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Regional FINAL > Lower Extremity Blocks > Flashcards

Lower Extremity Blocks Flashcards

1
Q

What is the lumbar plexus formed from?

A

L1-4

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2
Q

Where is the lumbar plexus formed?

A

in front of the quadratus lumborum muscle, behind psoas major muscle

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3
Q

How is the lateral femoral cutaneous nerve formed and where does it emerge?

A

formed from L2, 3. FIRST to leave compartment. emerges from lateral border of psoas major at midpoint

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4
Q

Where does the obturator nerve arise from?

A

L2, 3, 4

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5
Q

Where does the obturator nerve emerge from?

A

medial border of psoas major at level of the sacroiliac joint

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6
Q

What does the obturator nerve do?

A

primarily motor. SOME sensory to hip/medial femur/skin and soft tissue of lower thigh

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7
Q

Where does the obturator nerve go?

A

passes into pelvis minor, goes anteroinferiorly to obturator canal

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8
Q

What is the femoral nerve formed from?

A

L2, 3, 4

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9
Q

Where does the femoral nerve appear?

A

junction of middle/lower third of psoas major muscle

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10
Q

Where does the femoral nerve go?

A

runs deep under inguinal ligament, then lies anterior to iliopsoas muscle, lateral to the femoral artery

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11
Q

What encapsulates the femoral nerve?

A

iliaca fascia laterally. psoas fascia medially. transverse fascia anteriorly. posterior = bony pelvis

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12
Q

What are the 2 branches of the femoral nerve?

A

Anterior, posterior bundles

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13
Q

What does the anterior branch of the femoral nerve innervate?

A

anterior surface of thigh, sartorius muscle

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14
Q

What does the posterior branch of the femoral nerve innervate?

A

quadriceps muscle, knee joint, medial ligament.

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15
Q

What is the origin of the saphenous nerve?

A

posterior branch of femoral nerve

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16
Q

When attempting to block the lumbar plexus, how is the fascial plane bordered medially?

A

spinal column

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17
Q

When attempting to block the lumbar plexus, how is the fascial plane bordered dorsally?

A

quadratus lumborum

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18
Q

When attempting to block the lumbar plexus, how is the fascial plane bordered ventrally?

A

psoas major

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19
Q

What kind of needle do you use for psoas compartment block?

A

120 cm? mm?

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20
Q

When do you feel LOR in psoas compartment?

A

8-12 cm

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21
Q

How do you confirm you’re in the right place for psoas block?

A

nerve stimulator stimulates the quads. or can get paresthesia into thigh

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22
Q

How do you inject for psoas block?

A

5 mL increments, up to 30-40 mL

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23
Q

What is 3 in 1 block?

A

inguinal, femoral

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24
Q

What does the inguinal femoral block cover?

A

all nerves except for ankle

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25
Q

What kind of needle do you use for inguinal/femoral block?

A

22g 4 cm B bevel

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26
Q

How much do you inject for inguinal femoral block?

A

20 mL to reliably accomplish block, 30 mL increases chance of hitting all 3 nerves

27
Q

What do you during/after injection for inguinal femoral block?

A

pressure for 5-10 minutes

28
Q

What drugs do you use for inguinal femoral block?

A

0.5% bupi/ropi, 1.5% lidocaine, +/- epi

29
Q

Why don’t surgeons like the inguinal femoral block?

A

because of the motor component

30
Q

What kind of needle do you use for US femoral?

A

22g 2”

31
Q

What does the femoral nerve look like under US?

A

triangular, hyperechoic, lateral to femoral artery

32
Q

How much volume do you inject for US femoral?

A

20 mL

33
Q

What kind of block is fascia iliaca compartment block?

A

anterior lumbar plexus block (puncture distant from neurovascular sheath)

34
Q

What is fascia iliaca block used for?

A

postop pain control after lower limb surgery

35
Q

How does fascia iliaca compare to 3 in 1?

A

faster, more consistent block of lateral fem cutaneous and femoral nerves

36
Q

What kind of needle is used for fascia iliaca?

A

24g 5 cm

37
Q

How much is injected for fascia iliaca block?

A

30 mL

38
Q

What are some advantages of sciatic nerve block?

A

combination with lumbar plexus/fem/saph blocks, can be complete anesthesia/post op pain control for lower extremity surgery. with femoral, has better satisfaction and outcomes

39
Q

What does sciatic nerve supply?

A

muscles of back of thigh, skin of leg, muscles of lower leg/foot

40
Q

Where does sciatic nerve go?

A

passes out of pelvis through great sacrosciatic foramen, below piriform muscle. descends between major trochanter, tuberosity of ischium to the lower third of thigh

41
Q

What is sciatic nerve block for?

A

foot, ankle surgery

42
Q

What kind of needle is used for sciatic nerve block?

A

22g 10 cm insulated B bevel

43
Q

How much volume is given for sciatic nerve block?

A

10 mL each side

44
Q

What drugs are used for sciatic nerve block?

A

0.5% bupi/ropi. 1.5% lidocaine

45
Q

What are the 3 anatomic landmarks used for popliteal fossa block?

A

popliteal crease, laterally bordered by medial border of femoral bicep, medially bordered by tendon of semitendinous muscle

46
Q

What kind of needle is used for popliteal fossa block?

A

10 cm insulated needle with nerve stimulator

47
Q

How much volume is given for popliteal fossa block?

A

35-40 mL

48
Q

What kind of needle is used for US popliteal?

A

22g 2”

49
Q

How much volume is used for US popliteal?

A

20 mL

50
Q

What are the 5 nerves that need to be blocked in ankle block?

A

tibial, deep peroneal, sural, superficial peroneal, saphenous (S=superficial. T, D=deep)

51
Q

Where does the tibial nerve arise from?

A

L4-S3

52
Q

Where does the tibial nerve sit in the ankle?

A

behind posterior tibial artery, between tendons of the long flexor muscles of the toes and long flexor muscle of the great toe

53
Q

How is the sural nerve formed?

A

from union of a branch of tibial nerve and common peroneal nerve

54
Q

What sensory innervation does the sural nerve provide?

A

posterior portion of the sole of the foot, posterior heel, achilles tendon above ankle

55
Q

Where does the superficial peroneal nerve arise from?

A

L4-S2

56
Q

Where does the superficial peroneal become superficial?

A

middle 2/3 of lower leg. SQ as multiple branches proceed into dorsum of foot.

57
Q

Where does superficial peroneal branch?

A

just above ankle

58
Q

Where does the deep peroneal nerve arise from?

A

L4-S2

59
Q

What does the deep peroneal nerve provide innervation of?

A

short extensors of toes, sensory to lateral side of hallux, medial side of second digit

60
Q

What is the terminal branch of the femoral nerve?

A

saphenous nerve

61
Q

What is the path of the saphenous nerve?

A

travels SQ from lateral side of knee joint, follows greater saph vein to medial malleolus.

62
Q

What does the saphenous nerve innervate?

A

sensory – medial side of malleolus, skin of medial aspect of lower leg

63
Q

When positioning pt for ankle block, what do you need to keep in mind?

A

need to have the most sufficient mobility of foot

64
Q

How much volume do you give for ankle block?

A

5 mL after paresthesia then 3 mL as you withdraw needle. Can hit bone, withdraw 2 mm then do injections. MASSAGE afterwards

Regional FINAL (4 decks)

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