Article Text

Download PDFPDF
Assessment of Lower Extremity Nerve Block
  1. Joseph M. Neal, M.D.
  1. From the Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington.


Background and Objectives Successful performance of lower-extremity regional anesthesia includes sensory and/or motor block assessment of up to 4 major peripheral nerves. This brief report describes a methodology for the rapid evaluation of lower-extremity anesthesia before surgical incision.

Methods Illustrations highlight the techniques for evaluation of sciatic, obturator, lateral femoral cutaneous, and femoral nerve anesthesia. This methodology is based on a Four P’s acronym: push, pull, pinch, punt.

Conclusions Accurate assessment of lower-extremity regional anesthesia can be achieved rapidly using The Four Ps evaluation tool.

  • Femoral block
  • Lower-extremity nerve block
  • Sciatic block

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • David L. Brown, M.D., served as Editor-In-Chief for this manuscript.

    Reprints not available.