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Femoral nerve blockade has been purported to be an effective regional anesthetic in patients undergoing various procedures to lower extremities.Femoral nerve blockade will provide improved postoperative pain control over a local anesthetic in the knee joint alone in patients undergoing endoscopic patellar tendon anterior cruciate ligament reconstruction.Randomized, controlled trial; Level of evidence, 1.Fifty-six adult patients undergoing an endoscopic patellar tendon anterior cruciate ligament reconstruction under general anesthesia were prospectively randomized to receive either a bupivacaine femoral nerve blockade (block) or a saline placebo injection (control). Both groups received local bupivacaine injection and intravenous ketorolac at wound closure. Outcomes included postoperative pain measured on a validated visual analog scale at postoperative intervals for 72 hours, intraoperative and postoperative narcotic consumption, admission rates, hospital charges, patient satisfaction, and complications related to the femoral nerve block.There were 31 block patients and 25 control patients. No significant differences between groups for postoperative pain scores, intraoperative or postoperative narcotic consumption, readiness for discharge, duration of hospitalization, admission rates, hospital charges, or patient satisfaction were observed. There were no complications related to the femoral nerve block.A preemptive femoral nerve blockade, although safe, does not provide significant clinical benefit in this patient population to justify its routine use.