1) Femoral nerve block is now considered the standard of care for acute pain management for femoral fractures including hip and femoral shaft fractures.
2) Femoral nerve blocks are most beneficial when placed as quickly as possible after injury and should be placed by qualified ED staff as soon after presentation as possible after appropriate evaluation for high-risk features and contraindications.
3) Femoral nerve blocks have several serious potential complications including: a) potential masking of the clinical signs of an emerging compartment syndrome leading to delay in diagnosis, b) nerve injury c) local anesthetic toxicity.
4) Patients with with the following high risk clinical features are not appropriate for a femoral block. (Rare exceptions can be made on a case-by-case basis at the discretion of the attending orthopedic surgeon only. )
a) Clinical signs suggestive of an expanding thigh compartment at risk for compartment syndrome
b) Clinical signs suggestive of femoral nerve injury or deficit.
c) Clinical signs of a significant vascular injury with potential to produce elevated compartment pressures.
d) Open femoral fractures.
5) Standard best practice technique and general contraindications and indications for regional anesthesia in an acutely injured patient apply