Lower Peripheral Nerve Blocks Flashcards
What is formed by the Ventral Rami L1 - S5 (T12) and has Anterior & Posterior Divisions?
Lumbosacral Plexus
What does the Lumbosacral Plexus Innervate?
Lower Abdomen & Lower Extremities
Muscles
Joints
Skin
Peritoneal Lining
Where are the Iliohypogastric & Ilioinguinal Nerves
T12 - L1
Where is the Genitofemoral Nerve?
L1 - L2
Where is the Psoas & Iliacus Nerves?
L2 - L3
Where is the Femoral Nerve?
Posterior L2 - L4
Where is the Obturator Nerve?
Anterior L2 - L4
Where is the Superior Gluteal Nerve?
L4 - S1
Where is the Inferior Gluteal Nerve?
L5 - S2
Where are the Sciatic & Tibial Nerves?
L4 - S3
Where is the Common Peroneal Nerve?
L4 - S2
Where is the Periformis Nerve?
S2
What nerves are at L4 - S1?
Obturator Internus
Superior Gemellus
Inferior Gemellus
Quadratus Femoris
Where does the Iliohypograstric Nerve travel?
Abdominal Wall to Symphysis Pubis
What does the Iliohypogastric Nerve Innervate?
Parietal Peritoneum
Muscle
Inferior Abd. & Butt Skin
Where does the Ilioinguinal & Genitofemoral Nerves travel?
Abdominal Wall
Thru Posterior Inguinal Canal & Ring
Stops at Anterior Scrotom or Labia Majora
What does the Ilioinguinal Nerve Innervate?
Parietal Peritoneum
Muscle
Thigh & Genitalia Skin
What does the Genitofemoral Nerve Innervate?
Skin covering Femoral Hiatus, Scrotum/Labia Majora
Where is the Pudendal Nerve?
Anterior S2- S4
Where does the Pudendal Nerve travel?
Pelvis thru Sciatic Foramen into Gluteal Region
Posterior to Ischial Spine into Perineum
What does the Pudendal Nerve Innervate?
Muscle & Skin of Perineum
Where is the Lateral Femoral Cutaneous Nerve?
Posterior L2 - L3
Where does the Lateral Femoral Cutaneous Nerve Travel?
Down the back of Abdominal Wall and crosses Iliac Crest into Pelvis, then down to Inguinal Ligament & Anterior Iliac Spine
What does the Lateral Femoral Cutaneous Nerve Innervate?
Lateral Thigh Skin at Knee Level
Where is the Posterior Femoral Cutaneous Nerve?
Anterior & Posterior S1 - S3
Where does the Posterior Femoral Cutaneous Nerve travel?
Pelvis to Gluteal Region to back of Thigh
What does the Posterior Femoral Cutaneous Nerve Innervate?
Back of Thigh Skin @ Hip to Mid Calf
Where does the Obturator Nerve travel?
Middle of Thigh
What does the Obturator Nerve Innervate?
Thigh Muscles
Hip Movement
Middle Thigh Skin
Where does the Femoral Nerve travel?
Pelvis –> Inguinal Ligament –> Anterior Thigh –> Splits into Anterior & Posterior Branches
Posterior Branch has Saphenous Nerve
What does NAVEL stand for?
Nerve, Artery, Vein, Empty Space, Ligament
What does the Femoral Nerve Innervate?
Rectus Femoris
Vastus Lateralis
Vastus Intermedius
Vastus Medialis
Sartorious
Anterior Thigh Skin
Where is the Saphenous Nerve?”
Posterior Branch of Femoral Nerve
Where does the Saphenous Nerve Travel?
Sartorius muscle –> Tibia –> Skin
Accompanied by Saphenous Vein
What does the Saphenous Nerve Innervate?
Middle of Leg from Knee to Foot Arch
Sartorious Muscle across thigh
Patellar Twitch/Snap
Which two nerves form the Sciatic Nerve as well as the Sural Nerve?
Tibial Nerve
&
Common Peroneal Nerve
What is the Largest and Longest Nerve?
Sciatic Nerve
Where does the Sciatic Nerve travel?
Butt –> Obturator Internus –> Ischial Tuberosity –> Back of Thigh
What does the Sciatic Nerve do?
Hip Extension
&
Knee Flexion
Where does the Tibial Nerve travel?
Popliteal fossa –> Back of Leg –> Tibial & Fibial Heads –> Medial Malleolus –> Foot
Where does the Common Peroneal Nerve travel?
Popliteal –> Biceps Femoris –> Fibula –> Divides into Superfical & Deep Branches
Where does the Superficial Branch of the Common Peroneal Nerve travel?
Side of Leg to the Side & Top of foot
Where does the Deep Branch of the Common Peroneal Nerve travel?
Front of Leg –> Ankle –> Skin b/t Hallux & Second Toe
How does the Sural Nerve travel?
W/ Saphenous Nerve to Lateral Malleolus to the Foot
What does the Sural Nerve Innervate?
Back Sole of Foot
Heel
Achilles Tendon
What does Tibial Nerve Stimulation do to the foot?
Plantarflexion & Inversion
What does Superficial Peroneal Nerve Stimulation do to the Foot?
Abduction
&
Eversion
What does Deep Peroneal Nerve Stimulation do to the Foot?
Dorsiflexion
When is a Femoral Nerve Block Indicated?
Front of thigh
Middle of Leg Below Knee
Knee Arthroscopy
What are Contraindications to Femoral Nerve Blocks?
Prior Ilioinguinal Surgery - Vascular Graft, Kidney Transplant
Big Inguinal Lymph Nodes/Tumor
Patient Refuse
Local Infection
Coagulopathy
Neuropathy
What are Indications for a Sciatic Nerve Block?
Lower Limb Surgery
Usually combined w/ Femoral Blocks
What are Indications for a Popliteal Block?
Lower Leg Surgery - especially foot & ankle
May need Saphenous Coverage
What are Indications for a Saphenous Block?
Sphenous Vein Stripping/Harvest
Supplementation for Foot/Ankle Surgery
Pain Control for Knee Surgery
What are Indications for an Ankle Block?
Foot Surgery
What are the Landmarks for Ankle Blocks?
Medial & Lateral Malleoli
Achilles Tendon
Extensor Longus Tendon
Posterior Tibial
Dorsalis Pedis
Sustentaculum Tali