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Regional > Lower extremities (josh's take) > Flashcards

Lower extremities (josh's take) Flashcards

1
Q

Indications for LE anesthesia

A
  • sx and or tourniquet of LE
  • Post-op analgesia
  • Diagnostic
  • Therapeutic
  • Arterial occlusion disease
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2
Q

Contraindications to LE anesthesia

A
  • infection at teh injection site
  • Anticoagulant therapy
  • Persistant peripheral neuropathies/ paresthesias
  • High risk of delevoping compartment syndrome post op
  • surgical interention on LE nerves
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3
Q

***** must know ****

Anotomy of thre lumbarsacral plexus

it is composed of the nerve roots from what to what?

A

L2-S3

(aka lumbar (L2) Sacral (S3)

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4
Q

***** must know ****

Anotomy of thre lumbarsacral plexus

what are the 4 nerves that make up the lumbarsacral plexus

A
  • Sciatic
  • femoral
  • lateral femoral cutaneous
  • Obturator
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5
Q

***** must know ****

Anotomy of thre lumbarsacral plexus

which spinal nerves do the nerves origiante

  • Sciatic
  • Femoral
  • Lateral Femoral Cutaneous
  • Obturator
A
  • Sciatic- L4-S3
  • Femoral- L2-4
  • Lateral Femoral Cutaneous- L2-3
  • Obturator- L2-4

(femoral and obturator same)

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6
Q

Label

A
  1. Femoral n.
  2. Obturator n.
  3. Lumbosacral plexus
  4. Lateral femoral cutaneous n.
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7
Q

Label

A
  1. Lateral cutaneous n.
  2. Femoral n.
  3. obturator n.
  4. Sciatic n.
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8
Q

Label

A
  1. Lateral Femoral cutaneous n.
  2. Femral n.
  3. Obturator n.
  4. sciatic n.
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9
Q

Label

A
  1. T10
  2. T11
  3. T12
  4. L1
  5. L2
  6. iloinguinal n.
  7. S2,3
  8. Femoral br. of genitofemoral n.
  9. Genital br. of Genitofemoral n.
  10. Femoral n. L2,3,4
  11. Lateral Femoral Cutaneous n. L2,3
  12. T12 Subcostal n.
  13. L1
  14. Ilioinguinal n.
  15. Femoral br. of Genitofemoral n.
  16. Prudendal n.
  17. Genital br. of genitofemorial n.
  18. Femoral n.
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10
Q

Label

A
  1. Illiohypogastric n. (lateral cutaneous branch)
  2. Genitofemoral n. Femoral br.
  3. Genitofemoral br. Genital br.
  4. Lateral femoral cutaneous n.
  5. Femoral n.
  6. Obturator
  7. Peroneal n.
  8. Saphenous n.
  9. sural n.
  10. Deep peronal n.
  11. surerficial Peroneal n.
  12. Illiohypogastric n. (lateral cutaneous branch)
  13. Cluneal n.
  14. Lateral Femoral cutaneous
  15. Posterior Femora cutaneousl n.
  16. Femoral n.
  17. Obtruator n.
  18. Peroneal n.
  19. Saphenous n.
  20. Sural n.
  21. Calcaneal n.
  22. Medial plantar n.
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11
Q

Label

A
  1. Obturator n.
  2. Femoral n.
  3. obturator n.
  4. Femoral n.
  5. lateral femoral cutaneous n.
  6. Lateral femoral Cutaneous n.
  7. Femoral n.
  8. Obturator n.
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12
Q

Motor innervation of Plexus

what br. of the SCIATIC nerve is responsible for plantar flexion of the foot? and dorsiflexion of the foor?

A
  • Posterior tibial n.
  • Common perineal n.
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13
Q

Motor innervation of Plexus

the femoral n. is responsible for the twitching of what muscle? called the patellar snap

A

quadricps femoris

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14
Q

Motor innervation of Plexus

the obturator is responsible for the twitching of what muscles on the medial side of the leg

A

adductor muscles

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15
Q

Motor innervation of Plexus

the Lateral femoral Cutaneous n. is responsible for the motor innervation of what muscle?

A

none, it has bo motor innervation

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16
Q

Sciatic Nerve:

Derived from what nerve roots

A

L4-S3

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17
Q

Sciatic Nerve:

it runs as ONE nerve until where?

then divides into what 2 dissions?

A
  • popliteal fossa
  • medial (tibial n.) and Lateral (peronial n.)
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18
Q

Sciatic Nerve:

at teh poiteal fossa the sciatic n. divides into the _____ n. and the ____ ______ n.

A
  • tibial n.
  • common peroneal .
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19
Q

Sciatic Nerve:

the tibial n. proceeds down the posterior leg and further divides to form the ____ ___ n. and the ____ n.

A

Posterior tibial n.

Sural n.

20
Q

Sciatic Nerve:

the common peroneal n. come laterally around the head of the fibula and further divides to form the ____ ____ n. and the ____ ____ n.

A
  • deep peroneal n.
  • Surperficial peroneal n.
21
Q

Sciatic Nerve:

start at the top and go down with all its division!!

