Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Principles > Lower Extremity Nerve Blocks > Flashcards

Lower Extremity Nerve Blocks Flashcards

1
Q

What are the two approaches to the lumbar plexus block?

A

Posterior and Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the name for the posterior lumbar plexus block?

A

Winnie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of anterior lumbar plexus blocks?

A

3 in 1 and Fascia Iliaca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two types of approaches to the sciatic nerve block?

A

Posterior and Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the lumbar plexus located?

A

L1-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the four major nerves that supply the lower extremities?

A

Lateral femoral cutaneous
Femoral
Obturator
Sciatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the names of the two branches that the sciatic nerve divides into?

A

Peroneal and Tibial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the name of the nerve the femoral nerve turns into more distal down the leg?

A

Saphenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

At what point does the sciatic nerve branch into the peroneal and tibial nerve?

A

Just above the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How should the patient be positioned for a posterior approach of the lumbar plexus?

A

Lateral hips in line with the shoulders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the landmarks for a posterior approach of a lumbar plexus block?

A

L4 is the iliac crest
Posterior Superior iliac spine, draw a line perpendicular to iliac crest (up the butt crack)
Move 4cm laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should the needle be inserted for a posterior approach of a lumbar plexus block?

A

Perpendicular in all planes
5-6cm to contact bone (posterior surface transverse process)
Re-direct needle to pass caudad or cephalad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the desired response to ensure you are in the lumbar plexus?

A

Quadriceps contraction with symmetrical movement of patella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

At what amplitude would the provider know they are in the lumbar plexus?

A

0.5-1mA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How much LA should be injected into a lumbar plexus block?

A

25-35mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long can it take to develop a full sensory and motor block with a lumbar plexus approach?

A

Up to 30minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is the anterior lumbar plexus block also called a 3:1 approach?

A

It anesthetizes the lateral femoral cutaneous nerve, femoral nerve and the obturator nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the function of the lateral femoral cutaneous nerve?

A

Purely sensory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the function of the femoral nerve?

A

Mixed motor/sensory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the function of the obturator nerve?

A

Mixed motor/sensory

21
Q

Where is the needle insertion for the anterior approach of a lumbar plexus block?

A

Just below the inguinal ligament which is 1-1.5cm lateral to the femoral artery

22
Q

What direction should the needle be directed for an anterior approach of a lumbar plexus block?

A

Directed cephalic at about 60 degrees from the skin

23
Q

What type of motor response should be seen with an anterior approach of a lumbar plexus block?

A

Quadriceps contraction with symmetrical movement of patella at 0.5-1mA

24
Q

How much LA should be injected for an anterior approach of a lumbar plexus block?

A

Greater than 20mL (30-40)

25
Q

Why should the provider massage after injecting LA with an anterior approach?

A

To help distribute LA between the three nerves

26
Q

Why is it helpful to hold distal pressure after injecting LA in an anterior approach of a lumbar plexus block?

A

To help LA transverse up the plane

27
Q

What is the anterior approach also known as the “date block?”

A

The obturator nerve helps keep knees together

28
Q

What should the provider do if there is sartorious contraction with stimulation?

A

Redirect the needle laterally and advance 1-2mm farther

29
Q

What does a sartorious contraction look like?

A

Contraction of thigh arising from ASIS suggests anterior branch of femoral nerve

30
Q

What should the provider do if there is arterial blood aspirated with an anterior approach to a lumbar plexus block?

A

Move the insertion point 1cm lateral

31
Q

What is the fascia iliaca approach to a lumbar plexus block?

A

Blind technique no nerve stimulator or ultrasound, identify anterior superior iliac spine and pubic tubricle
Divide the line in thirds
Take most lateral third and drop down 2cm =insertion point

32
Q

When performing the fascia iliaca approach, what two pops should be felt when advancing?

A

Fascia lata and Fascia iliaca

33
Q

How much LA should be injected in the fascia iliaca approach?

A

3-40mL

34
Q

What dermatomes are encompassed in a sciatic nerve block?

A

L4-5, S1, 2, 3

35
Q

Where is the sciatic window located and what is its importance?

A

Around the bone of the pelvis this is where the sciatic nerve enters

36
Q

What position should the patient be in for a classic sciatic block?

A

Lateral (Sims) position with operative side uppermost

37
Q

What are the landmarks for the classic sciatic nerve block?

A

Posterior superior iliac spine PSIS
Greater trochanter
Connect and mark the midpoint, draw perpendicular in caudad direction

38
Q

Where should the needle be inserted in a classic sciatic nerve block?

A

4cm alone perpendicular

39
Q

What muscle stimulation may been seen initially after insertion of a classic sciatic nerve

A

Stimulation of the gluteus maximus

40
Q

What is the desired muscle contraction for a classic sciatic nerve block?

A

Stimulation of the tibial (plantar flexion) and Peroneal (dorsiflexion) and contraction of the hamstring

41
Q

What type of patient may have long term sciatic pain?

A

Those whose sciatic nerve goes over or through the piriformis muscle

42
Q

If contraction of the toes is not seen with a classic sciatic nerve block, what is an acceptable muscle to confirm placement?

A

Achilles tendon

43
Q

What might the problem be if a patient complains of an electric shock down half of the penis/vagina?

A

Stimulation of the pudendal nerve which lies medial to the sciatic nerve

44
Q

What are the landmarks for the anterior approach of a sciatic nerve block?

A

ASIS, Pubic tubercle –> connect and divide into thirds
At junction of medial 1/3 and lateral 2/3 draw a perpendicular line to extend caudally
Line through greater trochanter parallel to first line

45
Q

How should the leg be position for the anterior approach of a sciatic nerve block?

A

Patella towards the ceiling

46
Q

Where is the insertion point for the anterior approach of a sciatic nerve block?

A

Intersection of perpendicular with line through greater trochanter

47
Q

How far should the needle be inserted for the anterior approach of a sciatic nerve block?

A

8-10cm, perpendicular in all planes

48
Q

What bone might the provider come into contact with for the anterior approach of a sciatic nerve block?

A

Lesser trochanter, redirect medially

49
Q

What motor response should be seen for the anterior approach of a sciatic nerve block?

A

Tibial = plantar flexion and inversion

Common peroneal: dorsiflexion and eversion

Advanced Principles (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions