Perivascular Axillary Block V: Blockade following 60 ml of Mepivacaine 1 % Injected as a Bolus or as 30 + 30 ml with a 20-min Interval

Perivascular axillary blockade was performed on 60 patients with the aid of a catheter technique. The patients were randomly allocated to two groups. All patients received the same dose of local anaesthetic: 60 ml of mepivacaine 1% with adrenaline, but one group received the dose as a bolus injection, whereas the other group received the dose as fractional injections of 30 + 30 ml with an interval of 20 min. Blood concentrations of mepivacaine were measured up to 90 min after injection of local anaesthetic. Sensory and motor blockade were evaluated 20, 30 and 40 min after injection. Forty minutes after the last injection of local anaesthetic, there was no difference between the blockades of the two groups, except for the sensory blockade of the lower lateral cutaneous nerve of the arm, in which the frequency of analgesia was 90% after bolus injection and 63% after fractional injections. There was no difference in blood concentrations of mepivacaine between the two groups. None of the 60 patients showed any sign of systemic toxic reactions. Fractional injection of local anaesthetic in perivascular axillary blockade does not offer any advantage over bolus injection with regard to the resulting blockade.     

Perivascular Axillary Block IV: Blockade Following 40, 50 or 60 ml of Mepivacaine 1 % with Adrenaline

Perivascular axillary blockade was performed on 90 patients with the aid of a catheter technique. The patients were randomly allocated to receive either 40, 50 or 60 ml of 1% mepivacaine with adrenaline 1:200,000. Blood concentrations of mepivacaine were measured up to 90 min after injection in seven, eight and ten of the patients from the three groups. Sensory and motor blockade was evaluated 20, 30 and 40 min after injection. All groups showed the same temporal development of the blockade, i.e. improval of the blockade during the period from 20 to 40 min after injection, but no difference was found in the sensory or motor blockade between the three groups. However, a further analysis of the incomplete blockades showed a better quality of the sensory blockade in the groups given 50 and 60 ml than in the group given 40 ml. None of the 90 patients showed any signs of systemic toxic reactions. The mean peak values of blood concentrations were 0.5-1.0 microgram/ml higher in the groups given 50 ml and 60 ml than in the group given 40 ml. On the basis of the present and two previous investigations on the dose response in perivascular axillary blockade, a dose of 50 ml 1% mepivacaine with adrenaline or another equivalent drug with vasoconstrictor is recommended.     

Effects of using the posterior or anterior approaches to the lumbar plexus on the minimum effective anesthetic concentration (MEAC) of mepivacaine required to block the femoral nerve: a prospective, randomized, up-and-down study

BACKGROUND AND OBJECTIVES: To evaluate if psoas compartment block requires a larger concentration of mepivacaine to block the femoral nerve than does an anterior 3-in-1 femoral nerve block. METHODS: Forty eight patients undergoing anterior cruciate ligament repair were randomly allocated to receive an anterior 3-in-1 femoral block (femoral group, n = 24) or a posterior psoas compartment block (psoas group, n = 24) with 30 mL of mepivacaine. The concentration of the injected solution was varied for consecutive patients using an up-and-down staircase method (initial concentration: 1%; up-and-down steps: 0.1%). RESULTS: The minimum effective anesthetic concentration of mepivacaine blocking the femoral nerve in 50% of cases (ED(50)) was 1.06% +/- 0.31% (95% confidence interval [CI], 0.45%-1.68%) in the femoral group and 1.03% +/- 0.21% (95% CI, 0.6%-1.45%) in the psoas group (P = .83). The lateral femoral cutaneous and obturator nerves were blocked in 4 (16%) and 5 (20%) femoral group patients as compared with 20 (83%) and 19 (80%) psoas group patients (P = .005 and P = .0005, respectively). Intraoperative analgesic supplementation was required by 15 (60%) and 5 (20%) patients in the femoral and psoas groups, respectively (P = .01). CONCLUSIONS: Using a posterior psoas compartment approach to the lumbar plexus does not increase the minimum effective anesthetic concentration of mepivacaine required to block the femoral nerve as compared with the anterior 3-in-1 approach, and provides better quality of intraoperative anesthesia due to the more reliable block of the lateral femoral cutaneous and obturator nerves.     

Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block

BACKGROUND: Femoral and sciatic nerve block may not provide complete post-operative analgesia following total knee replacement. This study was designed to evaluate whether the addition of an obturator nerve block to combined femoral and sciatic nerve block improves the quality of post-operative analgesia following primary total knee replacement. METHODS: Sixty patients were randomised into one of two groups: combined femoral and sciatic nerve block with 15 ml 0.75% ropivacaine to each nerve or combined femoral and sciatic nerve block with 15 ml 0.75% ropivacaine to each nerve and an obturator nerve block with 5 ml 0.75% ropivacaine. RESULTS: Peripheral nerve blocks were successful in 85% of patients. The group which received the obturator nerve block showed a significant increase in the time until their first request for analgesia (mean 257.0 vs. 433.6 min) and a significant reduction in the total requirements for morphine throughout the study period (mean 83.8 vs. 63.0 mg) (P<0.05). There were no systemic or neurological sequelae in any of the groups. CONCLUSIONS: The addition of an obturator nerve block to femoral and sciatic blockade improved post-operative analgesia following total knee replacement.     

Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block

In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.     

Peri vascular axillary block VII: the effect of a supplementary dose of 20 ml mepivacaine 1 % with adrenaline to patients with incomplete sensory blockade

Perivascular axillary blockade was performed on 233 patients with the aid of a catheter technique. All patients received a primary injection of 50 ml of mepivacaine 1% with adrenaline. Sensory blockade was evaluated 20, 30 and 40 min after injection, and a complete sensory blockade was found in 90 (39%), 131 (57%) and 146 (63%), respectively. The blockade effect of a supplementary perivascular injection of 20 ml of the same agent was investigated on the remaining 87 blockades, which could be divided into three categories: blockades which at 20 min showed lack of analgesia in several cutaneous segments of the hand (34 patients); blockades which at 30 min showed a total lack of sensory blockade within a limited area (29 patients); and blockades which at 40 min showed signs of blockade of all cutaneous segments, but one or several segments were not blocked with an intensity compatible with surgery (24 patients). Blockades of categories 1 and 2 were at 20 and 30 min, respectively, randomly allocated to control or to perivascular supplementation groups, while blockades of category 3 all had supplementation at 40 min. Sensory blockade was reevaluated 10 and 20 min after group allocation, and it was found that perivascular supplementation had no significant effect on the sensory blockade in category 1 and 2, while 68% of the blockades in category 3 improved to a complete blockade.(ABSTRACT TRUNCATED AT 250 WORDS)     

Perivascular Axillary Block III: Blockade Following 40 ml of 0.5%, 1% or 1.5% Mepivacaine with Adrenaline

Perivascular axillary blockade was performed on 90 patients with the aid of a catheter technique. All blockades were performed by the same anaesthetist, who practised perivascular axillary blockade three or four times a day. The patients were randomly allocated to three groups. The injected volume of local anaesthetic was constant in each group: 40 ml mepivacaine with adrenaline. The concentration and, consequently, the amount (mg) were variable factors: 1/2% (200 mg), 1% (400 mg) and 1 1/2% (600 mg). Sensory and motor blockade were tested 30 min after each injection. All three groups showed a high incidence of analgesia (70%-100%) in all cutaneous segments, and none of the blockades showed total failure of the sensory blockade. The lowest incidence of sensory blockade was found in the areas innervated by the axillary, the radial and the musculocutaneous nerves, but no difference was found between the groups. However, the motor blockade was found to improve with increasing concentration of local anaesthetic solution.     

Extent of blockade with various approaches to the lumbar plexus

The extent of blockade when four different techniques were used for blocking the lumbar plexus was prospectively evaluated in 80 adult patients. The extent of blockade was measured by testing motor function of all nerves except the lateral and posterior femoral cutaneous nerves, which were evaluated by pinprick response. The posterior approaches of Dekrey at L3 (n = 20) and Chayen at L4-5 (n = 20) proved similarly effective in producing blockade of the femoral, obturator, and lateral femoral cutaneous nerves, as well as the nerves to the psoas muscle. The anterior approach of Winnie (femoral sheath or 3-in-1 block) using paresthesia (n = 20) or peripheral nerve stimulation (n = 20) proved effective in producing blockade of the femoral and lateral femoral cutaneous nerves, but ineffective for obturator nerve blockade. None of the four techniques produced blockade of the sacral plexus. Perhaps our means of assessing blockade (motor) is what produced the difference between our findings and those of others.     

Perivascular axillary brachial plexus block and patient positioning: the influence of a lateral, head-down position

The aim of this study was to examine the effect of a 20 degrees Trendelenburg position on the blockade of nerves that exit the brachial plexus proximally in patients undergoing single-injection axillary brachial plexus block. After a pilot study of eight cadavers suggested that a head-down and lateral position would encourage the proximal spread of local anaesthetic, 72 patients undergoing elective surgery were divided into two equal groups: a Supine group and a Modified Position group (lateral position, 20 degrees head-down tilt). Patients were left in the allocated position for 30 min after an axillary block had been performed with alkalinised mepivacaine 1% 49.5 ml. Sensory and motor blockade evaluation showed that there was a significantly higher proportion of axillary nerve (76% vs. 0%, p < 0.001), thoracodorsal nerve (86% vs. 0%, p < 0.001) and subscapular nerve (89% vs. 0%, p < 0.001) blockade in the Modified Position group. Sensory block of the radial nerve was also improved by the modified position (100% vs. 86%, p < 0.05).     

Labat法坐骨神经阻滞下局部麻醉药低容量高浓度较高容量低浓度更有效：一项前瞻性随机对照研究

背景有很多因素可以明显影响外周神经阻滞的起效时间和成功率,本项前瞻、随机、双盲研究比较了Labat后路法行坐骨神经阻滞时,单剂量的甲哌卡因300mg分别稀释至20和30ml注射后的阻滞效果差异。方法90例行足部手术的患者,随机分为2组接受坐骨神经阻滞,一组给予1．5％甲哌卡因20m1（45例）,另一组给予1％甲哌卡因30m1（45例）,所有阻滞均在神经刺激仪定位下进行（参数为刺激频率2Hz;刺激电流为1．5～0．5mA）。两组中,神经刺激反应在〈0．5mA时引出,亦可以定向诱发足部肌肉向跖侧屈曲,分别记录胫神经和腓总神经的运动感觉功能被阻滞的起效时间。而坐骨神经支配区域的针刺感觉消失,同时足部跖曲及背曲运动消失为阻滞成功的标准。结果用20ml的1．5％甲哌卡因组阻滞成功率（96．6％）显著高于30ml的1％甲哌卡因组（68．9％,P〈0．05）。而前者达到感觉与运动完全阻滞所需要的时间（11±6分钟,13±7分钟）也短于后者（17±8分钟,19±8分钟,P〈0．05）。结论Labat法行坐骨神经阻滞时,与高容量低浓度的局部麻醉药（1％甲哌卡因）比较,使用低容量高浓度的局部麻醉药（1．5％甲哌卡因）能够获得更高的阻滞成功率及更短的起效时间。     

Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid-diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/ml

Background : Transient radicular irritation (TRI) is common after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml. The purpose of this study was to determine the incidence of TRI after spinal anesthesia with hyperbaric lidocaine 50 mg/ ml diluted with cerebrospinal fluid (CSF) 1:1 and hyperbaric mepivacaine 40 mg/ml and hyperbaric bupivacaine 5 mg/ml.
Methods : Ninety ASA class I-IV patients undergoing mostly brief urological procedures under spinal anesthesia were randomly allocated to receive either hyperbaric lidocaine 50 mg/ ml diluted with CSF 1:1 (Group L), hyperbaric mepivacaine 40 mg/ml (Group M) or hyperbaric bupivacaine 5 mg/ml (Group B). Characteristics of the patients and details of the surgical procedures and spinal anesthesias were similar in all groups except for the intensity of motor block. The patients were evaluated on the first postoperative day by an anesthesiologist who did not know which spinal anesthetic agent had been used.
Results : Six patients (20%) in Group L, 11 patients (37%) in Group M and none (0%) in Group B experienced pain in the legs and /or back (TRI) after spinal anesthesia.
Conclusion : TRI is frequent after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml diluted with CSF 1:1. The incidence of TRI after hyperbaric mepivacaine 40 mg/ml is of the same magnitude. TRI could not be observed after bupivacaine spinal anesthesia.     

Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one block

The three-in-one technique of simultaneously blocking the femoral, the lateral femoral cutaneous (LFC), and the obturator nerves by a single injection of a local anesthetic was first described in 1973, and it was suggested that the underlying mechanism was one of cephalad spread resulting in a blockade of the lumbar plexus. Today, the technique is widely used in surgery and pain management of the lower limb. Many investigators have, however, reported suboptimal analgesia levels, particularly in the obturator nerve. The purpose of this prospective study was to trace the distribution of a local anesthetic during a three-in-one block by means of magnetic resonance imaging (MRI). Seven patients scheduled for surgery of the lower limb were analyzed with the aid of a primary MRI and then received three-in-one blocks using 30 mL of bupivacaine 0.5% under the guidance of a nerve stimulator. A secondary MRI was performed to determine the distribution pattern of the local anesthetic. It emerged that the local anesthetic blocks the femoral nerve directly, the LFC nerve through lateral spread, and the anterior branch of the obturator nerve by slightly spreading in a medial direction. No involvement of the proximal and posterior portions of the obturator nerve was observed, nor was there any cephalad spread that could have resulted in a lumbar plexus blockade. We therefore conclude that the basis of the three-in-one block is confined to lateral, medial, and caudal spread of the local anesthetic, which effectively blocks the femoral and LFC nerves, as well as the distal anterior branch of the obturator nerve. IMPLICATIONS: We demonstrate by using magnetic resonance imaging that the mechanism of a three-in-one block is one of lateral, caudal, and slight medial spread of a local anesthetic with subsequent blockade of the femoral, the lateral femoral cutaneous, and the anterior branch of the obturator nerves. It does not involve cephalad spread of the local anesthetic with blockade of the lumbar plexus.     

Combined block of femoral,sciatic, obturator nerves and lateral cutaneous nerve block with ropivacaine for leg amputation above the knee

A 76-yr-old male presented for leg amputation above the knee. The patient complained of dyspnea due to pulmonary embolism occurring 3 weeks before operation. In addition, the patient could not report paresthesias because he had suffered from a cerebral infarction. Anesthesia was performed with combined block of femoral, sciatic, obturator nerves and the lateral cutaneous nerve of the thigh. The nerves were anesthetized with 0.75% ropivacaine solution 31 ml by use of an electrical nerve stimulator and an insulated needle. Nerve stimulation technique is the best choice for patients who are unable to report paresthesias reliably.     

A randomised controlled trial of intrathecal blockade versus peripheral nerve blockade for day‐case knee arthroscopy

We allocated 100 patients scheduled for day‐case knee arthroscopy to unilateral spinal anaesthesia with 40 mg intrathecal hyperbaric prilocaine or to ultrasound‐guided femoral‐sciatic nerve blockade with 25 ml mepivacaine 2%, 50 participants each. The median (IQR [range]) time to walk was 285 (240–330 [160–515]) min after intrathecal anaesthesia vs 328 (280–362 [150–435]) min after peripheral nerve blockade, p = 0.007. The median (IQR [range]) time to home discharge was 310 (260–350 [160–520]) min after intrathecal anaesthesia vs 335 (290–395 [190–440]) min after peripheral nerve blockade, p = 0.016. There was no difference in time from anaesthetic preparation to readiness for surgery.     

