Lower Extremity PNB

Question 1

Where is the lumbosacral plexus located?

Answer 1

L1-S5 (may include T12).

Question 2

Where is the iliohypogastic nerve formed?

Answer 2

T12-L1

Question 3

Where does the iliohypogastric nerve travel?

Answer 3

In abdominal wall to level of the symphysis pubis.

Question 4

What does the iliohypogastric nerve innervate?

Answer 4

Muscle, skin, and patietal peritoneum.

Skin over inferior abdomen and buttocks.

Question 5

What PNB should be done for inguinal hernias?

Answer 5

May need both ilioinguinal and iliohypogastric blocks.

Question 6

Where is the ilioinguinal nerve formed?

Answer 6

T12-L1.

Question 7

Where does the ilioinguinal nerve travel to and from?

Answer 7

Travels in abdominal wall, pierces posterior wall of the inguinal canal, passes through superficial inguinal ring, terminates on the anterior scrotum/labia majora.

Question 8

What does the ilioinguinal nerve innervate?

Answer 8

Muscle, skin, parietal peritoneum.. Skin of superior/medial thigh, portions of external genitalia.

Question 9

Where is the genitofemoral nerve formed?

Answer 9

L1-L2

Question 10

Where does the genitofemoral nerve travel to and from?

Answer 10

Travels in abdominal wall. Though deep inguinal canal and through superficial inguinal ring. Terminates on anterior scrotum/labia majora.

Question 11

What does the genitofemoral nerve innvervate?

Answer 11

Skin covering femoral hiatus. Skin on the scrotum and labia majora

Question 12

What type of procedures is the genitofemoral nerve typically blocked for?

Answer 12

Mostly urinary and genital procedures

Question 13

What are the three muscles layers on our sides/front flanks?

Answer 13

External oblique, internal oblique, and transverse abdominus.

Question 14

In between what two muscle layers do most of the nerves run in between?

Answer 14

Between the internal oblique and transverse abdominus.

Question 15

After coming to the front of the body, where do the nerves lie?

Answer 15

Right over top the rectus abdominus

Question 16

Which block is used for episiotomy?

Answer 16

Pudendal nerve block.

Question 17

Where does the pudendal nerve originate?

Answer 17

S2-S4.

Question 18

Where does the pudendal nerve travel from and to?

Answer 18

Passes from pelvis through greater sciatic foramen into gluteal region. Passes posterior to ischial spine and into perineum.

Question 19

What does the pudendal nerve innervate?

Answer 19

Muscle and skin of perineum.

Question 20

Where does the lateral femoral cutaneous nerve originate from?

Answer 20

Posterior division of L2-L3.

Question 21

Where does the lateral femoral cutaneous nerve travel from and to?

Answer 21

Descends posterior abdominal wall, crosses iliac crest into pelvis and down to inguinal ligament and anterior iliac spine.

Question 22

What does the lateral femoral cutaneous nerve innervate?

Answer 22

Skin- lateral aspect of thigh to the level of the knee.

Question 23

Where is the block typically performed at for lateral femoral cutaneous nerve block?

Answer 23

In the lateral groin area.

Question 24

Where does the posterior femoral cutaneous nerve originate?

Answer 24

Anterior and Posterior division of S1-S3

Question 25

Where does the posterior femoral cutaneous nerve travel from and to?

Answer 25

Passes from pelvis into gluteal region to posterior thigh.

Question 26

What does the posterior femoral cutaneous nerve innervate?

Answer 26

Skin of posterior thigh (hip to mid-calf).

Question 27

Which nerve actually innervates the hip and controls adduction, flexion, and extension of hip?

Answer 27

Obturator nerve

Question 28

Where does the obturator nerve originate?

Answer 28

Anterior division of L2-L4

Question 29

What does the obturator nerve innervate?

Answer 29

Many muscles in thigh. Articular branches to hip= controls adduction, flexion, and extension of hip. Skin of medial thigh.

Question 30

Where does the femoral nerve originate?

Answer 30

Posterior division of L2-L4

Question 31

Where does the femoral nerve split into anterior and posterior branches?

Answer 31

Below inguinal ligament

Question 32

Which split (anterior/posterior) of the femoral nerve contains the saphenous nerve?

