ANAESTHETICS AND AIRWAY

Response1: Femoral vein
2. Femoral artery
3. Femoral nerve
NAVY - Nerve, Artery, Vein, Y-Fronts

ResponseConsent (Ideally written if time permits)
Calculate local anaesthetic dose -
U/S guided - Nerve lateral to artery
Aspirate + inject - nerve stimulator needle
Document in notes

ResponseAnaphylaxis to local anaesthetic
Injection site infection/lesion
Patient refusal
Bradyarrhythmia (2nd or 3rd devree AV block (ropivicaine toxicity can worsen)
Femoral bypass/graft near injection site
Anticoagulation/bleeding diathesis

ResponseFemroral n.
Obturator N.
Lateral cutaneous nerve of the thigh

ResponseConsent - Risks (failure of block, LA toxicity), benefits, alternative
Aseptic technique
Prepare LA + dilute to 20-30 mL for volume block (Give dose 20 mL of 0.75% Ropivacaine = 150 mg)
+/- lignocaine to wheal under skin
Identify anatomy with US
In plane or out of plane technique with nerve block needle - ensure needle tip visualised at all times.

• If needle tip lost, hold probe still, manipulate needle gently whilst looking at screen to find needle (or move probe - only move one at a time)
• Do not inject if not seen

When visualised near nerve, aspirate to ensure not in vessel, then inject local slowly. Aspirate every 3-5 mL to document no vessel entry aming for “donut” of LA around nerve
Review for signs of LA toxicity with patient and ensure nursing staff aware of signs of LA toxicity
Assess block effectiveness at 15 mins
Documentation of procedure