by | Aug 24, 2021


  • Fractures of the femoral head, neck, intertrochanteric/subtrochanteric regions, shaft
  • Proximal tibial fractures
  • Patella fractures
  • Anterior thigh lacerations or abscesses


  • Infection overlying injection site
  • Allergy to local anesthetic
  • Request of consultant
  • Concern for compartment syndrome


  • 15-20cc of local anesthetic of choice
  • 22G spinal needle
  • Saline Flush
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover



Position the patient supine



  1. Expose the groin to identify the anterior superior iliac spine and inguinal crease
  2. Place transducer transversly across the femoral region of the upper thigh parallel to the inguinal crease
  3. The femoral vessels are identified and centered on screen
  4. Follow the femoral artery proximal to the inguinal ligament and distal to the takeoff of the profunda femoris artery
  5. The femoral nerve should appear proximal to the bifurcation


  1. Find the large nonpulsatile femoral vein as the initial landmark under ultrasound
  2. Identify femoral nerve (hyperechoic structure lateral to the femoral artery)
    • Must also identify fascia lata and deeper fascia iliaca, as these two fascial planes overlie the femoral nerve. If anesthetic is not placed below these two fascial planes, the anesthetic will not reach femoral nerve and the block will fail.
  3. Under ultrasound guidance, advance needle to the femoral nerve sheath
  4. Aspirate to ensure not in blood vessel
  5. Inject 20cc of local anesthetic along nerve sheath


Demonstration of an in-plane femoral nerve block, with needle seen entering from lateral to medial, depositing anesthetic in the space just lateral to the femoral nerve (*).



  1. WikEM
  2. Highland Ultrasound
  3. The POCUS Atlas