Distal Lower Extremity Nerve Blocks

Question 1

What are the two branches of the sciatic nerve?

Answer 1

Tibial and Common peroneal

Question 2

What position must a patient be in for a posterior popliteal block?

Answer 2

Prone

Question 3

What are the landmarks used for a posterior popliteal block?

Answer 3

Semitendonous muscle and Biceps femoris muscle

Question 4

What is the insertion point for a posterior popliteal block?

Answer 4

A rectangle is made between the two muscles, in the middle of the rectangle we can draw a line down the middle = insertion point

Question 5

In what direction is the needle inserted for a posterior popliteal block?

Answer 5

Perpendicular in all planes

Question 6

How is a patient positioned for a lateral popliteal fossa block?

Answer 6

Supine with a pillow under the leg

Question 7

What are the landmarks for a lateral popliteal fossa block?

Answer 7

Lateral aspect of thigh slide into a crease between two muscles go 7cm above lateral femoral epicondyle = insertion point

Question 8

What are the two muscles that the insertion point will go between in a lateral popliteal fossa block?

Answer 8

Vastus lateralis

Biceps femoralis

Question 9

What bone will the provider run into when performing a lateral popliteal fossa block?

Answer 9

The femur, back out and redirect at a 45 degree angle while slowly advancing the needle

Question 10

What type of motor response is seen with a lateral popliteal fossa block?

Answer 10

Stimulation of tibial nerve= plantar flexion and inversion

Stimulation of the common peroneal nerve = dorsiflexion and eversion

Question 11

At what amplitude should a motor response occur in a lateral popliteal fossa block?

Answer 11

0.5mA

Question 12

How does the saphenous nerve being superficial affect the type of block?

Answer 12

Can do subcutaneous block to pick off nerve

Question 13

Where is the saphenous nerve located?

Answer 13

Below the sartorius muscle next to the saphenous vein on the medial aspect of the knee

Question 14

What are the landmarks for a saphenous nerve block?

Answer 14

Locate the tibia run band of LA just medial from the top of the tibia down medial aspect of the knee to posterior side

Question 15

What are the five nerves of an ankle block?

Answer 15

Saphenous Nerve
Superficial peroneal nerve
Deep peroneal nerve
Posterior tibial nerve
Sural Nerve

Question 16

How much LA should be injected for a saphenous nerve block?

Answer 16

5-10mL

Question 17

Where is the the deep peroneal nerve located?

Answer 17

Lies very close to the anterior tibial artery

Question 18

Where is the sural nerve located?

Answer 18

Lateral aspect just behind the epicondyle of the ankle

Question 19

Where is the posterior tibial nerve located?

Answer 19

Palpate behind the maleolous

Question 20

How much LA should be used for a saphenous nerve block?

Answer 20

5-6mL should be anesthetized subcutaneously between lateral malleolus and achilles tendon

Question 21

Where is the insertion point for the superficial peroneal nerve?

Answer 21

At tibial ridge and extend laterally toward lateral malleolus

Question 22

How much LA should be injected to anesthetize the superficial peroneal nerve?

Answer 22

5-10mL

Question 23

Where is the insertion point for the deep peroneal nerve?

Answer 23

In groove just lateral to extension hallucis longus

Question 24

How much LA should be inserted for a deep peroneal nerve block?

Answer 24

2-3mL

Question 25

What nerve of the foot is difficult to block because of its close proximity to the artery?

Answer 25

The posterior tibial nerve

Question 26

Where is the insertion point for the posterior tibial nerve?

Answer 26

Groove behind medial malleolus until contact with bone then withdraw 1-2mm

Question 27

How much LA should be injected for a posterior tibial nerve block?

Answer 27

3-5mL

Question 28

Where is the insertion point to block the sural nerve?

Answer 28

Lateral malleolus and infiltrate towards achilles tendon

Question 29

How should the LA be injected for a sural nerve block?

Answer 29

Superficial skin wheal of 5-6mL

Question 30

What are some indication for a digital block of the toe?

Answer 30

Wound debridement and small wound closure