Nerve blocks of the lower extremity are undertaken less often than blocks of the upper limb. Spinal and epidural techniques are more common approaches to regional anesthesia of the lower extremity. Contrary to neuraxial techniques, isolated nerve blocks do not cause hypotension, retain the ability to void, and allow earlier unassisted ambulation despite a longer duration of action. However, the ideal block for every clinical scenario is not known. A knowledge of anatomy and some imagination may add some new approaches to our armamentarium. This article describes several new approaches to lower extremity blockade developed at the University of Saskatchewan. Many have proven successful, whereas others will have more limited applications. In this review we wish to outline the parasacral sciatic nerve block, the nerve stimulator approach to the lateral femoral cutaneous nerve of the thigh, the transsartorial saphenous nerve block, and the intraoperative transcruciate injection for total knee arthroplasty. The strengths and limitations are discussed together with a discussion of the relevant clinical anatomy of each approach.