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Anesthesia Exam 1 > Lower Extremity Blocks > Flashcards

Lower Extremity Blocks Flashcards

1
Q

What are some advantages of regional anesthesia?

A
  • Avoid general anesthesia
  • Hemodynamic stability
  • May allow patient to participate during surgery
  • May equate to early discharge
  • Post-operative analgesia
  • Airway
  • Less cardiac effects if existing cardiac disease
  • Less pulmonary effects if existing pulmonary disease
  • Avoid use of opiates
  • Reduces postoperative pain
  • Reduced nausea/vomiting
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2
Q

What are contraindications to regional anesthesia?

A
  • Patient refusal
  • Inability of patient to cooperate
  • Coagulopathy
  • Pre-existing neurologic deficits
  • Skin infection near the site of injection
  • Sepsis
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3
Q

What are some risks of peripheral nerve blocks?

A
  • Local anesthetic toxicity
  • Allergic response
  • Permanent or transient nerve damage
  • Patient uncomfortable during surgery
  • Incomplete blocks
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4
Q

What are some effects of local anesthetic toxicity?

A

Systemic absorption can result in CNS and cardiac toxicity
-Depends on site of injection, total dose, the anesthetic itself and the use of epinephrine
-Rate of absorption depends on site: Maximum at intercostals
-caudal
-epidural
-brachial plexus
-sciatic
-lumbar plexus
Minimum at femoral

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5
Q

What are some signs and symptoms of local anesthetic CNS toxicity?

A
  • Tongue numbness
  • Lighheadedness
  • Dizziness
  • Tinnitus
  • Disorientation
  • Visual disturbances
  • Seizures
  • Respiratory depression
  • Respiratory arrest
  • Caridiovascular instability
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6
Q

What are some ways to prevent local anesthetic toxicity?

A
  • Vigilant monitoring
  • Limit dose accordingly
  • Aspirate before each injection
  • Inject small volumes (5ml)
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7
Q

What equipment do you need for regional anesthesia?

A
  • IV access
  • Oxygen, ambu bag
  • Suction
  • Intubation equipment
  • Monitors (EKG, SpO2, BP)
  • Emergency medication
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8
Q

What effect does the addition of epinephrine have on local anesthesia?

A

Prolongs effects

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9
Q

What are things to consider when deciding between regional or general anesthesia?

A
  • Patient preference
  • Coexisting medical conditions
  • Surgical considerations such as positioning and use of tourniquets
  • Surgeon preference
  • Skill of anesthesia provider
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10
Q

What equipment do you need for a regional nerve block?

A

Peripheral nerve stimulator and/or ultrasound

  • Disposable kit
  • Insulated needles
  • Syringes
  • Prep solution
  • Local anesthetic
  • Sterile gloves
  • Monitoring
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11
Q

What gauge needle is used for regional blocks?

A

A 22G “B” bevel insulated needle

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12
Q

What nerves are blocked during a sciatic nerve block?

A

Nerves originating from ventral branches of the lumbosacral plexus L4-S3

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13
Q

What are some indications for a sciatic nerve block?

A

Provides anesthesia to foot and lower extremity distal to knee and posterior leg. Good for achilli tendon surgery

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14
Q

Describe the location of a sciatic nerve block.

A
  • Line drawn from greater trochanter to posterior superior iliac spine
  • Line drawn from greater trochanter to sacral hiatus.
  • Superior line bisected and perpendicular line drawn down to bisect second line. Injection site is where perpendicular line and second line meet
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15
Q

During a sciatic nerve block what does dorsiflexion and eversion of the foot indicate during nerve stimulation?

A

A common peroneal branch (more lateral) position.

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16
Q

During a sciatic nerve block what does plantar flexion indicate during nerve stimulation?

A

Tibial branch (medial) position.

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17
Q

What volume do you inject during a sciatic nerve block?

A

20-30ml.

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18
Q

What are some complications from a sciatic nerve block?

A
  • Block failure

- Hematoma

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19
Q

What does a femoral nerve block provide anesthesia to?

A

The thigh, knee and a small part of the medial foot.

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20
Q

What motor can be blocked by a femoral nerve block?

A

Abduction of the leg or extension of lower leg.

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21
Q

What are the landmarks for a femoral nerve block?

