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AAN2 > Lower Extremity > Flashcards

Lower Extremity Flashcards

1
Q

Name the Push, Pull, Pinch, Punt of the lower extremities.

A
  • Push = Tibial
  • Pull = Common Peroneal
  • Pinch = Lateral Femoral Cutaneous
  • Punt = Femoral
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2
Q

The tibial nerve does what to the foot?

A

Plantar flexion (push gas)

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3
Q

What does the Common Perioneal do to the foot?

A

-Dorsiflex (Pull up to nose)

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4
Q

how do you test a lateral femoral cutaneous block?

A

-Pinch lateral thigh

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5
Q

How do you test a femoral nerve block?

A

-Hand under popliteal fossa and ask patient to lift leg (punt ball)

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6
Q

How to test obturator nerve block?

A

-Ask patient to adduct against pressure

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7
Q

What are the indications for a lumbar plexus block?

A
  • Lower extremity procedures
  • Femoral shaft and neck
  • Knee procedures
  • Anterior thigh
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8
Q

What is the major contraindication for lumbar plexus block?

A

-Coagulopathy

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9
Q

What position should the patient be in when performing a lumbar plexus block? How much LA?

A
  • Lateral decubitus with slight forward tilt (foot dangling for visualization)
  • 25-35 ml
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10
Q

Where is the lumbar plexus needle placed?

A
  • Draw line that connects illiac crest and spinous process.

- needle is place 4cm lateral from spinous process

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11
Q

When the using a stimulator for a lumbar plexus block, what amps should it be set at and what should twitch?

A
  • 1.5 and decrease to .5-1.0 (no lower than .5)

- Quadracep

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12
Q

What will you see with an epidural spread during a lumbar plexus block?

A

-Hypotension

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13
Q

Why is a lumbar plexus block more susceptible to LA toxicity than other blocks?

A

-Higher absorption rate

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14
Q

What are the indications for an obturator nerve block?

A
  • Hip pain
  • Knee or thigh w/ femoral block
  • Prevent movement during TURBT
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15
Q

What are the 4 contraindications to an obturator nerve block?

A
  • Inguinal lymphadenopathy
  • Perineal infection
  • Hematoma
  • Coagulopathy
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16
Q

When performing an obturator nerve block with an paravascular selective inguinal block, where is the needle inserted?

A
  • Find femoral artery and tendon of long adductor muscle. draw a line between the 2
  • Needle is inserted at the mid point of the line
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17
Q

When performing an obturator nerve block with an paravascular selective inguinal block, what stimulation are you looking for?

A

-Long adductor and gracilis muscles (posterior and medial thigh)

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18
Q

What are the complications associated with obturator nerve blocks?

A
  • Intraperitoneal puncture

- Damage to bladder, rectum, or spermatic cord

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19
Q

What are the indications for a femoral nerve block?

A
  • Anterior thigh
  • Superficial surgery medial leg and below knee
  • Knee arthroscopy
20
Q

What are the contraindications to femoral nerve block?

A
  • Previous ilioinguinal surgery (vascular graft or kidney transplant)
  • Large inguinal lymph nodes or tumor
  • Local infection
  • Neuropathy
21
Q

Where is the needle inserted for a femoral nerve block? How much LA?

A
  • Identify femoral artery in the femoral (inguinal) crease
  • Insert needle 1cm lateral to the pulse
  • 15-20 mls of LA
22
Q

What twitch is needed with the femoral nerve block?

A

-Quad (petellar twitch)

23
Q

the 3 in 1 block will cover which 3 nerves?

A
  • Femoral
  • Lateal femoral
  • Obturator
24
Q

What is the difference in the technique between femoral nerve block and 3 in 1 block?

A
  • 20-30 mls of LA (vs 15-20)

- Distal pressure for 30 seconds

25
Q

What are the indications for a sciatic nerve block?

A
  • Lower limb surgery

- Often combined with femoral

26
Q

In what position should the patient be in for a sciatic nerve block?

A

-Lateral decubitus

27
Q

Where is needle insertion for sciatic nerve block?

A
  • Draw line between greater trochanter and PSIS
  • At midpoint go 4cm perpendicular and distal
  • 5-8 cm needle depth
28
Q

What is the goal for stimulation of the sciatic nerve block? How much LA?

A
  • Twitch of hamstring, calf, foot or toes

- 15-25

29
Q

What are the indications for a popliteal block?

A

-Lower leg surgery (espically foot and ankle)

30
Q

What other nerve may need blocked in addition to the popliteal for adequate lower leg coverage?

A

-Saphenous

31
Q

What are the 2 different techniques for a popliteal block?

A

-Posterior or lateral

32
Q

The popliteal block is place between what to tendons?

A
  • Bicep femoris (lateral)

- Semitendinous

33
Q

Where is needle inserted for posterior popliteal block?

A
  • 7cm proximal of the popliteal fossa crease midway between bicep femoris and semitendinous
  • 3-5 cm depth
34
Q

What stimulation is needed for a posterior popliteal block?

A

-twitches in foot

35
Q

Why would one attempt to stimulate the tibial and common peroneal nerves during a popliteal block? what should happen?

A
  • To ensure your above the bifurcation
  • Tibial will plantar flex and inversions
  • Common peroneal will dorsiflex and eversion
36
Q

Where is the needle inserted for a lateral popliteal block?

A
  • 8cm above popliteal crease

- Between vastus lateralus and bicep femoris

37
Q

How should the needle be inserted for a lateral popliteal block?

A

insert till you hit bone (femur) then redirect down

  • nerve should be 1-2 cm deeper then bone
  • 5-7 cm deep
38
Q

What stimulation is needed for the lateral popliteal block?

A

-Foot twitch

39
Q

What are the 3 types of saphenous blocks?

A
  • Trans-satorial (through satorius muscle 1-2cm above patella)
  • Paravenous (tourniquet on leg to identify saphenous vein, 5ml on both sides of vein just below patella)
  • Below knee field block
40
Q

What are the 3 superficial foot nerves?

A

-Sural, Superficial peroneal, sural

41
Q

What are the 2 deep nerves in the foot?

A
  • Deep peroneal

- Tibial

42
Q

What are the complications of a lower extremity bier block?

A
  • High risk of LA toxicity

- Do not release tourniquet before 20 minutes

43
Q

What are the indications for a ilioinguinal/iliohypogastric block?

A
  • Lower abdominal wall (inguinal area)

- C-Section

44
Q

Where is the needle insertions site for a ilioinguinal/iliohypogastric block?

A

-2 cm medial and 2 cm superios to the ASIS

45
Q

Complications to a ilioinguinal/iliohypogastric block?

A

bowel perf

AAN2 (11 decks)

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