Ultrasound in Emergency Medicine| Volume 52, ISSUE 5, P699-701, May 2017

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Ultrasound-Guided Femoral Nerve Blockage in A Patellar Dislocation: An Effective Technique for Emergency Physicians

Published:February 19, 2017DOI:



      Patellar dislocation is an orthopedic emergency and its reduction can be painful. The aim of this case is to show that the ultrasound-guided femoral nerve blockage can be effectively used in the pain management of patellar reduction in the emergency department (ED).

      Case Report

      A 21-year-old man was admitted to our ED after suffering a fall down a flight of stairs. The initial physical examination and plain radiography showed a patellar dislocation in the right knee. We performed an ultrasound-guided femoral nerve blockage to provide a pain-free and comfortable patellar reduction. To our best knowledge, there is no manuscript except an old case series about use of the ultrasound-guided femoral nerve blockage in the management of patellar reduction in the medical literature. Procedural sedation is the preferred method used for this purpose in ED, but these medications need to be closely monitored because of their potential complications, such as nausea, vomiting, allergic reactions, and respiratory depression.

      Why Should an Emergency Physician Be Aware of This?

      Ultrasound-guided femoral nerve blockage gave rapid and effective pain control without any complication during the reduction in this patient. Therefore, we suggest this technique be used for pain management during the reduction of a dislocated patella in the ED.


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        • Atkin D.M.
        • Fithian D.C.
        • Marangi K.S.
        • et al.
        Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.
        Am J Sports Med. 2000; 28: 472-479
        • Ruddy R.M.
        Illustrated techniques of pediatric emergency procedures.
        in: Fleisher G.R. Ludwig S. Henretig F.M. Textbook of pediatric emergency medicine. 5th ed. Lippincott Williams & Wilkins, Philadelphia2006: 1861
        • Ritcey B.
        • Pageau P.
        • Woo M.Y.
        • et al.
        Regional nerve blocks for hip and femoral neck fractures in the emergency department: a systematic review.
        CJEM. 2016; 18: 37-47
        • Somvanshi M.
        • Tripathi A.
        • Meena N.
        Femoral nerve block for acute pain relief in fracture shaft femur in an emergency ward.
        Saudi J Anaesth. 2015; 9: 439-441
        • Baker M.D.
        • Gullett J.P.
        Ultrasound-guided femoral nerve blocks.
        Pediatr Emerg Care. 2015; 31: 864-868
        • Hsiao M.
        • Owens B.D.
        • Burks R.
        • et al.
        Incidence of acute traumatic patellar dislocation among active-duty United States military service members.
        Am J Sports Med. 2010; 38: 1997-2004
        • Kim Y.M.
        • Kang C.
        • Joo Y.B.
        • et al.
        Usefulness of ultrasound-guided lower extremity nerve blockade in surgery for patellar fracture.
        Knee Surg Relat Res. 2015; 27: 108-116
        • Hadzic A.
        Hadzic’s peripheral nerve blocks and anatomy for ultrasound- guided regional anesthesia.
        2nd ed. The McGraw-Hill Companies, New York2012
        • Brull R.
        • McCartney C.J.
        • Chan V.W.
        • et al.
        Neurological complications after regional anesthesia: contemporary estimates of risk.
        Anesth Analg. 2007; 104: 965-974
        • Widmer B.
        • Lustig S.
        • Scholes C.J.
        • et al.
        Incidence and severity of complications due to femoral nerve blocks performed for knee surgery.
        Knee. 2013; 20: 181-185
        • Godwin S.A.
        • Burton J.H.
        • Gerardo C.J.
        • et al.
        Clinical policy: procedural sedation and analgesia in the emergency department.
        Ann Emerg Med. 2014; 63: 247-258.e18
        • Bhattarai B.K.
        • Baral P.R.
        Brachial plexus block as a sole anaesthetic technique in upper extremity fracture/dislocation in children: subclavian perivascular vs parascalene approach.
        Kathmandu Univ Med J (KUMJ). 2006; 4: 426-430
        • Blaivas M.
        • Adhikari S.
        • Lander L.
        A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department.
        Acad Emerg Med. 2011; 18: 922-927
        • Tezel O.
        • Kaldirim U.
        • Bilgic S.
        • et al.
        A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction.
        Am J Emerg Med. 2014; 32: 549-552
        • Luhmann S.J.
        • Schootman M.
        • Schoenecker P.L.
        • et al.
        Use of femoral nerve blocks in adolescents undergoing patellar realignment surgery.
        Am J Orthop (Belle Mead NJ). 2008; 37: 39-43
        • Chen J.Y.
        • Li N.
        • Xu Y.Q.
        Single shot adductor canal block for postoperative analgesia of pediatric patellar dislocation surgery: a case-series report.
        Medicine (Baltimore). 2015; 94: e2217
        • Hoy G.
        • Walpole B.
        Reduction of acute patellar dislocation under femoral nerve blockade.
        Emerg Med. 1993; 5: 159-162