Lower Extremity blocks

Question 1

The Lumbar Plexus originates from the ________ of _______.

Answer 1

Anterior Rami of L1-L4
(+T12 contribution in ~ 50% of the population)

Question 2

Lumbar plexus primarily innervates _______.

Answer 2

the FRONT of the LEG

Question 3

The Sacral Plexus originates from the ________ of ________.

Answer 3

Anterior Rami of L4-S4

Question 4

The Sacral Plexus primarily innervates _______.

Answer 4

The BACK of the LEG

Question 5

The lumbar plexus provides sensory and motor innervation to the ______, ________. and ________.

Answer 5

lower abdominal wall, anteromedial thigh, and knee

Question 6

The sacral plexus provides sensory and motor innervation to the _______, ______, ________. and ________.

Answer 6

gluteal region, posterior thigh, lower leg, and foot

Question 7

The Lumbar Plexus gives rise to these 6 nerves

Answer 7

Illiohypogastric
Ilioinguinal
Genitofemoral
*Lateral femoral cutaneous
*Obturator
*Femoral

“I Invariably Get Lazy On Fridays”

Question 8

The Lateral Femoral Cutaneous nerve arises from _______.

Answer 8

L2-L3 (posterior divisions)

Question 9

The Femoral nerve arises from ______.

Answer 9

L2-L4 (Posterior divisions)

Question 10

The Femoral nerve divides into the _______ and ______ branches.

Answer 10

Anterior and posterior

Question 11

The posterior branch of the Femoral nerve gives rise to 1 terminal branch which is the________.

Answer 11

Saphenous Nerve

Question 12

The Saphenous nerve courses through the _______ and becomes _______ at the knee.

Answer 12

-adductor canal
-superficial

Question 13

The Obturator nerve arises from ________.

Answer 13

Arises from L2-L4 (Anterior divisions)

Courses through the obturator canal into the pelvis minor

Question 14

The Obturator nerve is often injured in patients _______.

Answer 14

Undergoing extensive pelvic surgery

Question 15

The Sacral Plexus arises from ________.

Answer 15

L4-S3

Question 16

The lumbosacral trunk (_____) coverges with the _______.

Answer 16

-L4 and L5
-sacral nerves

Question 17

The Sacral Plexus gives rise to 5 major nerves:

Answer 17

“SIPPS”
-Superior gluteal
-Inferior gluteal
-Posterior cutaneous
-Pudendal
-Sciatic

Question 18

What is the largest nerve in the body?

Answer 18

The Sciatic Nerve

Question 19

What is the most important branch of the sacral plexus in the context of regional anesthesia of the lower extremity?

Answer 19

The Sciatic Nerve

Question 20

The Sciatic nerve arises from ________.

Answer 20

L4-S3 (comprised of the tibial and common peroneal trunks)

Question 21

2 branches of Sciatic Nerve

Answer 21

sCiaTic “CT”
Common peroneal n.
Tibial n.

branches at the proximal popliteal fossa

Question 22

The Tibial nerve arises from the _______

Answer 22

sacral nerve (anterior branches of L4-S3)

Question 23

The Tibial nerve gives rise to 1 terminal branch which is the ______.

Answer 23

Posterior tibial n.

Question 24

The common peroneal nerve (fibular) arises from the _______.

Answer 24

Sacral nerve (posterior branches of L4-S3)

Question 25

The Common Peroneal nerve gives rise to 3 terminal branches:

Answer 25

-Deep peroneal n.
-Superficial peroneal n.
-Sural n.

Question 26

Skin innervation: Sensory Only (select all the apply question)

Answer 26

-Lateral femoral cutaneous
-Saphenous
-Sural

“LFC SS”

Question 27

Skin innervation: Combined sensory-motor (select all the apply question)

Answer 27

-Femoral
-Posterior tibial
-Obturator
-Deep peroneal
-Superficial peroneal

” Fantastic People Orally Deep Suction”

Question 28

Skin Innervation: Peripheral Nerves (picture)

Answer 28

Question 29

Hip & Knee: Flexion and Extension

Answer 29

-Hip flexion → Femoral n.
-Hip extension → -Sciatic n.
-Knee flexion → Sciatic n.
-Knee extension → Femoral n.

