Mod 6: Regional Anaesthesia Flashcards
Regional anaesthesia involves?
Blocking specific peripheral nerves to achieve anaethesia to large body parts using small amounts of LA.
Why is regional Anaesthesia and excellent option for at risk patients?
Does not interfere with body physiology as opposed general or spinal anaethesia.
Regional Anaethesia can be used to reduced amount of general anaesthetic required and to extend anagesia into post op, TRUE or FALSE?
TRUE.
What Nerve supplies the outer side of the thigh from hip to knee?
Lateral Femoral Cutaneous Nerve. (L2,3)
Which Nerve supplies the back of the Thigh?
Posterior Femoral Cutaneous Nerve (S1,2,3)
Which Nerve supplies the upper Thigh (anterior) lateral to medial?
- Subcostal (T12)
- Femoral branch of Genitofemoral (L1)
- Ilio-inguinal (L1)
Which Nerve supplies the front of the Thigh?
Femoral Nerve (L2,3,4)
Which Nerve supplies the inner Thigh?
Cutaneous branch of Obturator Nerve (L2,3)
Which Nerve supplies the Medial aspect of the Shin?
Saphenous Nerve (L3,4)
Which Nerve supplies the posterior aspect of the Shin, and lateral side of the foot?
Sural Nerve (S1)
Which Nerve supplies the anterior aspect of the Shin and dorsal aspect of the foot?
Superficial Peroneal (L4,5 S1)
Which Nerve supplies the upper lateral aspect of the Shin and the 1st web space?
Deep Peroneal Nerve (L5)
Which Nerve supplies the lateral aspect of the Knee?
Common Peroneal Nerve (L4,5,S1,2)
What are the Nerve supplies to sole of the foot?L
Medial: Medial Plantar Nerve, Saphenous N.
Lateral: Lateral Plantar Nerve, Sural Nerve
Heel: Calcaneal Nerve
What are the superficial nerves at the ankle joint?
- Sural (S1,2)
- Saphenous (L3,4)
- Superficial Peroneal (L4,5,S1,2)
What are the deep nerves of the ankle joint?
- Posterior Tibial Nerve (L4,5,S1,2,3)
2. Deep Peroneal Nerve (L5)
Complete anaesthesia of skin, subQ tissues, joints, bone can be achieved by?
Ankle Block of all 5 nerves crossing the AJ.
What volume of LA is usually required for Ankle block?
12-18cc’s
Epinephrine is contraindicated in ankle block. TRUE or FALSE?
TRUE, epinephrine can effect the integrity of the blood supply to the foot.
Describe Posterior Tibial Nerve Location.
PT Nerve lies in the tarsal space between the medial malleoli and the Achilles tendon, just posterior to PT artery.
What is the injection point of PT Nerve?
2cm proximal to mid point of medial malleoli, approx half way between malleoli and achilles tendon.
1.5-2cm deep.
What Volume of LA is required for PT nerve block?
1cc wheal in anticipation of injection
5cc’s of LA at injection site.
What could be the possible causes of PT n block failure?
- Injection into wrong tissue layer (too superficial)
2. Injection distal to early trifurcation.
Describe Sural n Location.
Sural n. passes posterior to lateral malleoli posterior and deep to peroneal tendons
What is injection point of Sural nerve?
1cm posterior and 2cm proximal to lateral malleoli, passing posteriorly to border of achilles tendon
What volume of LA is required for Sural nerve block?
1cc wheal at anticipated injection site
2-3cc’s in infiltration area 1cm posterior and 2cm proximal to medial mall.
Describe Deep Peroneal Nerve location.
DP n. lies on the interossius membrane between Tib Ant tendon and long extensor tendons, lateral to anterior Tibial artery.
What is injection point of DP n?
Above superior extensor retinaculum, between Tib ant and extensor tendons lateral to anterior Tibial artery. Needle is inserted as far as Tibia and withdrawn slightly
What volume of LA is required for DP n block?
1cc wheal at anticipated injection site
2-3cc’s all the way down to the Tibia
Describe the location of the Saphenous n.
Saphenous n. lies between the medial aspect of the tibial tuberosity to the medial condyle of Tibia. can be either anterior or posterior to Gt Saphenous vein.
What is the injection point for Saphenous n?
Injection point is same as for DP n. directed medially to medial malleoli staying superfiscial to fascia.
What volume of LA is required for Saphenous n. block?
2-3cc’s
Describe injection point for Superficial Peroneal n.
Injection point is same as for DP n. directed laterally to lateral malleoli staying superficial to facia. (stay anterior to small saph vein)
Describe the location of Superficial Peroneal n.
Superficial to fascia, lying between Peroneus brevis and Extensor digitorum longus tendons
What is a Mayo nerve block?
a ring block through all tissue planes at the base the 1st and 5th mets used to anaethestize the selected ray. involves 4 injections
Why would the Mayo block be used?
For procedures of the 1st and 5th ray such as bunion/bunionette sx
