Case 53 - Lower extremity anesthesia Flashcards
1
Q
What nerves are affected during ACL surgery?
A
- Femoral Nerve
- skin incision adjacent to patellar tendor
- Tibial Nerve
- tibial periosteum
- Femoral, obturator, sciatic
- internal knee joint capsule
-
autograft harvest
- femoral nerve - patellar tendon
- obturator nerve - gracilis tendon
- tibial nerve - semitendinosus tendon
2
Q
What are anesthetic options for ACL surgery?
A
Options
1) general
- side effects of GENA
- inferior post-op pain utilizing opioids
2) general/regional
* femoral nerve block or lumbar plexus block for post-op pain
3) regional
- neuraxial anes: epidural vs spinal
- femoral or lumbar plexus for post-op pain control
3
Q
benefits of femoral nerve catheter
A
- superior pain control compared to intraarticular, IV opioids, and local infiltration
- minimize opioid use –> decrease opioid side effects
- improved sleep, improved patient satisfaction
- assist with aggresive physical therpay due to controlled pain
4
Q
Which LA would you choose for a femoral nerve block?
A
Desired block density and duration of post op analgesia dictate choice of local anesthetic:
1) pre-op block for post-op pain control
- bupi 0.5% or ropi 0.75%
- dense block, blunts surgical stimulation, reduces opioid consumption intra-op
2) block done post-op for post-op control
- surgical anesthesia not required, therefore bupi 0.25% or 0.5% ropi
- provides analesia without profound motor blockade
3) continuous catheter
* 0.1% or 0.2% bupi –> provides analgesia, minimizes motor blockade and sensory blockade –> important for PT
5
Q
Fascia iliaca block
A
- can be used for hip surgery
- inferior to psoas nerve block in terms of analgesia and success of block
- location
- lateral to femoral nerve
- under fascia iliaca
- lateral to middle third zone from ASIS to pubic tubercle
- block relys on spread proximal into lumbar plexus located between psoas major and quadratus lumborm
6
Q
A
