Femoral Nerve Palsy Following Landmark Based Ilioinguinal-Iliohypogastric Nerve Block: Case Report and Safety Review

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Inguinal hernia repair is one of the most commonly performed procedures in the United States. Ilioinguinal-iliohypogastric nerve blocks are commonly performed for postoperative pain control. Transient femoral nerve palsy is a recognized complication of this block. A 75-year-old male underwent an uncomplicated Lichtenstein repair of an incarcerated right inguinal hernia. An ilioinguinal-iliohypogastric nerve block was performed at the conclusion. Postoperatively, he reported symptomatology of femoral nerve palsy, with full resolution within 8 h. Femoral nerve palsy occurs when anesthetic is infiltrated into the transverse abdominis muscle, allowing for diffusion toward the femoral nerve along contiguous planes of the transverse abdominis-iliacus fascia. Incidence can be as high as 5%. Literature favors ultrasound to landmark-based approaches for improved efficacy and reduced complications. Postoperative protocols for femoral nerve palsy can be implemented with minimal effect on nursing workflow to improve patient safety from the effects of this complication. J Med Cases. 2017;8(5):155-158 doi: https://doi.org/10.14740/jmc2809w