Lower Extremity Blocks - Torabi PP Flashcards
Sciatic Nerve Block Indications
Foot and Ankle Surgery
Below-knee amputation
Analgesia following knee surgery involving the posterior compartment
What type of transducer probe should be used for a sciatic nerve block?
Curved
How much local anesthetic should be injected for a sciatic nerve block?
10-20mL
What are three approaches to a Sciatic Nerve Block
Anterior Approach
Subgluteal Approach
Transgluteal Approach
Indications for a Femoral Nerve Block
-Operations on the anterior thigh (lacerations, skin graft, muscle bipsy)
-Pin or plate insertion/removal of the femur
-Femur fxs
-Total Knee Arthroscopy
How much local anesthetic is used for a femoral nerve block
10-20mL
The femoral nerve is ____ cm _____ to the femoral artery Torabi Red Item
1cm lateral!
What muscle response to a nerve stimulator do you want to see when performing a femoral nerve block? Torabi red item
Quadriceps femoris (patella twitch/snap)
(knee extension)
Indications for a Fascia-Iliaca Block
Hip Fxs, Hip Arthroplasty
What 3 nerves are blocked during a Fascia-iliaca Block
Femoral nerve
Genitofemoral nerve
lateral femoral cutaneous
How much local anesthetic do you inject when performing a Fascia-ilica block?
30-40mL
Landmarks for the Fascia-ilica nerve block
anterior superior iliac spine (ASIS) and the pubic tubercle
What three nerves does the 3 in 1 Block cover?
Femoral, Lateral femoral cutaneous and obturator* (rarely blocks obturator)
Which blocks the obturator nerve better, 3 in 1 Block or Fascia-Iliaca Block
Fascia Iliaca Block (FICB)
Indications for a 3 in 1 Block?
Hip, Femur
What are the indications for a Pericapsular Nerve Group (PENG) Block
Hip fx, Hip arthroplasties
Block articular branches of nerves and anterior capsule of hip joint
What is an advantage of the PENG block compared to other blocks targeting the femoral nerve?
No quadriceps weakness, spares mtor fxn
What nerves does a PENG block cover?
articulating branches from the Femoral, Obturator, Accessory Obturator
What block is usually combined with a PENG block to offer an alternative to the femoral or fascia iliaca blocks?
Lateral femoral cutaneous
Why is quadriceps function spared in the PENG block?
Because the true femoral nerve is spared, its articulating branches are covered.
What kind of probe do you want to use for a PENG block: linear or curved
curved
Where do you want to inject your local anesthetic for a PENG block
deep into the psoas tendon at the level of the iliopubic eminence (IPE)
Indications for an Adductor Canal Block
Total knee postop pain, patella fx
What nerve does the adductor canal block cover?
Saphenous nerve and a branch of the posterior femoral nerve (innervates vastus medialis)
How much local anesthetic do you inject for an adductor canal block?
10-20mL
Indications for popliteal block
Lower leg, below knee amputation, Achilles tendon, and foot surgery
How do you find where to inject when using the landmark technique for a popliteal block? How much do you inject?
Draw a transverse line between the lateral and medial epicondyles of the femur and mark its midpoint.
1cm lateral to the midpoint, draw a line up 7-10cm. This is the site of injection.
10-20mL
What two nerves lie within the sciatic nerve sheath (Vloka’s sheath)
common peroneal and tibial nerve
5 nerves that sensory innervate the ankle and foot
tibial
superficial peroneal
saphenous
sural
deep peroneal
What nerve corresponds with number one in the photo?
sural n
What nerve corresponds with number two in the photo?
saphnenous n.
What nerve corresponds with number three in the photo?
deep peroneal n
What nerve corresponds with number four in the photo?
superficial peroneal n.
What nerve corresponds with number five in the photo?
plantar nerve (posterior tibial)
What nerve corresponds with number six in the photo?
calcaneal n. (posterior tibial)
Hyperechoic structures on ultrasound appear? Because? An example would be?
Appeat Bright, Produce high amplitude echos.
example: bone
Which type of transducer produces the best image resolution?
High Frequency
Which nerves in the foot/ankle are sensory only?
Sural, Superficial Peroneal, and Saphenous
Adductor Canal block is performed for which location coverage: Hip, Knee, Ankle, Foot
Knee
Which of the following blocks can be performed for hip surgery? Adductor Canal, PENG, Femoral, Popliteal, and Fascia Iliaca. Select all that apply.
PENG and Fascia Iliaca
Which of the following blocks is appropriate for lower leg surgery? Fascia Iliaca, Adductor Canal, Popliteal, or PENG. Pick One
Popliteal
Which nerve block limits quadriceps weakness? (Not totally missed)
Adductor Canal
High volumes can still produce quad weakness
A popliteal block is most appropriate for: Femur ORIF, Achilles Tendon Repair, TKA, or Total Hip. Pick one
Achilles Tendon
