Ultrasound-Guided Nerve Blocks of the Lower Limb

  • Mandeep Singh
  • Imad T. Awad
  • Colin J. L. McCartney


The need for effective analgesia in the perioperative period for major lower limb surgery has generated interest in the field of regional anesthesia. These regional techniques are commonly performed before central neuraxial blockade, but they could potentially be used as the sole anesthetic technique in conjunction with monitored sedation techniques. Regional anesthesia of the lower limb in conjunction with a multimodal analgesic regimen could provide obvious advantages such as opioid sparing, shorter hospital stay, improved patient satisfaction, and better functional outcomes [1]. This chapter describes the current methods and reasons for performing specific blocks to the lower limb utilizing ultrasound guidance.


Lower limb Nerve blocks 



We thank Mr. Ewen Chen, HBSc, MBBS candidate, for his exceptional efforts and help with formatting and editing of the images included in this chapter.


  1. 1.
    Chang CB, Cho WS. Pain management protocols, peri-operative pain and patient satisfaction after total knee replacement: a multicentre study. J Bone Joint Surg Br. 2012;94:1511–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Liu SS, Ngeow JE, YaDeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med. 2009;34:47–59.CrossRefPubMedGoogle Scholar
  3. 3.
    Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007;104:1265–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Gofeld M. Ultrasonography in pain medicine: a critical review. Pain Pract. 2008;8:226–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Chin KJ, Perlas A, Chan VW, Brull R. Needle visualization in ultrasound-guided regional anesthesia: challenges and solutions. Reg Anesth Pain Med. 2008;33:532–44.PubMedGoogle Scholar
  6. 6.
    Awad IT, Duggan EM. Posterior lumbar plexus block: anatomy, approaches, and techniques. Reg Anesth Pain Med. 2005;30:143–9.PubMedGoogle Scholar
  7. 7.
    Chan VW, Abbas S, Brull R. Ultrasound imaging for regional anesthesia. 2nd ed; 2009.Google Scholar
  8. 8.
    Vloka JD, Hadzić A, April E, Thys DM. The division of the sciatic nerve in the popliteal fossa: anatomical implications for popliteal nerve blockade. Anesth Analg. 2001;92:215–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Sinha SK, Abrams JH, Houle TT, Weller RS. Ultrasound-guided obturator nerve block: an interfacial injection approach without nerve stimulation. Reg Anesth Pain Med. 2009;34:261–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med. 2007;8:669–77.CrossRefPubMedGoogle Scholar
  11. 11.
    Ng I, Vaghadia H, Choi PT, Helmy N. Ultrasound imaging accurately identifies the lateral femoral cutaneous nerve. Anesth Analg. 2008;107:1070–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Grothaus MC, Holt M, Mekhail AO, Ebraheim NA, Yeasting RA. Lateral femoral cutaneous nerve: an anatomic study. Clin Orthop Relat Res. 2005;437:164–8.CrossRefGoogle Scholar
  13. 13.
    Bodner G, Bernathova M, Galiano K, Putz D, Martinoli C, Felfernig M. Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers. Reg Anesth Pain Med. 2009;34:265–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Manickam B, Perlas A, Duggan E, Brull R, Chan VW, Ramlogan R. Feasibility and efficacy of ultrasound-guided block of the saphenous nerve in the adductor canal. Reg Anesth Pain Med. 2009;34:578–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Tsui BCH, Ozelsel T. Ultrasound-guided transsartorial perifemoral artery approach for saphenous nerve block. Reg Anesth Pain Med. 2009;34:177–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Redborg KE, Sites BD, Chinn CD, Gallagher JD, Ball PA, Antonakakis JG, Beach ML. Ultrasound improves the success rate of a sural nerve block at the ankle. Reg Anesth Pain Med. 2009;34:24–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Snaith R, Dolan J. Ultrasound-guided superficial peroneal nerve block for foot surgery. AJR Am J Roentgenol. 2010;194:W538; author reply W542.CrossRefPubMedGoogle Scholar
  18. 18.
    Canella C, Demondion X, Guillin R, Boutry N, Peltier J, Cotten A. Anatomic study of the superficial peroneal nerve using sonography. AJR Am J Roentgenol. 2009;193:174–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mandeep Singh
    • 1
  • Imad T. Awad
    • 2
  • Colin J. L. McCartney
    • 3
  1. 1.Department of AnesthesiaToronto Western Hospital, University of TorontoTorontoCanada
  2. 2.Department of AnesthesiaSunnybrook Health Sciences Center, University of TorontoTorontoCanada
  3. 3.The Ottawa Hospital, Civic CampusOttawaCanada

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