2. Overview of Hip/Lower Extremity Blocks Flashcards
how many nerves supply the leg
4
major nerves to leg
- femoral
- lateral femoral cutaneous
- obturator
- sciatic
femoral nerve innervation
anterior thigh and knee
lateral femoral cutaneous innervation
upper lateral thigh
hip
obturator nerve innervation
medial thigh
hip joint
knee joint
sciatic nerve innervation
posterior thigh
posterior knee
everythin below the knee except the medial portion of the lower leg
which nerve is a branch of the femoral nerve
saphenous
saphenous innervation
medial lower leg, ankle, foot
branches of the sciatic nerve
- deep peroneal
- superficial peroneal
- tibial
- sural
largest terminal branch of lumbar plexus
femoral nerve
dose the saphenous nerve have motor or sensory?
sensory only
longest spinal nerve in the body
sciatic nerve
which nerve provides motor innervation to the leg
sciatic
femoral
branches of tibial nerve
posterior tibial
sural
branches of common peroneal nerve
superficial peroneal
deep peroneal
saphenous nerve
superficial peroneal nerve
deep peroneal nerve
posterior tibial nerve
sural nerve
motor component of femoral nerve
quads
leg/knee extension
which blocks work for femoral nerve?
femoral nerve block
fascial iliaca block
which blocks for lateral femoral cutaneous?
fascia iliaca is better than femoral + fascial iliaca
which blocks for obturator nerve?
femoral and fascia iliaca are not reliable for obturator nerve
femoral and fascia iliaca block what nerves?
femoral (reliable)
saphenous (reliable)
lateral femoral cutaneous (reliable)
obturator (not reliable)
which lower leg nerve block uses less volume of anesthetic?
femoral nerve block
how much volume does femoral block use?
20 mL
FICB (fascia iliaca) is more ________
lateral
how much volume for FICB?
30-40 mL
which block is more reliable for obturator nerve?
FICB
which block is better at lateral femoral cutaneous nerve?
FICB
which block is better for hip surgery and femoral neck fractures?
FICB
which block is further from artery or nerve?
FICB
which plane is the FICB block delivered?
same fascial plane as femoral block
downside to femoral and FICB?
cause a motor block so only used for non-weight bearing surgeries
saphenous advantage
preserves motor function
saphenous diadvantage
only medial knee and lower leg/foot
other name for saphenous nerve block
adductor canal block
locations of needle for saphenous nerve block
groin
or
mid-thigh
adductor canal block indications
- total knee
- ankle/foot surgery
what can supplement an adductor canal block?
periarticular injection of local
which ankle surgery is fully covered by saphenous nerve block?
medial ankle surgery
which ankle surgery is not fully covered by saphenous block?
lateral ankle surgery
what supplements saphenous block for lateral ankle surgery?
popliteal block
indication for obturator nerve block
TURBT
does spinal anesthesia block obturator nerve reflex?
no
sciatic nerve block coverage: transgluteal approach
posterior thigh/knee
part of hip
everything below knee except medial
which block require sedation
transgluteal sciatic approach
sciatic nerve branches in popliteal fossa
tibial nerve (medial)
common peroneal (lateral)
sciatic block coverage: popliteal
everything below knee except medial
most popular block for ankle surgery
popliteal block
how can you anesthetize the entire leg?
sciatic block with femoral or fascia iliaca
IPACK block
infiltration between the popliteal artery and capsule of posterior knee
what type of block is IPACK
sensory only
IPACK coverage
posterior knee
does the sciatic block motor
yes
traditional total knee blocks
femoral
fascia iliaca
disadvantage to femoreal and fascia iliaca for total knee
no posterior knee coverage
block motor function
max covereage total knee block
adductor canal
+ IPACK
which nerves does the IPACK avoid
tibial
peroneal
(branches of sciatic)
which nerve does the iPACK hit
articular branches
femoral/fascia iliaca coverage
hip/knee joints
anterior knee
medial posterior knee
anterior/lateral thigh
medial lower leg
medial foot
saphenous coveraage
medial knee
medial lower leg
medial foot
sciatic: transgluteal coverage
posterior knee/thich
everything below knee except medial
sciatic: popliteal coverage
everything below knee except medial
IPACK coverage
posterior knee
which lower leg blocks will block motor?
femoral (quads)
fascial iliaca (quads)
sciatic transgluteal
sciatic popliteal
hip block of choice
fascia iliaca
anterior thigh block of choice
fascia iliaca
femoral
knee block of choice
fascia iliaca
femoral
adductor canal
+/- IPACK
tibia block of choice
popliteal
ankle block of choice
popliteal
+/- saphenous
foot block of choice
ankle
popliteal