The Case

Let's say we do a little time warp, and we are unfortunately six months into the past, stuck in the dredges of frigid winter. EMS appears with a patient who just wiped out big time on the ice. He's gripping his thigh with his hands, and he is screaming. Maybe he's broken his hip? Maybe it's dislocated? Maybe he cracked the shaft of his femur? For this exercise, let's say that it doesn't matter.



What does matter is that it looks like this might need a little pushing and pulling, either to get it reduced or maybe just for re-positioning for imaging. Procedural sedation? I mean, we're always down for that, but is there a better way?



Turns out there is! Specifically we will discuss the femoral 3-in-1 block--so titled as it knocks out the lateral cutaneous, obturator, and femoral nerves. This will completely anesthetize the femoral shaft, with some coverage of the proximal end of the femur. This can be done blind, but adding U/S greatly increases the chance of success--the evidence that's out there has shown that using a probe gets you blockade faster and has a higher rate of complete blockade.