A

-Inguinal ligament
-Femoral artery
Inject lateral to femoral artery and inferior to inguinal ligament

22
Q

What gauge needle do you use for a femoral nerve block?

A

22G- inserted perpendicular to the skin and advanced cephalad at 45 degree angle.

23
Q

How much volume do you use for a femoral nerve block?

A

25-35 ml.

24
Q

What are some complications of a femoral nerve block?

A
  • Intravascular injection
  • Hematoma
  • Direct nerve injury
25
Q

What are some indications for popliteal nerve blocks?

A

-Foot and ankle surgery

26
Q

What are the Landmarks for a popliteal block?

A
  • Crease of the popliteal fossa
  • Biceps femoris tendon
  • Semitendinosis and semimembranosis muscle
  • Injection site is 7cm above the crease at midline between two muscles
27
Q

What should you see during nerve stimulation when performing a popliteal block?

A

Foot or toe twitch.

28
Q

How much volume do you inject during a popliteal block?

A

30ml

29
Q

What are the indications for an ankle block?

A

Surgery below the ankle, usually foot surgery.

30
Q

What gauge and type of needle do you use for an ankle block?

A

22G, B-bevel

31
Q

How much LA do you inject during an ankle block?

A

5-7ml per nerve (5 nerves)

32
Q

What five nerves do you block during an ankle block?

A

Posterior tibial, sural, deep peroneal, saphenous, superficial peroneal

33
Q

Where is the needle inserted for a deep peroneal block?

A

Just lateral to the hallucis longus tendon. Slowly advance to contact the bone and then withdraw the needle 2-3mm.

34
Q

How much LA is injected during a deep peroneal block?

A

5ml

35
Q

Where is the needle inserted for a posterior tibial block?

A

Posterior tip of medial maleolus posterior to the tibial artery. Bone is hit and needle is withdrawn 2-3mm

36
Q

Where is the needle inserted for a saphenous block?

A

In a circular fashion subcutaneously just above the medial malleolus.

37
Q

Where is the needle inserted for a superficial peroneal block?

A

In a circular fashion at the level of the lateral malleolus.

38
Q

Where is the needle inserted for a sural block?

A

In a fanwise fashion and subcutaneously and below the fascia behind the lateral malleolus.

39
Q

Describe the landmark for a deep peroneal nerve block.

A
  • Find the groove between the extensor hallicus longus tendon and the tendon of the extensor digitorum longus
  • Try to palpate the DP (anterior tibial), and inject 5ml lateral to pulse if it is felt.
  • If no pulse felt inject 5ml medial to extensor hallicus longus tendon
40
Q

Describe the technique for a saphenous nerve block.

A

-After the deep peroneal and superficial peroneal block direct the needle towards the medial malleolus and inject 5ml of LA

41
Q

Describe the technique for a superficial peroneal block.

A

-After the deep peroneal block direct the needle towards the lateral malleolus and inject 5ml of LA.

42
Q

What gauge needle is used for a deep peroneal/saphenous/superficial peroneal block?

A

23-25G 1-1.5 inch needle.

43
Q

Where is the posterior tibial nerve located?

A

Posterior to the medial malleolus behind the posterior tibial artery.

44
Q

Where is the sural nerve located?

A

Subcutaneously posterior to the lateral malleolus. The block is performed in the groove between the lateral malleolus and the calcaneous with 5ml of LA.

45
Q

What is looked for during nerve stimulation of femoral nerve?

A

Twitching of quadriceps or patella snap

46
Q

How much LA is injected during a femoral nerve block?

A

25 ml

47
Q

What are the landmarks for a polpliteal block?

A

The crease at the popliteal fossa, the biceps femoris tendon and the tendons of the semimembranosus muscle. The needle is inserted 8cm above the fossa.

48
Q

What is looked for during nerve stimulation while performing a popliteal block?

A

Twitching of the foot or toes.

49
Q

What kind of surgery can a popliteal block be performed for?

A

Ankle or foot surgery.

50
Q

What nerve is the nerve stimulator closer to if dorsiflexion and eversion of the foot is noted during a common popliteal block?

A

common peroneal

51
Q

What nerve is the nerve stimulator closer to if plantar flexion and inversion of the foot is noted during a common popliteal block?

A

Tibial

52
Q

How much LA is injected during a popliteal block?

A

20-30 ml

Anesthesia Exam 1 (5 decks)

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