Dr. Axel R. Sauter

Department of Research and Development. Oslo University Hospital. Oslo. Norway

Department of Anesthesiology and Pain Medicine. lnselspital, Bern University Hospital. Bern, Switzerland

Peripheral nerve blocks (PNB) provide important benefits in the peri- and postoperative treatment of patients with lower limb surgery. Compared to the use of general, spinal, or epidural anaesthesia, improved hemodynamic stability can be maintained with PNB. Continuous nerve blocks with catheter placement are suitable for prolonged postoperative analgesia in many orthopaedic patients. This is particularly useful because the use of epidural catheters is no longer recommended for routine pain treatment after major orthopaedic surgery. Nerve supply of the lower extremity comes from two major neural pathways formed by the lumbar and sacral plexus. The lumbar plexus is formed by the ventral rami of the nerve roots L1 to L4, with a contribution from T12. The plexus is situated within the psoas mayor muscle, ventrally to the transverse processes.

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