Pain Management Procedures
Lower-Extremity Peripheral Nerve Blocks
Lower-Extremity Peripheral Nerve Blocks
What are they?
Individual nerves can be blocked to numb a specific part of the hip, thigh, knee, lower leg, ankle, or foot. APG's list includes femoral, adductor canal, popliteal-sciatic, common peroneal, sural, and tibial nerve blocks. These procedures are commonly used for surgery and acute injury, and may also be used diagnostically or therapeutically for selected chronic nerve pain.
What area does each target?
· Femoral nerve: front of the thigh and much of the knee; also controls quadriceps strength.
· Adductor canal: mainly sensory coverage around the inner knee and lower leg, with less quadriceps weakness than a femoral block in many patients.
· Popliteal-sciatic: much of the lower leg and foot below the knee, usually sparing the inner ankle.
· Common peroneal: outer lower leg and top of the foot; also controls ankle and toe lifting.
· Sural: outer ankle and side of the foot; sensory only.
· Tibial: sole of the foot and heel; also controls several foot muscles.
What happens?
Ultrasound identifies the selected nerve and nearby vessels. Local anesthetic is injected beside the nerve under standard monitoring. The exact block or combination is chosen to match the painful territory.
What should I expect?
The leg or foot may be numb and weak. Falls are a real concern. Use a brace, crutches, or assistance exactly as instructed; do not walk on a blocked limb without clearance. Protect numb skin from pressure and heat.
Important risks
Risks include bleeding, infection, nerve injury, local-anesthetic toxicity, prolonged numbness, and falls. New severe weakness that lasts beyond the expected block, increasing swelling, or severe pain should be reported promptly.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.