Lower Ext - Dr. Moritz Flashcards
Effect of LA on nerves
Pain (1st) -> Temperature -> Touch -> Proprioception
Everything we’ve learned is temp 1st than pain..
A popliteal block is essentially what type of block?
tibial nerve block
What does the tibial nerve innervate?
posterior leg and sole of foot
What type of surgeries is a popliteal nerve used for?
“ Great for rear foot case”
Achilles tendon work
Gastrocnemius recession
Clubfoot releases
Post operative pain mgmt.
Anatomy of popliteal block
Diamond shaped popliteal fossa
Medial & lateral heads of gractroc
Superiomedially by semitendinosus and semimembranosus
Found 0.5-1cm lateral to popliteal fossa
1.5-2 cm deep in skin
When doing a popliteal block where do you place the intradermal wheal?
5-7 cm proximal to crease
0.5-1 cm lateral to midline
How do you know that you are in the correct location during a popliteal block?
Plantarflexion of foot
What are the 2 deep and 3 superficial nerves at the ankle
2 Deep
- Posterior tibial
- Deep perineal
3 Superficial
- Superficial peroneal
- Sural
- Saphenous
What are the 4 terminal nerves of the sciatic nerve
Posterior tibial
Deep peroneal
Superficial peroneal
Sural
What is the terminal cutaneous branch of the femoral nerve
Saphenous
What is cutaneous innervation of posterior tibial nerve
medial posterior heel and plantar foot
Anatomy of posterior tibial nerve
7.5 cm proximal to medial malleolus tip and parallel to medial border achilles
The posterior tibial nerve branches into…
medial and lateral planter nerves and calcaneal nerves
T/F: saphenous is the only branch to innervate the foot that is not a brach of the sciatic nerve
TRUE
Anatomy of saphenous
anterior to medial malleolus
Where does the spaphenous nerve terminate
1st MTPJ
Cutaneous innervation of deep peroneal
cutaneous innervation to the 1st dorsal interspace
Anatomy of deep peroneal
2.5 cm proximal to the ankle joint the nerve lies between Extensor hallucis longus and the Extensor digitorum longus
The deep peroneal nerve is lateral to what pulse?
dorsalis pedis pulse
Cutaneous innervation of superficial peroneal
lower anterior leg and dorsal of foot
Superficial peroneal branches into what nerves
medial and intermediate dorsal cutaneous nerves
Anatomy of superficial peroneal?
Divide to branches 6.5 cm proximal to the ankle joint
Usually able to visualize the intermediate dorsal cutaneous n. directly (“guitar string”)
Cutaneous innervation of sural nerve
lateral lower leg and lateral foot
Anatomy of sural nerve
Courses the lateral tendo-achilles and runs antero-lateral to the small saphenous v.
1.5cm distal to the lateral malleolus
Sural nerve provides innervation to which branches?
lateral calcaneal branches
What is a mayo block used for?
commonly used for 1st MTPJ surgery
What is an advantage for the mayo block
preserves distal surgical tissue planes
What are the 4 nerves blocked in a mayo block?
Saphenous
Deep peroneal
Medial planter
Medial dorsal cutaneous
Anatomy of mayo block
1st Interspace
Medial to 1st Metatarsal
Directly plantar to 1st metatarsal
Superficial plantar to 1st Metatarsal
Benefits of digital blocks
useful for office and surgical setting
provides anesthesia to only the digit being blocked
Digital blocks are a __ point block
2 point
Digital block anatomy
2 dorsal digital nerves
2 plantar digital nerves
How many sticks for a digital block
3
What causes pain with nerve blocks?
Change in the pH of LA that we use that causes pain (not form the needle)
go at slow rate so pH change is slow
what should you never use in a digit block
epi
