Femoral nerve block right after spinal placement

[Mman]

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is there any good evidence of decreased incidence of nerve injury with U/S guidance compared to none for femoral nerve block? I'm not aware of any and have seen plenty of case reports of nerve injury in either scenario. I certainly wouldn't use it to feel like you have lesser chance of nerve injury.

 

[OB1🤙]

This is another reason why to do adductor canal blocks for TKA- you can do it asleep/spinalized and not worry about litigation. I do mine after the dressing goes on.

 

[Mman]

This is another reason why to do adductor canal blocks for TKA- you can do it asleep/spinalized and not worry about litigation. I do mine after the dressing goes on.

Huh? No worry of litigation? Why? I assume you are going to argue that it's a sensory block so they can't have a motor deficit, and while mostly true not entirely as I've seen plenty of motor blocks after adductor canal blocks. Or was there some other way it's impervious to causing injury? Because I can assure you I discuss risks of the procedure prior to performing it.

 

[OB1🤙]

OK put it this way- pretty much the worst possible motor injury with the ACB is the branch to the vastus medialis. You can't have a catastrophic injury to the entire quadriceps the way you can with a femoral.

If you saw motor weakness after ACBs (and I've never seen it, which isn't too say it can't happen), it may have been from local tracking proximal. But that won't/can't result in a nerve injury at those proximally blocked fibers.

Anyway, I'm completely comfortable with ACBs done this way, but if you're not, that's fine.

 

[sevoflurane]

I have done them asleep for the last 3-4 years.