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FEMORAL NERVE BLOCK ANATOMICAL INSERTION POINT: A PROSPECTIVE, RANDOMISED,

DOUBLE-BLIND CONTROLLED TRIAL
1,2 2 2 2 2
J. Anns , I. Awad , C. McCartney , N. Nikravan , E. Chen
1 2
Department of Anaesthesia, Royal United Hospital Bath, Bath, UK, Department of Anaesthesia,
Sunnybrook Health Sciences Centre and The Holland Orthopaedic and Arthritic Centre, Toronto, ON,
Canada
Background and aims: Femoral nerve block (FNB) is an established technique to control pain after total
knee replacement. Two evoked muscle responses may be elicited, sartorius and quadriceps muscle
contraction. Most authors advocate preferentially searching for the latter response. The success of FNB
using either twitch has not been confirmed with randomised controlled trials (1). The hypothesis is to
determine if FNB with sartorius stimulation causes an equivalent block to the classical method.

Methods: After IRB approval,sixty patients for primary unilateral total knee arthroplasty were recruited.
The patients were randomly allocated into two groups: Group 1; end point sartorius stimulation, Group 2;
end point quadriceps stimulation. The FNB was evaluated for both sensory and motor modalities for thirty
minutes post insertion. Opioid consumption was assessed on post operative day one. Studies show
100% success rate of blocking the femoral nerve using quadriceps stimulation (2), therefore a two sample
two sided test of proportions would require 60 subjects to detect a difference between 100% for the
classical method and 80% for the other block at 80% power with alpha=0.05.

Results: There was no statistically significant difference in the onset time of the following nerves; femoral
(p=0.295), lateral femoral cutaneous (p=0.085) and saphenous (p=0.336) at 30 minutes post insertion.
The duration of the block was 8.945.76 hours for the sartorius group and 10.967.59 hours for the
quadriceps group (p=0.265). Total hydromophone consumption was 6.373.75 mg in the sartorius group
and 4.832.82 mg in the quadriceps group (p=0.084). The post-operative VAS pain scores were not
statistically significant (p=0.531).

Conclusion: There is no significant difference in block onset and duration when using either quadricepts
femoris or sartorius muscle stimulation as an end point when performing FNB. There was also no
significant difference in hydromorphone consumption and post-operative VAS pain scores between both
groups.

References:

(1) De Tran QH et al. A review of approaches and techniques for lower extremity nerve blocks. Can J
Anesth 2007;54:922-34.

(2) Jochum D et al. Evaluation of femoral nerve blockade following inguinal paravascular block of Winnie:
are there still lessons to be learnt? Anaesthesia 2005;60:974-7.