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continuous femoral nerve block (via elastomeric device; mean duration 50 hours) provided
more effective analgesia for up to 4 days following anterior cruciate ligament reconstruction
than either single‐shot femoral nerve block or placebo (saline) block (Williams et al, 2006
Level II).
Continuous fascia iliaca block provided similar analgesia to a ‘3‐in‐1’ block following anterior
cruciate ligament repair and the catheter was considered technically easier to insert (Morau et
al, 2003 Level II). It is likely that many catheters placed as a classic ‘3‐in‐1’ block were in fact
relying on local anaesthetic spread along the plane of the fascia iliaca (Capdevila et al, 1998
Level II). Fascia iliaca block is also of benefit in some paediatric procedures (see Section 10.7.1).
For more information on any differences between the local anaesthetics used for femoral
nerve blocks see Section 5.1.2.
Sciatic nerve
Following total knee arthroplasty, combined sciatic and femoral nerve blockade did not
improve analgesia compared with femoral block alone (Allen et al, 1998 Level II). However, after
lower extremity surgery (Ilfeld, Morey, Wang et al, 2002 Level II) and foot surgery (White et al, 2003
Level II), continuous popliteal sciatic nerve analgesia resulted in better pain relief, lower opioid
requirements and fewer side effects compared with opioids alone.
A comparison of epidural analgesia and combined sciatic‐femoral nerve blockade after total
knee arthroplasty showed no differences in pain relief (rest and with movement), side effects
(apart from urinary retention, which was greater in the epidural group), rehabilitation or
length of hospital stay (Zaric et al, 2006 Level II).
For more information on any differences between the local anaesthetics used for sciatic nerve
blocks see Section 5.1.2.
Lumbar plexus
Continuous psoas compartment blockade can be used for postoperative analgesia following
total hip replacement (Capdevila et al, 2002 Level IV) and surgical repair of hip fractures (Chudinov
et al, 1999 Level II). CHAPTER 7
Femoral and posterior lumbar plexus blocks compared with placebo for knee and hip
arthroplasty respectively reduced the time to discharge readiness (criteria included adequate
analgesia, independence from IV analgesia and ambulatory targets) (Ilfeld, Le et al, 2008 Level II;
Ilfeld, Ball et al, 2008 Level II). However, there was no significant reduction in ambulation
distance achieved. There was no evidence that either a 4‐day continuous lumbar plexus block
after hip arthroplasty (Ilfeld, Ball et al 2009 Level II) or 4‐day continuous femoral nerve block
after knee arthroplasty (Ilfeld, Meyer et al 2009 Level II) improved health‐related quality of life
between 7 days and 12 months.
Both continuous posterior lumbar plexus and femoral analgesia significantly reduced 48‐hour
opioid requirements and pain scores following total knee joint replacement surgery compared
with IV PCA morphine (Kaloul et al, 2004 Level II). There were no differences in pain scores or
morphine consumption between the two regional analgesia groups.
A study comparing continuous femoral nerve, femoral/sciatic nerve and lumbar plexus
infusions found that the combination of femoral and sciatic nerve infusion reduced
postoperative opioid requirements after total knee replacement, however there were
no differences in pain scores or function (Morin, Kratz et al, 2005 Level II). Also after knee
arthroplasty surgery, epidural analgesia provided better analgesia at 6 hours than a lumbar
plexus infusion, but there were no differences in pain at rest or with movement at 24 hours,
or in range of movement or mobility (Campbell et al, 2008 Level II).

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