Distal Lower Extremity Nerve Blocks Flashcards
What are the two branches of the sciatic nerve?
Tibial and Common peroneal
What position must a patient be in for a posterior popliteal block?
Prone
What are the landmarks used for a posterior popliteal block?
Semitendonous muscle and Biceps femoris muscle
What is the insertion point for a posterior popliteal block?
A rectangle is made between the two muscles, in the middle of the rectangle we can draw a line down the middle = insertion point
In what direction is the needle inserted for a posterior popliteal block?
Perpendicular in all planes
How is a patient positioned for a lateral popliteal fossa block?
Supine with a pillow under the leg
What are the landmarks for a lateral popliteal fossa block?
Lateral aspect of thigh slide into a crease between two muscles go 7cm above lateral femoral epicondyle = insertion point
What are the two muscles that the insertion point will go between in a lateral popliteal fossa block?
Vastus lateralis
Biceps femoralis
What bone will the provider run into when performing a lateral popliteal fossa block?
The femur, back out and redirect at a 45 degree angle while slowly advancing the needle
What type of motor response is seen with a lateral popliteal fossa block?
Stimulation of tibial nerve= plantar flexion and inversion
Stimulation of the common peroneal nerve = dorsiflexion and eversion
At what amplitude should a motor response occur in a lateral popliteal fossa block?
0.5mA
How does the saphenous nerve being superficial affect the type of block?
Can do subcutaneous block to pick off nerve
Where is the saphenous nerve located?
Below the sartorius muscle next to the saphenous vein on the medial aspect of the knee
What are the landmarks for a saphenous nerve block?
Locate the tibia run band of LA just medial from the top of the tibia down medial aspect of the knee to posterior side
What are the five nerves of an ankle block?
Saphenous Nerve Superficial peroneal nerve Deep peroneal nerve Posterior tibial nerve Sural Nerve
How much LA should be injected for a saphenous nerve block?
5-10mL
Where is the the deep peroneal nerve located?
Lies very close to the anterior tibial artery
Where is the sural nerve located?
Lateral aspect just behind the epicondyle of the ankle
Where is the posterior tibial nerve located?
Palpate behind the maleolous
How much LA should be used for a saphenous nerve block?
5-6mL should be anesthetized subcutaneously between lateral malleolus and achilles tendon
Where is the insertion point for the superficial peroneal nerve?
At tibial ridge and extend laterally toward lateral malleolus
How much LA should be injected to anesthetize the superficial peroneal nerve?
5-10mL
Where is the insertion point for the deep peroneal nerve?
In groove just lateral to extension hallucis longus
How much LA should be inserted for a deep peroneal nerve block?
2-3mL
What nerve of the foot is difficult to block because of its close proximity to the artery?
The posterior tibial nerve
Where is the insertion point for the posterior tibial nerve?
Groove behind medial malleolus until contact with bone then withdraw 1-2mm
How much LA should be injected for a posterior tibial nerve block?
3-5mL
Where is the insertion point to block the sural nerve?
Lateral malleolus and infiltrate towards achilles tendon
How should the LA be injected for a sural nerve block?
Superficial skin wheal of 5-6mL
What are some indication for a digital block of the toe?
Wound debridement and small wound closure
