Lower Extremity blocks Flashcards
The Lumbar Plexus originates from the ________ of _______.
Anterior Rami of L1-L4
(+T12 contribution in ~ 50% of the population)
Lumbar plexus primarily innervates _______.
the FRONT of the LEG
The Sacral Plexus originates from the ________ of ________.
Anterior Rami of L4-S4
The Sacral Plexus primarily innervates _______.
The BACK of the LEG
The lumbar plexus provides sensory and motor innervation to the ______, ________. and ________.
lower abdominal wall, anteromedial thigh, and knee
The sacral plexus provides sensory and motor innervation to the _______, ______, ________. and ________.
gluteal region, posterior thigh, lower leg, and foot
The Lumbar Plexus gives rise to these 6 nerves
Illiohypogastric
Ilioinguinal
Genitofemoral
*Lateral femoral cutaneous
*Obturator
*Femoral
“I Invariably Get Lazy On Fridays”
The Lateral Femoral Cutaneous nerve arises from _______.
L2-L3 (posterior divisions)
The Femoral nerve arises from ______.
L2-L4 (Posterior divisions)
The Femoral nerve divides into the _______ and ______ branches.
Anterior and posterior
The posterior branch of the Femoral nerve gives rise to 1 terminal branch which is the________.
Saphenous Nerve
The Saphenous nerve courses through the _______ and becomes _______ at the knee.
-adductor canal
-superficial
The Obturator nerve arises from ________.
Arises from L2-L4 (Anterior divisions)
Courses through the obturator canal into the pelvis minor
The Obturator nerve is often injured in patients _______.
Undergoing extensive pelvic surgery
The Sacral Plexus arises from ________.
L4-S3
The lumbosacral trunk (_____) coverges with the _______.
-L4 and L5
-sacral nerves
The Sacral Plexus gives rise to 5 major nerves:
“SIPPS”
-Superior gluteal
-Inferior gluteal
-Posterior cutaneous
-Pudendal
-Sciatic
What is the largest nerve in the body?
The Sciatic Nerve
What is the most important branch of the sacral plexus in the context of regional anesthesia of the lower extremity?
The Sciatic Nerve
The Sciatic nerve arises from ________.
L4-S3 (comprised of the tibial and common peroneal trunks)
2 branches of Sciatic Nerve
sCiaTic “CT”
Common peroneal n.
Tibial n.
branches at the proximal popliteal fossa
The Tibial nerve arises from the _______
sacral nerve (anterior branches of L4-S3)
The Tibial nerve gives rise to 1 terminal branch which is the ______.
Posterior tibial n.
The common peroneal nerve (fibular) arises from the _______.
Sacral nerve (posterior branches of L4-S3)
The Common Peroneal nerve gives rise to 3 terminal branches:
-Deep peroneal n.
-Superficial peroneal n.
-Sural n.
Skin innervation: Sensory Only (select all the apply question)
-Lateral femoral cutaneous
-Saphenous
-Sural
“LFC SS”
Skin innervation: Combined sensory-motor (select all the apply question)
-Femoral
-Posterior tibial
-Obturator
-Deep peroneal
-Superficial peroneal
” Fantastic People Orally Deep Suction”
Skin Innervation: Peripheral Nerves (picture)
Hip & Knee: Flexion and Extension
-Hip flexion → Femoral n.
-Hip extension → -Sciatic n.
-Knee flexion → Sciatic n.
-Knee extension → Femoral n.
Plantar flexion (Ankle)
Tibial nerve
Dorsiflexion (ankle)
Peroneal nerve
Eversion of ankle
Superficial peroneal nerve
Inversion of ankle
Deep peroneal nerve
The hip joint is innervated by the ______, ________, and the _________.
Femoral, Obturator, and Sciatic nerves (FOS)
-Most of the hip pain rises from the joint capsule
Which nerve is spared during a Pericapsular Nerve Group Block (PENG)
The Femoral Nerve is spared !!!!!
Indications for PENG block
Hip fracture and arthroplasty
Local anesthetic volume: 30-40mL
Objective of PENG block
Inject local anesthetic deep into the psoas tendon at the level of the iliopubic eminence
Femoral Nerve is spared!
Complications from PENG block
URETER injury, LAST, quadriceps weakness
The ________ supplies sensory innervation to the hip.
Lumbar Plexus
Less likely to get ________ weakness from PENG
Quadricep
The PENG when combined with a lateral femoral cutaneous block offers an alternative to the ________.
femoral and fascia iliaca block
Indications for Fascia Iliaca block
-Procedures involving the femur, quadriceps, and knee
-Acute pain management for hip fractures
Local anesthetic volume: 40mL
Select Complications of Fascia Iliaca Block
LAST, failed block, quadricep weakness
3 Target of Fascia Iliaca Block
-Femoral n.
-Obturator n.
-Lateral femoral cutaneous n.
“FOL”
Indications for Femoral nerve block
Procedures involving the hip, femur, quadriceps, and knee
Local anesthetic volume: 20-30mL
Femoral nerve arises from the _______.
Posterior divisions of L2-4
The femoral triangle borders: (SAIL)
-Sartorius muscle
-Adductor longus muscle
-Inguinal Ligament
“SAIL”
Anterior branch of Femoral Nerve
→ Ventral surface of the thigh and sartorius muscle
Posterior branch of the Femoral Nerve
The SAPHENOUS nerve arises from the posterior branch
→ Quadriceps muscles, knee joint, and its medial ligament
Most common Lower Extremity block
Femoral Nerve Block
Targets the largest nerve of the lumbar plexus
The Femoral nerve block when combined with the Sciatic nerve block does what?
Provides almost complete surgical coverage to the lower extremity
Adductor Canal block Indications:
-ACL repair
-MCL repair
-Patella fracture
-Vein stripping and harvesting
-Supplementation to a sciatic nerve block for foot/ankle surgery
15-20mL
The adductor canal originates at the ________ of the ________ and ends at the _______.
-apex of the femoral triangle
-adductor hiatus
Indications for a Popliteal block
procedures on the lower leg, ankle, and foot. May require supplementation with saphenous nerve block
25ml local
Select complications for Popliteal block:
Foot drop (fall risk),
SENSORY nerves of the foot and ankle:
Saphenous
Sural
Superficial peroneal
“SSS” ensory
SENSORY-MOTOR nerves of foot and ankle:
-Deep peroneal (eversion + dorsiflexion)
-Posterior tibial (inversion + plantar flexion
“DP”
