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Lower limb blocks 

Lower limb blocks
Lower limb blocks

Colin McCartney

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date: 12 November 2019

Peripheral nerve blocks of the lower limb can provide profound intraoperative anaesthesia and postoperative analgesia without many of the side effects of central techniques. However, spinal and lumbar epidural anaesthesia and analgesia remain the most commonly performed regional techniques for lower limb surgery, and all anaesthetists should be competent in these methods. Central blocks have several disadvantages, especially when used for postoperative analgesia, and in the last decade the use of peripheral nerve blocks has become more common. This is related to a number of factors including the association of continuous epidural analgesia with increased side effects such as urinary retention and pruritis compared to peripheral (especially continuous) techniques, fear of epidural haematoma with newer more potent anticoagulants, and the significant incidence of failure of continuous epidural analgesia (up to 20% in some studies). In addition, the emergence of better techniques for localizing nerves and the availability of improved equipment have increased the popularity of blocks of the lumbar and sacral plexus. Lower limb peripheral nerve block techniques can be challenging, especially in obese individuals, but the view that all nerve blocks of the lower limb are difficult and unreliable is incorrect. The aim of this chapter is to present simple techniques which give consistent results and may be used routinely. The use of ultrasound has, in a number of cases, increased our ability to locate lower limb nerves and appropriate techniques have been included. Only brief reference will be made to techniques which have not been found useful in routine clinical practice.

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