8. Performing Hip & Lower Extremity Blocks Flashcards
which 5 nerves are anesthetized for ankle block
tibial
sural
deep peroneal
superficial peroneal
saphenous
femoral block landmarks
inguinal ligament
femoral arterial pulse
NAVEL
lateral
nerve
artery
vein
empty
lymphatic
medial
femoral block most medial
vein
femora block middle
artery
femoral block most lateral
nerve
where does the femoral nerve lie
within the fascia iliaca compartment
probe placement femoral block
parallel to inguinal ligament
at the level of femoral crease
needle insertion femoral block
in-plane towards nerve
where do you stop your needle femoral block
underneath the fascia iliaca ligament
LA volume femoral block
10-20 mL
how long can you leave a femoral catherin in
48 hrs
where do the fascial layers lie FICB?
superficial to the iliacus and psoas muscle
2 fascial layers FICB
fascia lata
fascia iliaca
most superficial layer
fascia lata
fascia iliaca compartment location
between fascial iliaca and iliopsoas muscle
what is in the fascia iliaca compartment?
femoral
lateral femoral cutaneous
obturator
where is LA deposited FICB
fascia iliaca compartment
1st “pop” FICB
fascia lata
2nd “pop” FICB
fascia iliaca
needle insertion FICb
lateral to femoral nerve
superficial to iliacus muscle
which block has more volume: femoral or FICB
FICB
which block is more lateral from femoral nerve: femoral or FICB
FICB
historal FICB approach
infrainguinal
current FICB approach
suprainguinal
why is suprainguinal FICB favored?
more spread
more reliable obturator block
suprainguinal landmark
deep circumflex iliac artery
adductor canal location
medial-mid thigh
adductor canal muscles
sartorius
vastus medialis
adductor longus
what is inside adductor canal
saphenous nerve
femoral artery
femoral vein
pt positioning adductor canal
supine
thigh abducted
thigh rotated for medial access
probe placement adductor canal
anteromedial mid-thigh
adductor canal landmark
femoral artery
where is the femoral artery located
under the sartorius muscle
needle insertion adductor canal
in-plane
lateral to medial
what muscle should the needle pass through adductor canal
satorius muscle
where is saphenous nerve adductor canal
adjacent to superficial femoral artery
between sarotius and vastus medialis
saphenous volume
15-20 mL
IPACK targeted nerves
articular branches of tibial n
articular branches of common peroneal n
articular branches of obturator n
superomedial n
lateral genicular n
what are you avoiding blocking in IPACK
avoid blocking trunks of tibial and common peroneal
this causes motor block
blocking trunk of tibial SE
inhibit plantarflexion of foot
blocking trunk of common peroneal SE
foot drop
dorsiflexion
foot and shin approximate closertogether
plantaflexion
move foot downward away from body
IPACK landmark
lateral condyle of femur
IPACK LA placement
between lateral condyle and popliteal artery
probe placement IPACK
medial thigh
1-2 fingers above patella
what is the needle inserted through in IPACK
vastus medialis
LA volume IPACK
15 mL
transgluteal sciatic markings
line from great trochanter to posterior iliac spione
midpoint line caudal
transgluetal sciatic needle insertion
5 cm caudad along perpendicular line
popliteal block LA location
bifurcation of sciatic nerve
6-8 cm cephaland of politeal foss
posterior politeal needle insertion
between biceps femoris and smitendinosus and meimebranosus muscles
what 3 things are you palpating in posterior popliteal appraoch
politeal fossa crease
biceps femoris tendon (lateral)
semitendinosus (medial)
posterior popliteal u/s goal
identify where sciatic nerve bifucates
lateral popliteal needle insertion
between biceps femoris and vastus lateralis
8cm cephalad of politeal crease in intertendinous groove
why is u/s nice for politeal block
u/s guidance reduces volume of block
which blocks have longest onset and duration of peripheral blocks
sciatic nerve block due to largest nerve
SPEDI block
combo block to cover entire leg except upper medial thigh
what does SPEDI block
sciatic and saphenous with 1 penetration and 2 injection
fastest was to anesthetize a leg
SPEDI block
SPEDI advantages
1 needle stick
faster (1.8 min to full anesthesia)
SPEDI disadvantages
incr risk of femoral art puncture
harder to visualize enrves
incr block failure
