lower extremity blocks

Question 1

PUSH PULL PINCH PUNT: how do you assess the tibial nerve

Answer 1

PUSH the foot (gas pedal). plantar flexion.

Question 2

PUSH PULL PINCH PUNT:how do you assess the common peroneal nerve

Answer 2

dorisiflex the foot (PULL up toward your nose)

Question 3

PUSH PULL PINCH PUNT:how do you assess the tibial nerve

Answer 3

PINCH - pinch the lateral thigh

Question 4

PUSH PULL PINCH PUNT:how do you assess the femoral nerve

Answer 4

PUNT - place hand under popliteal fossa and raise leg, have patient extend the knee, “punt the ball”

Question 5

what are some indications for lumbar plexus block

Answer 5

lower extremity procedures, femoral shaft and neck, knee procedures, anterior thigh

Question 6

PUSH PULL PINCH PUNT:how do you assess the obturator nerve

Answer 6

abduct leg at hip and have pt adduct against pressure

Question 7

what position for lumbar plexus block?

Answer 7

lateral decub with slight forward tilt… foot dangling free for visualization

Question 8

what amt of local are you gonna inject for lumbar plexus block?

Answer 8

25-35ml

Question 9

the landmarks for lumbar plexus block

Answer 9

midline spinous processes, iliac crest.

Question 10

lumbar plexus block: draw a line from ___ to intersect ___. ___cm from midline is needle insertion point, and should be ____ too PSIS

Answer 10

iliac crest to intersect midline. 4cm from midline is needle insertion point.
should be superior to PSIS

Question 11

lumbar plexus block: insert the needle ___ to skin

Answer 11

perpendicular.

Question 12

do not go lower then ___mA for lumbar plexus block

Answer 12

0.5

Question 13

then using the stimulator for lumbar plexus block, first you get local twitches from muscles, then advance thru to get stim of ____

Answer 13

quadriceps

Question 14

complications of lumbar plexus block include ___ spread (hOtn) and high absorption rate (higher risk LA toxicity)

Answer 14

epidural spread

Question 15

what are indications for obturator nerve block

Answer 15

pain in hip, procedures on knee and thigh with femoral block, prevent movement during TURBT

Question 16

what are contraindications to obturator nerve block

Answer 16

inguinal lymphadenopathy, perineal infection, hematoma at site, coagulopathy

Question 17

how much LA for obturator nerve block?

Answer 17

5-7ml

Question 18

when performing the obturator block which two muscles will you stimulate

Answer 18

long adductor and gracilis muscle (seen in posterior and medial thigh). continue deeper to stimulate major abductor muscle seen in medial thigh

Question 19

what are complications with obturator block?

Answer 19

poss intraperitoneal puncture, damage to bladder, rectum, spermatic cord

Question 20

what are indications for femoral nerve block?

Answer 20

anterior aspect of thigh, superficial surgery on medial aspect of leg and below knee, knee arthroscopy

Question 21

where are contraindications for femoral nerve block ?

Answer 21

previous ilioinguinal surgery - [femoral vascular graft, kidney transplant], large inguinal lymph nodes or tumor, local infection, neuropathy`

Question 22

what are the ligaments for femoral nerve block?

Answer 22

inguinal ligament, inguinal crease, femoral artery

Question 23

how much local for a femoral nerve block?

Answer 23

15-20ml

Question 24

femoral nerve block: needle is inserted __cm ____ to pulse and angered ___ degrees ____

Answer 24

insert 1cm lateral to pulse and angled 45 degrees cephelad

Question 25

femoral nerve block: you will see ___ contraction (____ twitch)

Answer 25

patellar

Question 26

what does the 3 in one block block

Answer 26

entire lumbar plexus : femoral , lateral fem, obturator (questionable)

Question 27

what is the 3 in 1 block indicated for

Answer 27

patella surgery, hip fractures, femoral shaft, knee surgery

Question 28

3 in 1: landmarks

Answer 28

ASIS, inguinal ligament, abdominal facial layer fixed at ASIS

Question 29

3 in 1: needle inserted 1-2cm ___ to the inguinal ligament

Answer 29

distal

Question 30

3 in 1: ____ degree ____ direction

Answer 30

30-45, cephalad

Question 31

adductor canal block blocks what nerve?

Answer 31

saphenous nerve in thigh

Question 32

the saphenous nerve runs deep to ____ muscle, medial to ____ ____, very close to ____

Answer 32

the saphenous nerve runs deep to sartorius muscle, medial to vests medialis, very close to femoral artery

Question 33

what is the sciatic nerve block indicated for

Answer 33

lower limb surgery.

Question 34

which block is often combined with the femoral block?

Answer 34

sciatic

Question 35

which block takes a posterior approach?

Answer 35

sciatic

Question 36

what are the landmarks for sciatic block?

Answer 36

greater trochanter, PSIS. draw line in between. mark midpoint and 4cm perpendicular and distal

Question 37

how much LA for a sciatic nerve block?

Answer 37

15-25ml

Question 38

what is the popliteal block indicated for

Answer 38

lower leg surgery especially foot and ankle

Question 39

what are the two stimulation techniques for a popliteal block?

Answer 39

posterior or lateral

Question 40

the landmarks for the posterior popliteal = popliteal crease. _____ (laterally) and ______ medially

Answer 40

tendons of semitendinosus and semimembranosus

Question 41

posterior popliteal block: how will you see stimulation of the tibial?

Answer 41

plantar flexion and inversion

Question 42

posterior popliteal block: how will you see stimulation of the common peroneal?

Answer 42

dorsiflexion and eversion