<p begin="00:00:07.378" end="00:00:09.000" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.000" end="00:00:11.275" style="s2">with a nerve exam type is used to perform</p>
<p begin="00:00:11.275" end="00:00:14.181" style="s2">an ultrasound-guided femoral nerve block.</p>
<p begin="00:00:14.181" end="00:00:17.382" style="s2">The target depth is approximately<br />one to three centimeters</p>
<p begin="00:00:17.382" end="00:00:19.631" style="s2">in an 80 kilogram adult.</p>
<p begin="00:00:19.631" end="00:00:22.367" style="s2">The patient is placed<br />in a supine position.</p>
<p begin="00:00:22.367" end="00:00:24.579" style="s2">The transducer is placed just superior</p>
<p begin="00:00:24.579" end="00:00:26.294" style="s2">to the inguinal skin crease</p>
<p begin="00:00:26.294" end="00:00:30.461" style="s2">with the orientation marker<br />directed to the patient's right.</p>
<p begin="00:00:31.318" end="00:00:33.157" style="s2">The common femoral artery is seen</p>
<p begin="00:00:33.157" end="00:00:35.893" style="s2">as a round, pulsatile structure.</p>
<p begin="00:00:35.893" end="00:00:38.069" style="s2">The transducer should be moved laterally</p>
<p begin="00:00:38.069" end="00:00:41.966" style="s2">one to two centimeters to<br />identify the femoral nerve.</p>
<p begin="00:00:41.966" end="00:00:44.927" style="s2">The nerve lies deep to the fascia iliaca</p>
<p begin="00:00:44.927" end="00:00:48.332" style="s2">and appears as an oblong,<br />bright hyperechoic structure</p>
<p begin="00:00:48.332" end="00:00:50.561" style="s2">lying on the iliacus muscle.</p>
<p begin="00:00:50.561" end="00:00:53.344" style="s2">It may contain dark hyperechoic circles</p>
<p begin="00:00:53.344" end="00:00:55.686" style="s2">that represent the nerve fascicles.</p>
<p begin="00:00:55.686" end="00:00:58.920" style="s2">The nerve always lies<br />deep to the fascia iliaca</p>
<p begin="00:00:58.920" end="00:01:00.135" style="s2">and should not be confused</p>
<p begin="00:01:00.135" end="00:01:03.340" style="s2">with the bright hyperechoic<br />tissue lying above the fascia,</p>
<p begin="00:01:03.340" end="00:01:05.481" style="s2">which is lymphatic tissue.</p>
<p begin="00:01:05.481" end="00:01:08.793" style="s2">The needle is advanced<br />using an in-plane technique.</p>
<p begin="00:01:08.793" end="00:01:11.734" style="s2">The needle is positioned one<br />to two centimeters lateral</p>
<p begin="00:01:11.734" end="00:01:15.563" style="s2">to the transducer and<br />advanced under the transducer.</p>
<p begin="00:01:15.563" end="00:01:17.219" style="s2">The initial end point for the needle</p>
<p begin="00:01:17.219" end="00:01:21.762" style="s2">is just lateral to the nerve<br />and deep to the fascia iliaca.</p>
<p begin="00:01:21.762" end="00:01:24.475" style="s2">The local anesthetic is<br />injected incrementally,</p>
<p begin="00:01:24.475" end="00:01:25.860" style="s2">close to the nerve.</p>
<p begin="00:01:25.860" end="00:01:28.643" style="s2">For a successful block, a spread of local</p>
<p begin="00:01:28.643" end="00:01:31.367" style="s2">should be observed behind<br />the femoral artery.</p>
<p begin="00:01:31.367" end="00:01:34.771" style="s2">If local anesthetic is identified<br />anterior to the artery,</p>
<p begin="00:01:34.771" end="00:01:38.097" style="s2">then the needle is superficial<br />to the fascia iliaca</p>
<p begin="00:01:38.097" end="00:01:42.014" style="s2">and the needle needs to<br />be repositioned deeper.</p>