ABSTRACT
When peripheral techniques are selected for a specific surgical procedure, it is paramount to consider not only the neurotomes but also the osteotomes and dermatomes. For example, the dermatomal supply of the hip joint typically is from L4 to as low as S2, whereas the bony structures of the hip joint do not follow the same segmental pattern and are supplied from L3 to S1. However, when neurotomes are considered, the obturator and femoral nerves, which originate from L2-L4, supply articular branches to the hip joint. Thus, the entire lumbar and sacral plexuses must both be blocked to ensure adequate coverage of the neurotomes of the hip. The same considerations hold for knee and ankle surgery. The importance of understanding the limitations of each of these blocks is essential to successful application.
