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6901 > Ankle blocks > Flashcards

Ankle blocks Flashcards

1
Q

The cutaneous branch of the femoral nerve that is blocked in an ankle block?

A

saphenous

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2
Q

Ankle block requires how many needle insertions?

A

5

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3
Q

Onset time for ankle block?

A

10-25 minutes

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4
Q

What develops faster in ankle block-motor or sensory anesthesia?

A

sensory

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5
Q

Ankle block volume?

A

5-6 mL

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6
Q

Can you use epi in ankle blocks?

A

never

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7
Q

With the exception of the saphenous nerve, an ankle block is a block of which branches of the sciatic nerve?

A

terminal

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8
Q

What are the 2 deep nerves and 3 superficial nerves blocked in ankle block?

A

2 deep: posterior tibial, deep peroneal; superficial: saphenous, sural, superficial peroneal nerves

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9
Q

How are the 2 deep nerves anesthetized?

A

injecting LA underneath superficial fassa

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10
Q

How are the 3 superficial nerves anesthetized?

A

injecting LA SQ

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11
Q

Largest nerve in body?

A

sciatic (2 cm in breadth at take off)

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12
Q

Sciatic nerve is formed starting where on the spine to what part of spine?

A

L4-S3 roots

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13
Q

Where does the sciatic nerve exit the pelvis?

A

greater sciatic foramen

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14
Q

The sciatic nerve descends between what 2 structures?

A

greater trochanter of the femur and tuberosity of ischium

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15
Q

The sciatic nerve splits in to what 2 branches at the lower 1/3 of the back of the thigh?

A

common peroneal, tibeal nerve

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16
Q

Largest branch of the lumbar plexus?

A

femoral branch

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17
Q

The femoral branch arises from which 3 lumbar nerves?

A

2nd, 3rd, 4th

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18
Q

Eventually the femoral nerve passes under which ligament?

A

inguinal

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19
Q

As the femoral nerve passes under the thigh and inguinal ligament, it flattens and how is it positioned?

A

laterally and slightly deeper than the femoral artery

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20
Q

Think of what pneumonic when going from medial to lateral and trying to recall the relationship of the femoral nerve to vessels in the femoral triangle?

A

LVAN (lymph, vein, artery, nerve)

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21
Q

This nerve is the origin of the deep peroneal nerve and superficial peroneal nerve?

A

common peroneal nerve

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22
Q

The common peroneal nerve separates from which nerve and descends along?

A

tibial nerve; tendons of biceps femoris muscle around neck of fibula

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23
Q

How can you find where the deep peroneal nerve is on the patient?

A

ask the pt to flex the foot back towards nose and there is a devit between anterior tibial and extensor digitorum longus muscle

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24
Q

The superficial peroneal nerve is a branch of which nerve?

A

common peroneal nerve

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25
Q

What is the size of the superficial peroneal nerve and what does that mean for anesthesia?

A

its tiny and easy to block

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26
Q

The superficial peroneal nerve divides in to which branches?

A

terminal cutaneous branches; medial and lateral dorsal cutaneous nerves

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27
Q

Where is the tibial nerve located/positioned between what?

A

positioned laterally and posteriorly to posterior tibial artery and midway between posterior aspect of medial malleolus and posterior aspect of achilles tendon

28
Q

What type of nerve is the sural nerve?

A

sensory

29
Q

This nerve supplies the medial malleolus, achilles tendon, and ankle joint

A

sural nerve

30
Q

This nerve supplies innervation to skin, SQ tissue, 4th interossius space, and sensory innervation of 5th toe

A

sural nerve

31
Q

This nerve is the terminal cutaneous branch of the femoral nerve?

A

saphenous nerve

32
Q

Does an ankle block result in anesthesia of the ankle?

A

no

33
Q

The proximal branches of which 2 nerves provide innervation to the deep structures of the ankle?

A

tibial and peroneal

34
Q

Which nerve in the foot provides sensation to the web between the 1st and 2nd toes?

A

deep peroneal nerve

35
Q

You should only use propofol for sedation for ankle block if?

A

you have an assistant

36
Q

How do you position the foot for an ankle block?

A

supine with foot over footrest

37
Q

Equipment needed for ankle block?

A

sterile towels, 4x4 gauze, CHG or betadine prep solution, 3 10 mL syringes with LA, sterile gloves, marking pen, one 1.5 inch 25 gauge needle

38
Q

Is ultrasound helpful for an ankle block?

A

no

39
Q

Deep peroneal nerve is located where?

A

immediately lateral to tendon of extensor hallucis langus

40
Q

Deep peroneal nerve is located between which 2 structures?

A

extensor hallucis longus, extensor digitorum longus

41
Q

The pulse of which artery can be felt at the landmark for deep peroneal nerve?

A

DP

42
Q

The deep peroneal nerve is what position from the anterior tibial artery (DP)?

A

immediately lateral

43
Q

Which nerves do you start with with Kathy’s technique in ankle block?

A

deep-deep peroneal and posterior tibial

44
Q

How can you anesthetize the superficial nerves for an ankle block?

A

fanning out across a line that extends from the most cephalad point of the medial malleolus to the most cephalad point of the lateral malleolus

45
Q

Tip for blocking the peroneal nerve?

A

put your index finger on the groove just lateral to the extensor hallus longus. advance needle to the bone and withdraw 1-2 mm and inject 2-3 mL in a direction that is perpendicular in all planes (redirect needle 30 degrees laterally and medially)

46
Q

How do you inject the posterior tibial nerve?

A

inject LA just behind the medial malleolus and advanced until bone is felt; withdraw needle 1-2 mm and inject 2-3 mL of LA. 2 boluses given laterally and medially

47
Q

How do you do a sural, saphenous, and superficial peroneal block?

A

start where extensor hallus longus is and inject in a superficial ring in the direction of the line that you made from the top of the medial malleolus to the lateral malleolus

48
Q

4 complications of ankle block?

A

infection, hematoma, vascular injection, nerve injury

49
Q

What can you do to prevent vascular injection?

A

aspirate

50
Q

How can you prevent nerve injury while doing ankle block?

A

stop if pt reports excruciating pain or if encounter high pressures

51
Q

Most commonly failed block?

A

ankle block

52
Q

Most common indication for ankle nerve block?

A

diabetic ankle surgery

53
Q

Ankle block is not suited for which type of surgery?

A

ankle

54
Q

Most of dorsal part of foot gets innervation from?

A

superficial peroneal nerve

55
Q

Medial aspect of foot receives sensory innervation from?

A

saphenous nerve

56
Q

Lateral aspect of foot is supplied by?

A

sural nerve; originates from tibeal nerve in popliteal fossa behind knee

57
Q

Medial and posterior aspect of heel supplied by?

A

medial branch of tibial nerve

58
Q

Does LA cross fascia readily?

A

no

59
Q

This nerve supplies approx complete sole of foot?

A

tibial

60
Q

Main blood supply to foot?

A

posterior tibial artery, dorsal pedal artery

61
Q

Post tibial artery and dorsal pedal artery are close to which nerves?

A

tibial nerve and deep peroneal nerve

62
Q

If PT cannot be palpated what is the landmark?

A

halfway between medial malleolus and achilles tendon

63
Q

What action when using nerve monitoring to block tibial and deep peroneal nerve indicates that the nerve has been encountered?

A

toe flexion

64
Q

When using nerve monitor in diabetic patients with neuropathy, what may you have to do to the ampules?

A

increase

65
Q

The motor response, when using nerve monitoring, immediately ceases upon?

A

injection of LA

6901 (18 decks)

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