lower extremity blocks Flashcards
PUSH PULL PINCH PUNT: how do you assess the tibial nerve
PUSH the foot (gas pedal). plantar flexion.
PUSH PULL PINCH PUNT:how do you assess the common peroneal nerve
dorisiflex the foot (PULL up toward your nose)
PUSH PULL PINCH PUNT:how do you assess the tibial nerve
PINCH - pinch the lateral thigh
PUSH PULL PINCH PUNT:how do you assess the femoral nerve
PUNT - place hand under popliteal fossa and raise leg, have patient extend the knee, “punt the ball”
what are some indications for lumbar plexus block
lower extremity procedures, femoral shaft and neck, knee procedures, anterior thigh
PUSH PULL PINCH PUNT:how do you assess the obturator nerve
abduct leg at hip and have pt adduct against pressure
what position for lumbar plexus block?
lateral decub with slight forward tilt… foot dangling free for visualization
what amt of local are you gonna inject for lumbar plexus block?
25-35ml
the landmarks for lumbar plexus block
midline spinous processes, iliac crest.
lumbar plexus block: draw a line from ___ to intersect ___. ___cm from midline is needle insertion point, and should be ____ too PSIS
iliac crest to intersect midline. 4cm from midline is needle insertion point.
should be superior to PSIS
lumbar plexus block: insert the needle ___ to skin
perpendicular.
do not go lower then ___mA for lumbar plexus block
0.5
then using the stimulator for lumbar plexus block, first you get local twitches from muscles, then advance thru to get stim of ____
quadriceps
complications of lumbar plexus block include ___ spread (hOtn) and high absorption rate (higher risk LA toxicity)
epidural spread
what are indications for obturator nerve block
pain in hip, procedures on knee and thigh with femoral block, prevent movement during TURBT
what are contraindications to obturator nerve block
inguinal lymphadenopathy, perineal infection, hematoma at site, coagulopathy
how much LA for obturator nerve block?
5-7ml
when performing the obturator block which two muscles will you stimulate
long adductor and gracilis muscle (seen in posterior and medial thigh). continue deeper to stimulate major abductor muscle seen in medial thigh
what are complications with obturator block?
poss intraperitoneal puncture, damage to bladder, rectum, spermatic cord
what are indications for femoral nerve block?
anterior aspect of thigh, superficial surgery on medial aspect of leg and below knee, knee arthroscopy
where are contraindications for femoral nerve block ?
previous ilioinguinal surgery - [femoral vascular graft, kidney transplant], large inguinal lymph nodes or tumor, local infection, neuropathy`
what are the ligaments for femoral nerve block?
inguinal ligament, inguinal crease, femoral artery
how much local for a femoral nerve block?
15-20ml
femoral nerve block: needle is inserted __cm ____ to pulse and angered ___ degrees ____
insert 1cm lateral to pulse and angled 45 degrees cephelad
femoral nerve block: you will see ___ contraction (____ twitch)
patellar
what does the 3 in one block block
entire lumbar plexus : femoral , lateral fem, obturator (questionable)
what is the 3 in 1 block indicated for
patella surgery, hip fractures, femoral shaft, knee surgery
3 in 1: landmarks
ASIS, inguinal ligament, abdominal facial layer fixed at ASIS
3 in 1: needle inserted 1-2cm ___ to the inguinal ligament
distal
3 in 1: ____ degree ____ direction
30-45, cephalad
adductor canal block blocks what nerve?
saphenous nerve in thigh
the saphenous nerve runs deep to ____ muscle, medial to ____ ____, very close to ____
the saphenous nerve runs deep to sartorius muscle, medial to vests medialis, very close to femoral artery
what is the sciatic nerve block indicated for
lower limb surgery.
which block is often combined with the femoral block?
sciatic
which block takes a posterior approach?
sciatic
what are the landmarks for sciatic block?
greater trochanter, PSIS. draw line in between. mark midpoint and 4cm perpendicular and distal
how much LA for a sciatic nerve block?
15-25ml
what is the popliteal block indicated for
lower leg surgery especially foot and ankle
what are the two stimulation techniques for a popliteal block?
posterior or lateral
the landmarks for the posterior popliteal = popliteal crease. _____ (laterally) and ______ medially
tendons of semitendinosus and semimembranosus
posterior popliteal block: how will you see stimulation of the tibial?
plantar flexion and inversion
posterior popliteal block: how will you see stimulation of the common peroneal?
dorsiflexion and eversion