A
  • starts at L4-S3
  • runs as 1 nerve and divides into 2 divisions (lateral and Medial) at the popliteal fosa
  • divides into medial (tibial n) and lateral (common peroneal n.)
  • Tibial n. travels down and divides into the posterior tibial n. and sural n.
  • the common peroneal n. comes lateraly around the head oh fibula and divides into the deep and superficial peroneal n.
22
Q

what are the blocks done at teh level of the hip

A

Sciatic

Femoral

Lateral femoral cutaneous

Obturator

23
Q

What are blocks at level of knee

A
  1. Popiteal fossa
  • sciatic n.
  • Tibial n.
  • Common Peronial Nerve
  1. Common Perineal n.
  2. Saphenous
24
Q

Bocks at level of Ankle

A

Posterior tibial n.

Sural n.

Deep peroneal n.

Superficial Peroneal n.

Saphenous

25
Q

Label

A
  1. Calcan eal n.
  2. Saphenous n.
  3. Sural n.
  4. Sahenous n.
  5. Superficial n.
  6. sural n.
  7. Plantar n.
  8. Deep peroneal n.
  9. Calcaneal n.
  10. Sapenous n.
  11. Superficial Peroneal n,
  12. Plantar n.
26
Q

Label

A
  1. Tibail artery
  2. Tibial Nerve
  3. Sural n.
  4. Achilles tendon
27
Q

so for a posterior tibial n. what side of leg are you injecting?

and for a Sural n. block what side of leg are you injecting?

A
  • posterior medial
  • Posterior lateral
28
Q

Label

A
  1. Superficial peroneal n.
  2. Saphenous n.
  3. Deep peroneal n.
29
Q

So the Superficial peroneal n. location on foot?

Saphenpous n. location on foot?

Deep peroneal n. location on foot?

A
  • Anterior lateral then spreads medial
  • anterior medial
  • Anterion midline (no branches) to big toe
30
Q

Complications of LE anesthesia?

A
  • infection
  • Iintrathecal/epidural injection of LA
  • Intraabdominal injury
  • Puncture or injury of vagina or bladder
  • IV injection of LA
  • Intraneural injection
  • Hematoma
  • Persistant paresthesia
  • Post-procedure pain
31
Q

tech for injection with indulated needles and nerve stimulators.

Give me the steps

A
  • Prepare and drape area
  • ensure all epuip working
  • have resusciatation equip ready
  • insert needle once pierced skin turn stimulator on and set at 1 mA
  • with continuous intermittant aspiration advance needle until desired twitch is elicted
  • Decrease mA until twitch is lost
  • if twitch is lost b/t 0.2-0.4 mA inject local
  • if twitch lost b4 0.4 mA advance needle and repeat last step
  • if twitch is present with 0.2 mA or less withdraw needle and begin again
  • prior to injecting LA insure negative aspiration
  • inject 1 cc of LA to r/o intraneural injection
  • inject 3 cc to r/o IV injection
  • inject remaining LA in 5cc aliquots
32
Q

Nerve stimulator:

once needle is in set stimulator to what?

A

1 mA

33
Q

Nerve stimulator:

if twitch is lost b/t 0.2 and o.4 mA what does that mean

A

great spot inject

34
Q

Nerve stimulator:

if twitch lost b4 0.4 what does that mean and what should you do?

A

to far out

advance needle and repeat

35
Q

Nerve stimulator:

if twitch still present at 0.3 mA what does that mean? and what should you do?

A

too deep (dwayne has and will never experience that) (intraneural)

pull out and repeat steps

36
Q

Sciatic Nerve Block:

arises from the ____ plexus and is formed by the anterior divisions of ___-___

A

sacral plexus

L4-S1 (maybe S3)

37
Q

Sciatic Nerve Block:

is often useful for surgical procedures of the _____ but often requires supplemental nerve blocks to provide surgical anesthesia/ full postop analgesia

A

Knee

38
Q

Sciatic Nerve Block:

Besides sciatic what other blocks are needed for thr following procedures?

  • TKA
  • ACL repair
  • Saphenous vein stripping
  • Ankle/ foot sx
A
  • Femoral nerve block, obturator n. block
  • Femoral nerve block
  • Posterior cutaneous
  • Femoral n.
39
Q

Sciatic Nerve Block:

useful in pt’s requiring analgesia prior to OR transport or pts in which you want to avoid what?

A

sympathectomy

40
Q

Femoral Nerve Block:

is useful for what procedures

A

anterior thigh and most commonly combined with other blocks

41
Q

Femoral Nerve Block:

pros of block

A
  • Preemptive analgesia, blocks nociceptive response
  • Avoids intraneural injection
  • May augment primary anesthesia
  • Should be used with all PNBs
42
Q

Fascia Iliaca Compartment block:

the lumbar plexus is made up of 1st 4 lumbar nerves loocated deep within the ___muscle and anterior to transverse process of each lumbar vertebrae

A

Psoas

43
Q

Fascia Iliaca Compartment block:

the lumbar plexus divides innto compartent nerves. what are they (6)

A
  1. iliohypogastric
  2. Ilioinguinal
  3. Genitofemoral
  4. Lateral Femoral coutaneous
  5. Obturator
  6. Femoral nerve
44
Q

Fascia Iliaca Compartment block:

blockade of lumbar plexus can be used for anesthesia in sx to where?

A

LE

45
Q

Fascia Iliaca Compartment block:

what is teh main problem with these blocks

A

Often requires multiple injection

46
Q

Fascia Iliaca Compartment block:

major nerves needing blockade

A

Femoral n.

Obturator n.

Lateral Femoral cutaneous n.

47
Q

Thats it not bad

A

do it again

Regional (24 decks)

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