, techniques and drugs used for lower extremity nerve blocks, and complications specific to these blocks. Where appropriate, the use of perineural catheters for continuous nerve block will be discussed. Indications, contraindications, comparison of techniques relevant to all peripheral nerve blocks, equipment, and complications common to all nerve blocks are discussed separately. (See "Overview of peripheral nerve blocks".)

INNERVATION: LOWER EXTREMITY

The lumbar plexus is formed by the anterior divisions of the first three lumbar nerves (L1, L2, L3) and part of the fourth lumbar nerve (L4). A branch from the 12th thoracic spinal nerve (T12) often joins the L1 nerve root (figure 1).

The lumbar plexus is located in the posterior third of the psoas muscle, anterior to the lumbar transverse processes. It gives rise to nerves that supply the muscular and cutaneous innervation to the lower extremity, including the iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve, femoral nerve, lateral femoral cutaneous nerve, and obturator nerve (figure 2).

The femoral nerve (L2 to L4) runs through the psoas muscle and emerges at the lower border between the psoas and iliacus muscles, beneath the inguinal ligament lateral to the common femoral artery. The femoral nerve provides motor branches to thigh extensors and sensation to the anterior thigh, femur, knee joint, and medial leg (figure 3 and figure 4). The saphenous nerve is the terminal sensory branch of the femoral nerve.

                                                  

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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 21 00:00:00 GMT+00:00 2016.
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References
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