Lower extremity blocks 2 (new) Flashcards
A pericapsular nerve group block would be MOST effective for perioperative pain management for which patient scenario?
a. ORIF of a distal femur fracture
b. total knee arthoplasty
c. ankle arthoplasty
d. nailing of a hip fracture
d. nailing of a hip fracture
A pericapsular nerve group block is also known as
PENG
Indications for a pericapsular nerve group block include
hip fracture and arthoplasty
The objective of the pericapsular nerve group block is to inject LA
deep into the psoas tendon at the level of the iliopubic eminence
Complications of the PENG block include
ureter injury
LAST
injection directly into the psoas muscle may increase the risk of quadriceps weakness
The hip joint is innervated by the following nerves:
femoral, obturator, & sciatic nerves
Key anatomic landmarks of the PENG block include
the femoral vein, artery, and nerve
the iliopsoas muscle and tendon
anterior inferior iliac spine
iliopubic eminence
What type of block is the PENG block?
sensory only (preserves quadriceps function)
When combined with a ____________________________ block, the PENG offers an alternative to the femoral and fascia iliaca block.
lateral femoral cutaneous nerve
Which of the following nerves is NOT blocked when performing a fascia iliaca block?
a. femoral nerve
b. lateral femoral cutaneous nerve
c. obturator nerve
d. posterior femoral cutaneous nerve
d. posterior femoral cutaneous nerve
The objective of a fascia iliaca block is to
deposit LA below fascia iliaca that travels towards the lumbar plexus
A fascia iliaca block is indicated for
procedures involving the femur, quadriceps, and knee
acute pain management for hip fractures
Complications of a fascia iliaca block include
LAST
What nerves does the fascia iliaca block target
femoral nerve
obturator nerve
lateral femoral cutaneous nerve
When compared to the lumbar plexus block, the fascia iliaca block provides a
faster and more consistent blockade of the femoral and lateral femoral cutaneous nerves
If using a landmark technique & nerve stimulator for the fascia iliaca block, you should see
patellar snap
If using a landmark technique with nerve stimulator for the fascia iliaca block and you cause stimulation of the sartorius muscle,
it will cause inner thigh twitching if the needle is inserted too superficially and medially to the femoral nerve
Local anesthetic injected above the fascia iliaca frequently results in
a failed or incomplete block
Due to the large volume of local anesthetic injected with a fascia iliaca block, you may see
quadriceps weakness
The objective of the femoral nerve block is to deposit local anesthetic around the
femoral nerve
Indications for performing a femoral nerve block include
procedures involving the hip, femur, quadriceps, and knee
Complications of a femoral nerve block include
LAST
nerve injury
The femoral triangle borders include
Sartorius muscle
Adductor longus muscle
Inguinal ligament
(SAIL)
The anterior branch of the femoral nerve provides innervation for the
ventral surface of the thigh and sartorius muscle
The posterior branch of the femoral nerve provides innervation to the
quadriceps muscles, knee joint, and its medial ligament
When used alone, the femoral nerve block
does not provide sufficient coverage for surgical anesthesia (must be combine with a sciatic nerve block)
The femoral nerve is most compact
just distal to the inguinal ligament
With the femoral block, local anesthetic injected above the fascia iliaca frequently results in
a failed or incomplete block
Because of associated quadriceps weakness, FNB contributes to the
rate of falls following lower extremity total joint surgery
What is the advantage of performing an adductor canal block over a femoral nerve block as part of a multimodal pain management plan?
a. prevents foot drop
b. limits quadriceps weakness
c. reduces plantar flexion
d. provides both motor and sensory nerve block
b. limits quadriceps weakness
What is the objective of the adductor canal block?
to deposit LA around the saphenous nerve in the adductor canal
Indications for an adductor canal block include
ACL & MCL repair
vein stripping and harvesting
supplementation to a sciatic nerve block for foot/ankle surgery
patella fracture
Complications of an adductor canal block include
Nerve injury, LAST
The adductor canal starts at the ____________ and ends at the _____—
base of the femoral triangle & ends at the adductor hiatus
The roof of the adductor canal is the
sartorious
The lateral wall of the adductor canal is the
vastus medialis
The remainder of the canal is the
adductor longus or magnus
Quadriceps weakness with the adductor canal block is more likely with
proximal injections and local anesthetic volumes that exceed 20 mLs
Stimulation of the tibial nerve in the popliteal fossa causes:
a. plantar flexion and inversion of the foot
b. plantar flexion and eversion of the foot
c. dorsiflexion and inversion of the foot
d. dorsiflexion and eversion of the foot
a. plantar flexion and inversion of the foot
The objective of a popliteal nerve block is to
deposit LA around the common peroneal and tibial nerves located between the biceps femoris & the semimembranosus and semitendinosus
Indications for a popliteal nerve block include
procedures on the lower leg, ankle, and foot
Complications of a popliteal nerve block include
Foot drop
LAST
hematoma
Key landmarks of the popliteal fossa include
popliteal artery and vein
biceps femoris, semitendinosus, and semimembranosus muscles
bifurcation of the sciatic nerve into the common tibial nerve and common peroneal nerves
What is the popliteal nerve block used for?
provides pain control for below-the-knee surgical procedures such as ankle surgeries, achilles tendon repair, and foot surgeries
Describe the landmark technique for the popliteal bloc,
Patient in prone position with slight extremity flexion
draw a line from the biceps femoris medially to the smitendinosus at the popliteal crease
at the midpoint, extend a perpendicular line approx 10 cm. cephalad
needle insertion point is 1 cm lateral to this line
What does the mnemonic TIPPED stand for?
Tibial Inversion Plantar flexion + Peroneal Eversion Dorsiflexion
The main drawbacks of the peroneal nerve block include
foot drop & numbness of the sole which can lead to patient falls
