Femoral Nerve

Casati A, Cappelleri G, Aldegheri G, et al. Total intravenous anesthesia, spinal anesthesia or combined sciatic-femoral nerve block for outpatient knee arthroscopy. Minerva Anestesiol. 2004 70 493-502. 

Peripheral The femoral nerve provides an excellent system for evaluating... 

Fig. 20.5. Femoral nerve dissection. The motor and sensory branches of the femoral nerve are exposed. The mouse is supine and the right hip is shown (forceps are retracting the abdominal wall, A, P, M, L are anterior, posterior, medial, and lateral respectively, H is hamstring muscles). Some adipose tissue has been removed for clarity. The motor branch of the femoral nerve innervates the quadriceps (Q). The sensory branch becomes the saphenous nerve, which runs adjacent to the saphenous vein (Saph) on the medial side of the thigh. Dissecting the nerve where the tick marks provides a reasonable length of nerve to work with. Note the sensory branch sometimes runs as two fascicles and both should be taken to get reproducible counts. The scale bar is 2 mm. (Color figure is available online).

Epidural anesthesia can mask a neurological deficit, such as nerve compression of the femoral nerve and lateral femoral cutaneous nerve of the thigh from the lithotomy position (SEDA-22, 137). 

Two case reports have highlighted the potential danger of injecting pethidine into the lateral thigh region, which can cause injury to the femoral nerve branch to the vastus lateralis, causing muscle atrophy (12). 

Eleven patients referred for neurological evaluation after cisplatin infusion into the internal or external iliac arteries for pelvic or lower limb tumors aU developed symptoms within 48 hours of nerve or plexus dysfunction within the territory supplied by the cannulated artery (108). The lumbosacral plexus was affected in nine patients, the femoral nerve in one, and the peroneal nerve in one. The doses of cisplatin ranged from 50 to 160 mg/m and they did not correlate with the severity or course of the neuropathy. Small-vessel injury and infarction or a direct toxic effect are likely explanations. 

Injection of a local anesthetic into or around individual peripheral nerves or nerve plexuses produces even greater areas of anesthesia than do the techniques described above. Blockade of mixed peripheral nerves and nerve plexuses also usually anesthetizes somatic motor nerves, producing skeletal muscle relaxation, which is essential for some surgical procedures. The areas of sensory and motor block usually start several centimeters distal to the site of injection. Brachial plexus blocks are particularly useful for procedures on the upper extremity and shoulder. Intercostal nerve blocks are effective for anesthesia and relaxation of the anterior abdominal wall. Cervical plexus block is appropriate for surgery of the neck. Sciatic and femoral nerve blocks are useful for surgery distal to the knee. Other useful nerve blocks prior to surgical procedures include blocks of individual nerves at the wrist and at the ankle, blocks of individual nerves such as the median or ulnar at the elbow, and blocks of sensory cranial nerves. 

Using implanted stimulators and electrodes on the femoral nerves bilaterally, Brindley [27] was able to achieve in a paraplegic the movement of rising from a sitting position and limited gait assisted... 

Dynamic stability is provided by the muscles acting across the joint. These are principally the hamstrings which flex the knee joint and are innervated by the sciatic nerve or its branches, and the quadriceps which extend the knee and are supplied by the femoral nerve or its branches. 

Ezra, M., et al. 2013. Enhanced femoral nerve regeneration after tubulization with a tyrosine-derived polycarbonate terpolymer effects of protein adsorption and independence of conduit porosity. Tissue Engineering Part A 20(3 ) 518-528. 

SaUm MA, DiSessa TG, Watson DC. The wandering pacemaker intraperitoneal migration of an epicardially placed pacemaker and femoral nerve stimnlation. Pediatr Cardiol 1999 20 164-6. 

A 78-year-old woman received a femoral nerve block with 30 ml of bupivacaine 0.5% for total knee replacement. After surgery an infusion of bupivacaine 0.25% (8 ml/hour) was given via a femoral nerve catheter. She developed complete heart block 9 hours later. A preoperative electrocardiogram had shown sinus rhythm and electrolytes were normal. Sinus rhythm resumed 6 hours after the end of the infusion. There was no other cardiac pathology, and the authors assumed that bupivacaine had caused the dysrhythmia. 

Cardiac arrest has been reported after femoral nerve block [bS ]. 

A 17-year-old patient had seizures directly after receiving 20 ml of bupivacaine 0.5% over 2-3 minutes for femoral nerve blockade aspiration tests every 5 ml were negative. He was bag-ventilated and given 3 mg of midazolam intravenously, followed by Intralipid 20% 1-2 minutes later he went into cardiac arrest with ventricular fibrillation. He was successfully resuscitated. 

A case is reported of femoral nerve injury as a complication of percutaneous simple renal cyst. Renal cysts are benign, common and often as3miptomatic disease in old age, and sometimes treated with ethanol sclerotherapy. The present case describes an iatrogenic femoral nerve injury following p>ercutaneous injection of ethanol into a renal cyst imder sedation [60 ]. The percutaneous injection was guided by sonography At end of the procedure. 

Ashraf A, Karami MY, Amanat A. Femoral nerve injury as a complication of percutaneous simple renal cyst sclerotherapy with ethanol a case report Case Rep Med 2012. 

The lateral femoral cutaneous nerve courses more lateral relative to the femoral nerve. It arises from the L2 and L3 spinal nerve roots, emerges from the lateral border of the psoas muscle and crosses the iliacus muscle passing through a tunnel formed by a small split in the lateral end of the inguinal ligament in close proximity with the anterior superior iliac spine (Fig. 12.10b). This nerve is purely sensory and supplies the skin of the anterior and lateral aspects of the thigh. 

Fig. 12.14a,b. Iliopsoas muscle and tendon, a Transverse and b sagittal 12-5 MHz US images obtained over the anterior aspect of the hip joint in a healthy subject demonstrate the iliopsoas muscle (IPs) and tendon (arrow), which are located between the rectus femoris (RF) and the neurovascular bundle, superficial to the anterior capsular plane (white arrowhead) and the articular cartilage (rhombi) of the femoral head (FH). FN, femoral nerve FA, common femoral artery Ac, acetabulum. The photograph and the schematic drawing at the left side of the figure indicate probe positioning... 

Fig. 12.17. Intrapelvic portion of the iliopsoas muscle. Transverse 12-5 MHz US image obtained over the intrapelvic portion of the iliopsoas (IPs) muscle in a healthy subject. The muscle is seen lying over the anterior surface of the iliac bone. Its tendon (arrow) is located in an anterior and medial position. It appears as a well-defined oval hyperechoic structure embedded within the hypoechoic muscle belly. The femoral nerve (FN) is found in a superficial location, just laterally to the common femoral artery (FA). FV, femoral vein. The photograph and the schematic drawing at the left side of the figure indicate probe positioning...

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