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Pain Exam 3 > LE blockade (Part 2) > Flashcards

LE blockade (Part 2) Flashcards

13-23

1
Q

Femoral block complications

A
  • Infection
  • Hematoma
  • Vascular puncture
  • Nerve injury
  • Obturator n. twitch (adductors of the medial leg) mistaken for quads: move needle laterally
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2
Q

⭐️

A
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3
Q

Lateral Femoral Cutaneous Nerve
(LFCN)
sensory innervation

A

lateral thigh
lumbar distributions from L2-4

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4
Q

⭐️
Of the 3 large anterior nerves in this region, the Lateral Femoral Cutaneous Nerve is the most…

A

lateral and superficial

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5
Q

This nerve lies away from major vessels and is close to skin surface

A

Lateral Femoral Cutaneous Nerve

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6
Q

Anatomical variations of Lateral Femoral Cutaneous Nerve

A

can lie inside, deep to or lateral to the sartorius muscle

usually away from major vessels and close to skin surface

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7
Q

Lateral Femoral Cutaneous Nerve Block gives limited anesthesia of ____ so we must …

A

lateral thigh

supplement FNB
(Mid shaft and distal femur fracture repairs)

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8
Q

Femoral Nerve block mostly affects (sensory/motor).

A

motor

(why its decining in use for knee replacement)

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9
Q

Lateral Femoral Cutaneous Nerve Block
Transducer position

A

Inject 5-10 ml via short 22G:
* 2 cm inferior and lateral to ASIS
* lateral edge of sartorius muscle

ASIS=anterior superior iliac spine

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10
Q

Lateral Femoral Cutaneous Nerve Block
Goal

A

LA spread around LFCN between tensor fasciae latae and sartorius muscles

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11
Q

PEricapsular Nerve Group (PENG) Block
is used for…

A
  • Hip pain
  • fast-track post Anterior THR

Needle: lateral aspect and contact the superior pubic ramus just lateral to the psoas tendon; then inject

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12
Q

PEricapsular Nerve Group (PENG) Block
Nerve branches

A

articular branches (sensory) of
* femoral nerve
* obturator nerve
* accessory obturator nerve

NYSORA: https://www.nysora.com/updates/new-addition-hip-block/

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13
Q

This nerve block avoids motor block

A

PEricapsular Nerve Group (PENG) Block

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14
Q

PEricapsular Nerve Group (PENG) Block
How much LA do we give?

A

10-15 ml diluted LA

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15
Q

Dilute your LA before injecting when peforming a ____ block

A

PEricapsular Nerve Group (PENG) Block

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16
Q

Provides analgesia of knee and medial leg

A

Adductor Canal (Saphenous Nerve) Block

17
Q

Blocks the Saphenous nerve

A

Adductor Canal Block

18
Q

Which block affects the quadriceps less?
A) Femoral
B) Adductor Canal/Saphenous

A

B) Adductor Canal/Saphenous

19
Q

Adductor Canal/Saphenous Block
Anatomy

A
  • vastus medialis muscle (anteriorly)
  • Sartorius muscle (medially)
  • adductor muscles (posteriorly)

analgesia of knee and medial leg

20
Q

In addition to the saphenous nerve, an adductor canal block may also affect…

A

posterior division of obturator nerve
and
nerve to the vastus medialis m.

21
Q

ACB Landmarks

A

transverse on the anteromedial thigh at middle/distal third of thigh above knee

needle 2-3 cm lateral to the transducer and advanced in-plane

22
Q

Adductor Canal Block
Inject ____ ml of LA between …

A

15-20
sartorius and vastus medialis muscles

23
Q

LFCN provides (motor/sensory) innervation to the lateral thigh.

A

sensory

24
Q

T/F
A Lateral Femoral Cutaneous Nerve Block can be used as the sole block for femur fracture repairs.

A

False
Mid shaft and distal femur fracture repairs (supplement FNB); limited anesthesia of lateral thigh

25
Q

ACB is used for which procedures?

A
  • Supplement Multimodal analgesia protocols for knee arthroplasty
  • supplemental block for foot and ankle procedures
26
Q

Saphenous nerve
presentation on U/S

A
  • small, round
  • hyperechoic structure
  • anterior to artery

15-20 ml of LA between sartorius and vastus medialis muscles

27
Q

iPACK Block
injection site

A

inject between the Popliteal Artery and Capsule of the Knee

28
Q

iPACK Block

A
  • analgesia of posterior knee capsule
  • Motor-sparing
29
Q

These 3 blocks can be used together to provide analgesia to the knee capsule

A

iPACK, LIA, adductor canal

30
Q

The iPACK, LIA, and adductor canal block combo can be used for…

A

(analgesia for knee capsule)
* knee arthroplasty
* ACL repair
* knee manipulation

Preserves motor function of the lower extremity by targeting the articular branches

31
Q

When performed correctly, theiPACKblock avoids blockade of the _____, which can be subjected to stretch injury during total knee arthroplasty in patients with valgus deformity.

A

common peroneal nerve

32
Q

If a block only targets the _____ branches, it is motor sparing

A

articular

33
Q

Inject up to __ml into the space for both the iPACK and LIA blocks

A

20

34
Q

LIA Block

A

Provides analgesia to the anterior knee capsule

35
Q

An iPACK Block proves analgesia to the ___ knee, while the LIA block provides anaglesia to the ___ knee.

A

iPACK: posterior knee capsule
LIA: anterior knee capsule

36
Q

LIA Block
Targets…

A

femoral nerve’s posterior division that give rise to articular branches that innervate the anterior knee capsule:
* Nerve to vastus Lateralis
* Nerve to vastus Intermedius
* Nerve to vastus Medialis

37
Q

LA distribution of iPACK and LIA Blocks

A
38
Q

Saphenous Nerve
location

A
  • Below knee: tibial side of leg, adjacent to the great saphenous vein subQ
  • At ankle: branches are medial
39
Q

LIA Block
Targets the _____ division of the femoral nerve that gives rise to articular branches that innervate the _______________

A

posterior division
anterior knee capsule

Pain Exam 3 (16 decks)

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