Answer 32

The posterior

Question 33

Describe the femoral nerve's relation to femoral artery and vein.

Answer 33

Nerve is most lateral to femoral artery and vein.

Question 34

What is the mnemonic to remember femoral nerve location?

Answer 34

VAN Vein, Artery, Nerve V=venous penis or V=Vagina.

Question 35

Which muscle wraps from lateral to medial across the thigh?

Answer 35

Sartorius

Question 36

Which muscle goes straight down the thigh?

Answer 36

Rectus femoris.

Question 37

Which nerve is typically blocked within the adductor canal directly under the sartorius muscle?

Answer 37

Saphenous nerve

Question 38

Which muscles are innervated by the femoral nerve?

Answer 38

``` Rectus femoris. Vastus lateralis. Vastus intermedius. Vastus medialis. Sartorius. ```

Question 39

Where does the saphenous nerve originate?

Answer 39

Posterior cutaneous branch from femoral nerve.

Question 40

What nerve would be stimulated if sartorius muscle contraction or patellar twitch occurs?

Answer 40

Femoral nerve.

Question 41

If saphenous nerve is blocked, will it be motor block/sensory block/or both?

Answer 41

Sensory block

Question 42

What structure does the saphenous nerve follow/accompany?

Answer 42

Saphenous vein/artery

Question 43

What does the saphenous nerve innervate?

Answer 43

Medial leg from knee to the arch of the foot.

Question 44

What two nerves form the sciatic nerve?

Answer 44

Tibial Nerve and Common Peroneal Nerve.

Question 45

Where does the sciatic nerve branch off again?

Answer 45

Popliteal fossa.

Question 46

Where does the popliteal nerve originate?

Answer 46

Trick question. No popliteal nerve.

Question 47

What is a popliteal block?

Answer 47

Block of the sciatic nerve at the popliteal fossa which is near the popliteal artery.

Question 48

Where does the tibial nerve originate from?

Answer 48

Anterior division of L4-S3.

Question 49

What does the common peroneal nerve branch into?

Answer 49

Superficial and Deep.

Question 50

Which branch of the common peroneal nerve passes in front of the ankle and terminates between great toe and second toe?

Answer 50

Deep peroneal nerve

Question 51

Where does the superficial peroneal nerve run?

Answer 51

Stays at the front of the leg into the front of the foot.

Question 52

Which nerve is formed from the union of the tibial and common peroneal?

Answer 52

Sural Nerve.

Question 53

What nerve does the sural nerve travel with?

Answer 53

Saphenous nerve.

Question 54

What does the sural nerve innervate?

Answer 54

Posterior sole of foot. Posterior heel. Achilles tendon above ankle.

Question 55

What five nerves extend all the way to the ankle?

Answer 55

Sural, deep peroneal, tibial, saphenous, superficial peroneal.

Question 56

Which of the five nerves that extend to the ankle run subcutaneously and which run deep?

Answer 56

The "S"s are superficial Sural. Saphenous. Superficial peroneal. Non-"S"s run deep. Deep Peroneal and tibial.

Question 57

Where does the sural nerve terminate in the ankle?

Answer 57

Posterior to lateral malleolus

Question 58

Which nerve runs posterior to the medial malleolus?

Answer 58

Tibial nerve.

Question 59

Which two nerves run at the front of the ankle?

Answer 59

Deep peroneal (deeper) and Superficial peroneal (subcutaneous).

Question 60

Stimulation of deep peroneal will cause what foot response?

Answer 60

Straight up.

Question 61

Stimulation of tibial nerve will cause what foot response?

Answer 61

Down and inward.

Question 62

Which nerve stimulation will cause outward and upward foot movement?

Answer 62

Superficial peroneal.

Question 63

T/F: Femoral nerve block is good for knee arthroscopy?

Answer 63

True; but not good for knee arthroplasty

Question 64

What are contraindications for femoral nerve block?

Answer 64

Previous ilioinguinal surgery. Large inguinal lymph node/tumor. Local infection. Neuropathy

Question 65

What are indications for femoral nerve block?

Answer 65

Anterior aspect of thigh. Superficial surgery on medial aspect of leg and below knee. Knee arthroscopy

Question 66

What are indications for popliteal block?

Answer 66

Lower leg surgery especially lateral. Especially foot and ankle. May also require saphenous coverage.