• Analgesia for knees and hips
• Innervation
• Hip
• Femoral nerve (nerve to rectus femoris)
  Sciatic nerve (nerve to quadratus femoris)
  Obturator (anterior division)
• Knee
• Femoral nerve (branch to vastus medialis)
  Sciatic (tibial and common peroneal branches)
  Obturator (posterior branch)
• Regional techniques associated with lower intra-op & post-op blood loss due to lower MAP and venodilatation
• VTE is reduced by about 50% due to attenuation of the stress response action on the clotting cascade
• Epidural analgesia benefit is limited to the first 6 hours post op
• PONV is about 35% with intrathecal opioids
• Typical rate of infusion in continuous catheter techniques is 5-10ml/hr of low concentration (~0.1% bupivicaine)
• TKR
• Femoral nerve block: reliable but poor proximal spread
• Sciatic nerve block: single shot likely to help
• Lumbar plexus block: little evidence of extra benefit over femoral nerve block
• Obturator nerve block: can be blocked separately
• THR
• Lumbar plexus block: blocks LCNT, femoral and obturator nerves (6-12 hrs pain relief)
• Femoral nerve block: only obtains plexus block (3 in 1) in 35% of cases. Little added over PCA morphine
• Fascia iliaca block: easy to perform
• Sciatic nerve block: parasacral approach advised. Complete anaesthesia impossible to achieve without blocking the sciatic nerve
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/8/2/56.full.pdf