Question 30

Plantar flexion (Ankle)

Answer 30

Tibial nerve

Question 31

Dorsiflexion (ankle)

Answer 31

Peroneal nerve

Question 32

Eversion of ankle

Answer 32

Superficial peroneal nerve

Question 33

Inversion of ankle

Answer 33

Deep peroneal nerve

Question 34

The hip joint is innervated by the ______, ________, and the _________.

Answer 34

Femoral, Obturator, and Sciatic nerves (FOS)

-Most of the hip pain rises from the joint capsule

Question 35

Which nerve is spared during a Pericapsular Nerve Group Block (PENG)

Answer 35

The Femoral Nerve is spared !!!!!

Question 36

Indications for PENG block

Answer 36

Hip fracture and arthroplasty

Local anesthetic volume: 30-40mL

Question 37

Objective of PENG block

Answer 37

Inject local anesthetic deep into the psoas tendon at the level of the iliopubic eminence

Femoral Nerve is spared!

Question 38

Complications from PENG block

Answer 38

URETER injury, LAST, quadriceps weakness

Question 39

The ________ supplies sensory innervation to the hip.

Answer 39

Lumbar Plexus

Question 40

Less likely to get ________ weakness from PENG

Answer 40

Quadricep

Question 41

The PENG when combined with a lateral femoral cutaneous block offers an alternative to the ________.

Answer 41

femoral and fascia iliaca block

Question 42

Indications for Fascia Iliaca block

Answer 42

-Procedures involving the femur, quadriceps, and knee
-Acute pain management for hip fractures

Local anesthetic volume: 40mL

Question 43

Select Complications of Fascia Iliaca Block

Answer 43

LAST, failed block, quadricep weakness

Question 44

3 Target of Fascia Iliaca Block

Answer 44

-Femoral n.
-Obturator n.
-Lateral femoral cutaneous n.

“FOL”

Question 45

Indications for Femoral nerve block

Answer 45

Procedures involving the hip, femur, quadriceps, and knee

Local anesthetic volume: 20-30mL

Question 46

Femoral nerve arises from the _______.

Answer 46

Posterior divisions of L2-4

Question 47

The femoral triangle borders: (SAIL)

Answer 47

-Sartorius muscle
-Adductor longus muscle
-Inguinal Ligament

“SAIL”

Question 48

Anterior branch of Femoral Nerve

Answer 48

→ Ventral surface of the thigh and sartorius muscle

Question 49

Posterior branch of the Femoral Nerve

Answer 49

The SAPHENOUS nerve arises from the posterior branch

→ Quadriceps muscles, knee joint, and its medial ligament

Question 50

Most common Lower Extremity block

Answer 50

Femoral Nerve Block

Targets the largest nerve of the lumbar plexus

Question 51

The Femoral nerve block when combined with the Sciatic nerve block does what?

Answer 51

Provides almost complete surgical coverage to the lower extremity

Question 52

Adductor Canal block Indications:

Answer 52

-ACL repair
-MCL repair
-Patella fracture
-Vein stripping and harvesting
-Supplementation to a sciatic nerve block for foot/ankle surgery

15-20mL

Question 53

The adductor canal originates at the ________ of the ________ and ends at the _______.

Answer 53

-apex of the femoral triangle

-adductor hiatus

Question 54

Indications for a Popliteal block

Answer 54

procedures on the lower leg, ankle, and foot. May require supplementation with saphenous nerve block

25ml local

Question 55

Select complications for Popliteal block:

Answer 55

Foot drop (fall risk),

Question 56

SENSORY nerves of the foot and ankle:

Answer 56

Saphenous
Sural
Superficial peroneal

“SSS” ensory

Question 57

SENSORY-MOTOR nerves of foot and ankle:

Answer 57

-Deep peroneal (eversion + dorsiflexion)
-Posterior tibial (inversion + plantar flexion

“DP”