ESRA Academy. Hyeon Ju S. Sep 8, 2016; 138311
Prof. Dr. Shin Hyeon Ju
Prof. Dr. Shin Hyeon Ju

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Background and Aims:

Continuous femoral nerve block improves postoperative analgesia in total knee arthroplasty (TKA). Recently, ultrasound-guided nerve block in children has been performed under general anesthesia. In our study, the femoral catheter was inserted postoperatively in anesthetized patients to decrease procedural pain and discomfort, and to reduce impact on the operating list. The aim of this study was to evaluate the clinical outcome and complications of ultrasound-guided femoral catheter placement using our 'in-plane 3-step needle insertion technique' for TKA in anesthetized patients.


This retrospective study included 488 patients who had undergone TKA. Ultrasound-guided femoral catheter placement was performed after surgery under general or spinal anesthesia using “in-plane 3-step needle insertion technique” that is devised to reduce the risk of direct femoral nerve injury. Step 1; the Tuohy needle is inserted to penetrate the fascia iliaca at the lateral part of the femoral nerve. Step 2; after penetration of the fascia iliaca, the needle tip is pulled back slightly and the angle of the needle shaft is decreased to near horizontal. Step 3; the needle is inserted into the space between the fascia iliaca and the femoral nerve.


The femoral catheters were placed as 100% of success rate. There was no femoral hematoma, femoral abscess, and neurologic complications including paresthesia or neurologic deficit for 8 weeks follow-up period.


Our results presented that our in-plane 3-step needle insertion technique allowed safe and easy placement of the femoral catheter for TKA and resulted in no paresthesia or neurologic deficit in 488 anesthetized patients.

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