The Relative Location of the Major Femoral Nerve Motor Branches in the Thigh

Abstract

In peripheral nerve surgery, repair of the femoral nerve (FN) requires identification of normal nerve elements both proximal and distal to the level of the injury. We identified FN branches to the sartorius (SRT) and quadriceps muscles in 16 embalmed specimens and calculated the length of each branch to its point of entry into its respective muscle. The SRT and rectus femoris (RF) muscles were mobilized but not transected to mimic the surgical approach. Ratios of the length of each motor branch as a unit of the total length of the thigh, defined as the FN at the inguinal ligament to the superior margin of the patella were also calculated. The proximal branch to RF spanned a ratio of .19 ± .11 (mean ± standard deviation) from the FN at the inguinal ligament to its endpoint. The ratio of the distal branch to the RF was .29 ± .08. The ratio of the proximal SRT branch was .20 ± .05. The distal branch to SRT was located at a ratio of .43 ± .11. The proximal branch to vastus lateralis (VL) was .26 ± .08. The distal branch to VL was .39 ± .07. The ratio of the motor branch to vastus intermedius (VI) was .30 ± .05. Lastly, the branch to vastus medialis (VM) was .55 ± .06. The motor branch to SRT frequently emerged as a bifurcation of itself and saphenous nerve within the adductor canal. Knowledge of the relative location of the motor branches of the FN in the thigh can be helpful to surgeons during the nerve exploration and repair.

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

“…Although ESPB was first described with the in-plane technique, reports suggest that the out-of-plane technique is easier to apply. 28 When the transverse process is chosen as the target, the out-of plane technique leads to safe application. The safety margin may also be increased by measuring the distance from the skin to the transverse process using ultrasonography.…”

“…While the needle length may change according to the location of the application and patient characteristics, generally a 22 G needle measuring 50, 80, or 100 mm is used for thoracic applications, while a 22 G needle measuring 80-100 mm should be used for lumbar or other applications. 4,7,13,28 Catheterization Catheter use in bilateral thoracic ESPB has been reported in the literature. Clinical trials using catheterization for bilateral ESPB in adults undergoing cardiac procedures have been reported.…”

“…The choice of local anesthetic agent has been reported to be ropivacaine, levobupivacaine, bupivacaine (at concentrations of 0.5%, 0.25%, or 0.375%), and lidocaine (1% or 2% concentration). 2,4,28 When choosing a local anesthetic agent, an appropriate agent for single-shot use that would stay below the maximum and daily dosage should be chosen. Higher concentrations may be required for surgical anesthesia and lower concentrations for postoperative analgesia.…”

“…Bilateral ESPB has been used in lower cervical and interscapular myofascial pain, as well as chronic low-back pain. 28,41,42 Also, bilateral ESPB was used for effective and long-term analgesic in a patient with fracture of the lumbar vertebra transverse process. 43 Bilateral ESPB has been reported for effective analgesia in hyperalgesia caused by acute pancreatitis.…”

“…52 Bilateral ESPB has been reported to lead to effective postoperative analgesia in a patient undergoing bilateral mastectomy and abdominoplasty. 28 Also, a randomized controlled study compared tumescent anesthesia with bilateral ESPB in reduction mammoplasty, and found that NRS scores and tramadol consumption in the first 24 hours were significantly lower in the ESPB group. Aygun et al 53 reported that bilateral ESPB led to effective postoperative analgesia in a subscapular placed bilateral elastofibroma patient.…”