POCUS IOTW: Femoral Nerve Block

Posted on: March 27, 2018, by :

4 year old with a left femur fracture for which Dr. Thomas did an ultrasound guided femoral nerve block.

US is crutial in performing this procedure given the close proximity to the relatively large femoral artery.  The video below shows the artery and the vein.   Mneumonic ‘NAVEL’.

To the right of the artery you may notice a hyperechoic bundle of nerve fibers (honeycomb) which is what you would be aiming for to bath in the anesthetic.  You can see the needle entering from the right of the screen and aiming above the nerve bundle.  You want to always make sure the tip of the needle is in view on ultrasound so as not to poke the close lying vasculature.

For more information on performing and learning about femoral nerve blocks please follow the below link which is a great resource for point of care ultrasound teaching in general.

https://www.acep.org/sonoguide/femoral_nerve_block.html

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.

Haroon Shaukat MD

Pediatric Emergency Medicine Attending at Children's National Health System
I was born and raised in Silver Spring, Maryland, but with very little knowledge of all things DC. “Crabs and football, that’s what Maryland does”, unfortunately I could only partake in one of those. I grew up with a crab allergy so blue crabs are a make believe creature to me, much like the lochness monster. I decided to take the leap of faith and attend medical school abroad but family and home could not keep me away for too long. Residency took me to New Jersey where I began to cultivate my love for medical education and low tolerance for poor pain control. Did I mention I also learned that I outgrew my crab allergy in NJ! Alas, to the DMV I return! Hopefully to contribute to medical education and quality improvement while feasting on a Maryland blue crab or two.
Haroon Shaukat MD

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