Ankle blocks

Question 1

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

Answer 1

saphenous

Question 2

Ankle block requires how many needle insertions?

Answer 2

5

Question 3

Onset time for ankle block?

Answer 3

10-25 minutes

Question 4

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

Answer 4

sensory

Question 5

Ankle block volume?

Answer 5

5-6 mL

Question 6

Can you use epi in ankle blocks?

Answer 6

never

Question 7

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

Answer 7

terminal

Question 8

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

Answer 8

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

Question 9

How are the 2 deep nerves anesthetized?

Answer 9

injecting LA underneath superficial fassa

Question 10

How are the 3 superficial nerves anesthetized?

Answer 10

injecting LA SQ

Question 11

Largest nerve in body?

Answer 11

sciatic (2 cm in breadth at take off)

Question 12

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

Answer 12

L4-S3 roots

Question 13

Where does the sciatic nerve exit the pelvis?

Answer 13

greater sciatic foramen

Question 14

The sciatic nerve descends between what 2 structures?

Answer 14

greater trochanter of the femur and tuberosity of ischium

Question 15

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

Answer 15

common peroneal, tibeal nerve

Question 16

Largest branch of the lumbar plexus?

Answer 16

femoral branch

Question 17

The femoral branch arises from which 3 lumbar nerves?

Answer 17

2nd, 3rd, 4th

Question 18

Eventually the femoral nerve passes under which ligament?

Answer 18

inguinal

Question 19

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

Answer 19

laterally and slightly deeper than the femoral artery

Question 20

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?

Answer 20

LVAN (lymph, vein, artery, nerve)

Question 21

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

Answer 21

common peroneal nerve

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

The superficial peroneal nerve is a branch of which nerve?

Answer 24

common peroneal nerve

Question 25

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

Answer 25

its tiny and easy to block

Question 26

The superficial peroneal nerve divides in to which branches?

Answer 26

terminal cutaneous branches; medial and lateral dorsal cutaneous nerves

Question 27

Where is the tibial nerve located/positioned between what?

Answer 27

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

Question 28

What type of nerve is the sural nerve?

Answer 28

sensory

Question 29

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

Answer 29

sural nerve

Question 30

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

Answer 30

sural nerve

Question 31

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

Answer 31

saphenous nerve

Question 32

Does an ankle block result in anesthesia of the ankle?

Answer 32

no

Question 33

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

Answer 33

tibial and peroneal

Question 34

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

Answer 34

deep peroneal nerve

Question 35

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

Answer 35

you have an assistant

Question 36

How do you position the foot for an ankle block?

Answer 36

supine with foot over footrest

Question 37

Equipment needed for ankle block?

Answer 37

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

Question 38

Is ultrasound helpful for an ankle block?

Answer 38

no

Question 39

Deep peroneal nerve is located where?

Answer 39

immediately lateral to tendon of extensor hallucis langus

Question 40

Deep peroneal nerve is located between which 2 structures?

Answer 40

extensor hallucis longus, extensor digitorum longus

Question 41

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

Answer 41

DP

Question 42

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

Answer 42

immediately lateral

Question 43

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

Answer 43

deep-deep peroneal and posterior tibial

Question 44

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

Answer 44

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

Question 45

Tip for blocking the peroneal nerve?

Answer 45

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)

Question 46

How do you inject the posterior tibial nerve?

Answer 46

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

Question 47

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

Answer 47

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

Question 48

4 complications of ankle block?

Answer 48

infection, hematoma, vascular injection, nerve injury

Question 49

What can you do to prevent vascular injection?

Answer 49

aspirate

Question 50

How can you prevent nerve injury while doing ankle block?

Answer 50

stop if pt reports excruciating pain or if encounter high pressures

Question 51

Most commonly failed block?

Answer 51

ankle block

Question 52

Most common indication for ankle nerve block?

Answer 52

diabetic ankle surgery

Question 53

Ankle block is not suited for which type of surgery?

Answer 53

ankle

Question 54

Most of dorsal part of foot gets innervation from?

Answer 54

superficial peroneal nerve

Question 55

Medial aspect of foot receives sensory innervation from?

Answer 55

saphenous nerve

Question 56

Lateral aspect of foot is supplied by?

Answer 56

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

Question 57

Medial and posterior aspect of heel supplied by?

Answer 57

medial branch of tibial nerve

Question 58

Does LA cross fascia readily?

Answer 58

no

Question 59

This nerve supplies approx complete sole of foot?

Answer 59

tibial

Question 60

Main blood supply to foot?

Answer 60

posterior tibial artery, dorsal pedal artery

Question 61

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

Answer 61

tibial nerve and deep peroneal nerve

Question 62

If PT cannot be palpated what is the landmark?

Answer 62

halfway between medial malleolus and achilles tendon

Question 63

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

Answer 63

toe flexion

Question 64

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

Answer 64

increase

Question 65

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

Answer 65

injection of LA