Lower Extremity Flashcards
Name the Push, Pull, Pinch, Punt of the lower extremities.
- Push = Tibial
- Pull = Common Peroneal
- Pinch = Lateral Femoral Cutaneous
- Punt = Femoral
The tibial nerve does what to the foot?
Plantar flexion (push gas)
What does the Common Perioneal do to the foot?
-Dorsiflex (Pull up to nose)
how do you test a lateral femoral cutaneous block?
-Pinch lateral thigh
How do you test a femoral nerve block?
-Hand under popliteal fossa and ask patient to lift leg (punt ball)
How to test obturator nerve block?
-Ask patient to adduct against pressure
What are the indications for a lumbar plexus block?
- Lower extremity procedures
- Femoral shaft and neck
- Knee procedures
- Anterior thigh
What is the major contraindication for lumbar plexus block?
-Coagulopathy
What position should the patient be in when performing a lumbar plexus block? How much LA?
- Lateral decubitus with slight forward tilt (foot dangling for visualization)
- 25-35 ml
Where is the lumbar plexus needle placed?
- Draw line that connects illiac crest and spinous process.
- needle is place 4cm lateral from spinous process
When the using a stimulator for a lumbar plexus block, what amps should it be set at and what should twitch?
- 1.5 and decrease to .5-1.0 (no lower than .5)
- Quadracep
What will you see with an epidural spread during a lumbar plexus block?
-Hypotension
Why is a lumbar plexus block more susceptible to LA toxicity than other blocks?
-Higher absorption rate
What are the indications for an obturator nerve block?
- Hip pain
- Knee or thigh w/ femoral block
- Prevent movement during TURBT
What are the 4 contraindications to an obturator nerve block?
- Inguinal lymphadenopathy
- Perineal infection
- Hematoma
- Coagulopathy
When performing an obturator nerve block with an paravascular selective inguinal block, where is the needle inserted?
- 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
When performing an obturator nerve block with an paravascular selective inguinal block, what stimulation are you looking for?
-Long adductor and gracilis muscles (posterior and medial thigh)
What are the complications associated with obturator nerve blocks?
- Intraperitoneal puncture
- Damage to bladder, rectum, or spermatic cord
What are the indications for a femoral nerve block?
- Anterior thigh
- Superficial surgery medial leg and below knee
- Knee arthroscopy
What are the contraindications to femoral nerve block?
- Previous ilioinguinal surgery (vascular graft or kidney transplant)
- Large inguinal lymph nodes or tumor
- Local infection
- Neuropathy
Where is the needle inserted for a femoral nerve block? How much LA?
- Identify femoral artery in the femoral (inguinal) crease
- Insert needle 1cm lateral to the pulse
- 15-20 mls of LA
What twitch is needed with the femoral nerve block?
-Quad (petellar twitch)
the 3 in 1 block will cover which 3 nerves?
- Femoral
- Lateal femoral
- Obturator
What is the difference in the technique between femoral nerve block and 3 in 1 block?
- 20-30 mls of LA (vs 15-20)
- Distal pressure for 30 seconds
