Lower Regional Flashcards
Lumbar plexus
Located within __ __ muscle and __ to transverse processes
Psoas major, anterior
Ilioinguinal and iliohypogastric in __ branch of __ and __
Genitofemoral in __ branch of __ and a branch of __
Upper, L1, T12
Lower, L1, L2
Obturator in __ divisions of __, __, and __
Anterior, L2, L3, L4
Femoral
Large branches of __ divisions of __ and __
__ division of __
Posterior, L2, L3
Posterior, L4
Lateral femoral cutaneous- __ branches of the __ division of __ and __
Small, posterior, L2, L3
Femoral nerve
Formed by __ divisions of __ rami of __-__
Dorsal, anterior, L2-L4
Femoral nerve
Descends through the __ muscle __ border
Enters thigh underneath the __ ligament
Divides into __ and __ branches
Psoas, lateral
Inguinal
Anterior and posterior
Femoral nerve
Anterior branch
motor innervation of 2, sensory innervation of 2 places
Motor: sartorius and pectineus
Sensory: skin of anterior and medial thigh
Femoral nerve
Posterior branch
Motor innervation to: 4
Sensory to 1
Rectus femoris, vastus intermedius, vastus lateralis, vastus medius
Medial part of lower leg by saphenous nerve
Femoral nerve block indications
- surgery of __ __
- __ muscle biopsy
- skin graft for __ __
- __ arthroscopy
- __ __ fractures
- completely blocks lower extremity when combined with __ __ block
Anterior thigh Quadriceps Anterior thigh Knee Femoral shaft Sciatic nerve
Contraindications to femoral nerve block
- pre existing femoral ___
- local ___ or enlarged __ __
Neuropathy
Infection, lymph nodes
Femoral nerve block landmarks
Position:
Landmarks: 4
Femoral nerve lies 1-2 cm __ of __ __
Supine
ASIS, line between ASIS and PS (inguinal ligament), femoral artery, femoral nerve
Lateral, femoral artery
Femoral nerve block Depth \_\_g stim needle or \_\_g touhy needle directed \_\_ \_\_ stim with patellar snap. Volume
1-3 cm
22, 18, cephalad
Quadriceps
20-40 ml
Saphenous nerve From \_\_-\_\_ nerve roots \_\_ sensory nerve branch of femoral nerve Only nerve below knee not derived from \_\_ nerve Continuation of \_\_ nerve
L3-L4
Largest
Sciatic
Femoral
Saphenous nerve
Continuous innervation of __, __, and __ of __ leg
Can be anesthetized with __ nerve block
Frequently blocked with __ nerve for complete block below knee
Medial, anteromedial, posteromedial, lower
Femoral
Sciatic
Saphenous nerve block
Position
Landmark
__g __cm __bevel needle inserted __ and __ to landmark, inject __ ml
Inject __ ml as a ring deeply SQ starting at __ surface and ending at __ aspect of upper calf
Supine
Tibial condyle
22, 4, b, anterior and distal, 5
5, medial, dorsomedial
Transsartorial saphenous nerve block
Position: __ with __ __
Landmark: __ muscle just above __
__g __ tip needle through __ muscle
Supine, leg extended
Sartorius, patella
22, blunt, sartorius
Transsartorial saphenous nerve block
- __ and __ pop as needle passes through __
- get 2
- loss of resistance usually - cm from skin to posterior body of muscle
- __ ml of local anesthetic
First and second, sartorius
- loss of resistance and gentle aspiration
- 1.5-3 cm
- 10 ml
Adductor canal block done through __-__ __ nerve
Mid thigh saphenous
Sciatic nerve
Provides anesthesia to leg __ __
Complete lower block requires additional block of __ nerve
Below knee
Femoral/saphenous
Sciatic nerve is __ nerve in the body
Formed by __ rami of __-__
Contains most of the __ plexus __-__
Largest
Anterior, l4-s3
Sciatic, l4-s4
Sciatic nerve Exits the pelvis where Travels under what Contains the \_\_ and \_\_ \_\_ nerves Nerve bundle separates where
Greater sciatic foramen
Gluteus Maximus
Tibial and common peroneal
Mid thigh
Sciatic nerve
Motor to : 3
Sensory to: 4
Motor of posterior thigh, leg, and foot muscles
Posterior thigh, anterior/lateral leg, foot
Sciatic nerve block Position \_\_ decubitus Lower leg slightly \_\_ at \_\_ Upper leg (block side) \_\_ so foot is near knee of lower leg
Labats classic approach
Lateral
Flexed at knee
Flexed
Sciatic nerve block
Landmarks: 3
Lines drawn between __ __ and __ and __ __ and __ __
Greater trochanter, PSIS, sacral hiatus
Greater trochanter and PSIS, sacral hiatus
Sciatic nerve block
Perpendicular line drawn from___ of __ __
Needle insertion is __-__ cm __ to a midpoint between first two landmarks
Midpoint, first line
4-5, distal
Sciatic nerve
Initial settings __-__ ma
Expect stim of __ __ prior to __ __ stim
Observe for 2
Volume given __-__ ml after identified with __ma or less
1.5-1
Gluteus Maximus, sciatic nerve
Plantar flexion/inversion, dorsiflexion/eversion
20-30, 0.5
Sciatic nerve block with ultrasound
__ frequency __ probe __-__ MHz
Landmarks 2
Position
Low, curvilinear, 2-5
Greater trochanter and ischial tuberosity
Lateral decubitus
Sciatic nerve block with ultrasound
Place probe where
Greater trochanter and ischial tuberosity appear ___
Sciatic nerve is __ __ structure. Needle directed in __ plane, __ plane.
__-__ approach to avoid __ artery
Line between landmarks
Hyperechoic
Hyperechoic, elliptical, lateral, in
Lateral to medial, gluteal
Popliteal nerve anatomy
__ nerve supplies motor innervation via __ __ nerve and __ nerves
Sciatic, posterior tibial, peroneal
Popliteal nerve anatomy
Popliteal fossa bordered by __ __ laterally and __ muscle medially
Sciatic nerve splits __-_ cm from popliteal crease
__ nerve and __ __ nerve
Biceps femoris, semimembranosus
5-10
Tibial, common peroneal
Popliteal nerve
Superficial to __ __ and __ and slightly __
Popliteal artery and vein, lateral
Popliteal nerve block
Indications for __ or __ surgery
Offers improved __ tolerance over __ block
Must combine with __ or __ block to complete anesthesia below the knee
Foot and ankle
Tourniquet, ankle
Saphenous or femoral
Popliteal nerve block
Needle insertion __-__ cm above the __ __
__cm lateral to midpoint between two tendons
__g __cm __ needle, __ to skin
7-10, popliteal fossa
1
22, 5, perpendicular
Popliteal nerve block
Place hand over __ __, __, and __ muscles
Twitch of __ or __ at __-__ ma
Biceps femoris, semitendinosus, semimembranosus
Foot or toes, 0.3-0.4
Popliteal block
Deep peroneal- __ and __
Posterior tibial- __ __ and __
Dorsiflexion and eversion
Plantar flexion and inversion
Popliteal block
__ inject __-__ ml anesthetic
Injection on __ nerve may be more reliable
Consider __ __ technique
Incrementally, 35-45
Tibial
Double injection
