title: Lower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.
abstract: BACKGROUND
  The utilization of peripheral nerve blocks in orthopaedic surgery has paralleled the rise in the number of ambulatory surgical procedures performed. Optimization of pain control in the perioperative orthopaedic patient contributes to improved patient satisfaction, early mobilization, decreased length of hospitalization, and decreased associated hospital and patient costs. Our purpose was to provide a concise, pertinent review of the use of peripheral nerve blocks in various orthopaedic procedures of the lower extremity, with specific focus on procedural anatomy, indications, patient outcome measures, and complications.
  
  
  METHODS
  We reviewed the literature and reference textbooks on commonly performed lower-extremity peripheral nerve block procedures in orthopaedic surgery, focusing on those most commonly used.
  
  
  RESULTS
  The use of lower-extremity peripheral nerve blocks is a safe and effective approach to perioperative pain management. Different techniques and timing can have an important impact on patient satisfaction, and each technique has specific indications and complications. For major hip surgery, one of the most commonly used is the lumbar plexus block, which can result in early mobilization, reduced postoperative pain, and decreased opioid-associated adverse events. Associated complications include epidural spread of anesthesia, retroperitoneal hematoma formation, and postoperative falls. For arthroscopic and open knee procedures, the femoral nerve block is frequently used adjunctively. It provides improved early postoperative pain control, early mobilization with therapy, and increased patient satisfaction compared with intra-articular or intravenous opioids alone; it also provides cost savings. However, some studies have shown no significant difference in outcome measures compared with intra-articular opioids alone for arthroscopic anterior cruciate ligament reconstruction. Associated complications include nerve injury, intravascular injection, and postoperative falls.
  
  
  CONCLUSIONS
  The use of peripheral nerve blocks in lower-extremity surgery is becoming a mainstay of perioperative pain management strategy.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780, USA.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Stein
authors.forename: Umasuthan
authors.initials: U
authors.lastname: Srikumaran
authors.forename: Eric W
authors.initials: EW
authors.lastname: Tan
authors.forename: Michael T
authors.initials: MT
authors.lastname: Freehill
authors.forename: John H
authors.initials: JH
authors.lastname: Wilckens
mesh_terms: D004434:Early Ambulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000294:innervation / Q000601:surgery*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods; D010525:Peripheral Nerves / Q000187:drug effects*; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome