Lower Extremity Nerve Coverage

As someone who used to do a fair amount of corrective pediatric orthopedic procedures, understanding the innervation of various muscle groups or bones can be of paramount importance if one is looking to provide optimal analgesic coverage. While upper extremity coverage (cutaneous vs myotomes vs osteotomes) has considerable overlap, the lower extremity is a bit more nuanced. As such, a detailed roadmap for all three has been provided.

Though it is obvious, it should be pointed out that the peroneal and tibial nerves are branches of the sciatic nerve. Blocking the sciatic nerve prior to its bifurcation will block all distal branches, including the tibial and peroneal nerves.

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Cutaneous Innervation

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Myotome Innervation

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Osteotome Innervation

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Sacral Multifidus Plane/Sacral ESP Block

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Femoral Nerve Block