Lateral infraclavicular plexus block vs. axillary block for hand and forearm surgery

BACKGROUND: In the last few years infraclavicular plexus block has become a method of increasing interest. However, this block has been associated with high complication incidences and without advantage in the quality of blockade over the axillary approach. We prospectively studied 40 patients (ASA I-III) undergoing surgery of the forearm and hand, and investigated the performance of the lateral infraclavicular plexus block against an axillary paravascular block to evaluate the success rate as well as the extent and quality of blockade. METHODS: Patients were randomized into two groups: group I (lateral infraclavicular approach; n=20) and group A (axillary approach; n=20). The lateral infraclavicular approach is a technique with the coracoid process (CP) as landmark. Alone the sagittal plane, the needle is inserted until contact with the CP. The needle is then withdrawn 2-3 mm and reinserted directly under the CP, until it contacts the brachial plexus sheath. Plexus blockade was performed using 40 ml of mepivacaine 1%. Quality of sensory and motor block was recorded selectively for each nerve distribution at close intervals for 6 h. RESULTS: Successful block according to Vester-Andersen's criteria was achieved in 100% of group I and 85% of group A. In group I, a pronounced sensory and motor blockade of the musculocutaneous nerve was observed, while patients of group A had a weak block of this nerve. In group I, an additional spectrum of nerves (thoracodorsal, axillary and medial brachial cutaneous nerves) was involved compared to group A. There was no difference among groups in onset and duration of block. CONCLUSION: Based on the safe landmark and feasibility of this procedure and the additional spectrum of nerve block achieved, the application of lateral infraclavicular technique has to be reconsidered in clinical practice.     

An evaluation of the cutaneous distribution after obturator nerve block.

In 1973, Winnie et al. introduced the inguinal paravascular three-in-one block, which allegedly provides anesthesia of three nerves--the femoral, lateral cutaneous femoral, and obturator nerves--with a single injection. This concept was undisputed until the success of the obturator nerve block was reassessed by using evidence of adductor weakness rather than cutaneous sensory blockade, the latter being variable in its distribution and often absent. We performed this study, therefore, to evaluate the area of sensory loss produced by direct injection of local anesthetic around the obturator nerve. A selective obturator nerve block with 7 mL of 0.75% ropivacaine was performed in 30 patients scheduled for knee surgery. Sensory deficit and adductor strength were evaluated for 30 min by using sensory tests (cold and light-touch perception) and the pressure generated by the patient's squeezing a blood pressure cuff placed between the knees. Subsequently, a three-in-one block was performed, and the sensory deficit was reassessed. The obturator nerve block was successful in 100% of cases. The strength of adductors decreased by 77% +/- 17% (mean +/- SD). In 17 patients (57%), there was no cutaneous contribution of the obturator nerve. The remaining 7 patients (23%) had an area of hypoesthesia (cold sensation was blunt but still present) on the superior part of the popliteal fossa, and the other 6 (20%) had sensory deficit located at the medial aspect of the thigh. The three-in-one block resulted in blockade of the lateral aspect of the thigh in 87% of cases, whereas the anteromedial aspect was always anesthetized. By use of magnetic resonance imaging in eight volunteers, we demonstrated that the obturator nerve has already divided into its two branches at the site of local anesthetic injection. However, the injection of blue dye after having simulated the technique in five cadavers showed that the fluid regularly spread to both branches. We conclude that after three-in-one block, a femoral nerve block may have been assessed as an obturator nerve block in 100% of cases when testing the cutaneous distribution of the obturator nerve on the medial aspect of the thigh. IMPLICATIONS: Previous studies reporting an incidence of obturator nerve block after three-in-one block may have mistaken a femoral nerve block for an obturator nerve block in 100% of cases when the cutaneous distribution of the obturator nerve was assessed on the medial aspect of the thigh. The only way to effectively evaluate obturator nerve function is to assess adductor strength.     

Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve

Background: We tested the hypothesis that ultrasound guidance may reducethe minimum effective anaesthetic volume (MEAV₅₀) of ropivacaine0.5% required to block the femoral nerve compared with nervestimulation guidance. Methods: After standard premedication and sciatic nerve block were given,60 patients undergoing knee arthroscopy were randomly allocatedto receive a femoral nerve block with ropivacaine 0.5% usingeither nerve stimulation (group NS, n = 30) or ultrasound (groupUS, n = 30) guidance. The volume of the injected solution wasvaried for consecutive patients based on an up-and-down staircasemethod according to the response of the previous patient. Theinitial volume was 12 ml. A double-blinded observer evaluatedthe occurrence of complete loss of pinprick sensation in thefemoral nerve distribution, with concomitant block of the quadricepsmuscle: positive or negative responses within 30 min after theinjection determined a 3 ml decrease or increase for the nextpatient, respectively. Results: The mean (SD) MEAV₅₀ for femoral nerve block was 15 (4) ml (95%CI, 7–23 ml) in group US and 26 (4) ml (95% CI, 19–33ml) in group NS (P = 0.002). The effective dose in 95% of cases(ED₉₅) calculated with probit transformation and logistic regressionanalysis was 22 ml (95% CI, 13–36 ml) in group US, and41 ml (95% CI, fs 24–66 ml) in group NS. Conclusions: Ultrasound guidance provided a 42% reduction in the MEAV ofropivacaine 0.5% required to block the femoral nerve as comparedwith the nerve stimulation guidance.     

Ultrasound-guided lateral femoral cutaneous nerve block: comparison of two techniques

The aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nerve-targeting technique). The time required to perform the block and the onset time of the block were similar for both techniques. However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably.     

Ultrasound-guided fascia iliaca compartment block in pediatric patients using a long-axis, in-plane needle technique: a report of three cases

Ultrasound guided fascia iliaca compartment block (FICB) has not been previously described in pediatric patients. Reported here is an ultrasound guided long axis, in-plane needle technique used to perform FICB in three pediatric patients undergoing hip or femur surgery. Postoperative assessment revealed nerve blockade of the lateral femoral cutaneous, femoral, and obturator nerves or no requirement for narcotics in the PACU. FICB using this ultrasound guided technique was easy to perform and provided postoperative analgesia for hip and femur surgical procedures within the presumed distribution of the lateral femoral cutaneous, femoral, and obturator nerves.     

Femoral and lateral femoral cutaneous nerve block for muscle biopsies in children

Retrospective chart review (1978–1993) of 179 children less than age 18 (10.0 ± 3.8 SD yrs) undergoing muscle biopsy for determination of susceptibility to malignant hyperthermia provided data. One hundred and forty-six patients received femoral and lateral femoral cutaneous nerve blocks as their primary anaesthetic. We examined age, weight, duration of surgery, time to discharge from hospital, choice and dosage of local anaesthetics, choice and dosage of sedation, postoperative pain medications, and complications. All children receiving this form of anaesthesia remained outpatients. Between 1978 and 1985 procaine (10 mg·kg^-1) with hyaluronidase or 2-chloroprocaine (12 mg·kg^-1) provided nerve blockade; after 1985, lignocaine (6.8 mg·kg^-1), or a combination of lignocaine or mepivacaine and 2-chloroprocaine, were the preferred agents. More recently the combination of 2-chloroprocaine and bupivacaine has been popular. Three patients required admission to the recovery room postoperatively, due to heavy sedation. Forty-three children (29%) received pain medication during recovery. Femoral and lateral femoral cutaneous block anaesthesia with light to moderate sedation is well tolerated in children undergoing anterior thigh procedures.