Module 9 Flashcards
1
Q
The lower extremity blocks are based on what 2 plexuses
A
Sacral & Lumbar
2
Q
The lower extremity blocks are based on what nerves?
A
Lateral Femoral Cutaneous
Obturator
Femoral
Posterior Cutaneous
Saphenous Nerve
Common Peroneal Nerve
Tibial Nerve
3
Q
Where is your femoral nerve?
A
Anterior
4
Q
What nerves come out of the sacral plexus
A
Sciatic & Pudendal nerves
5
Q
The orientation of the sciatic nerve
A
Comes out of the sacral plexus, goes below gluteus Maximus, through, above or below multiple muscles, down the back of the leg (posterior tibial), branches at the popliteal plexus to the common peroneum & tibial
6
Q
What is apart of the lumbar plexus
A
Lateral Femoral Cutaneous
Femoral
Obturator
6
Q
The ilioinguinal & iliohypogastric innervates the
A
Anterior lower abdomen
6
Q
Obturator Nerve branches off of
A
L2/L3/L4 (important for hip)
7
Q
What are the nerves of the ankle
A
Saphenous
Deep Peroneal
Superficial Perineal
Aural
Posterior Tibial
8
Q
Name the ankle nerves going clockwise
A
Posterior Tibial
Saphenous
Deep Peroneal
Superficial Peroneal
Sura
11
Q
What nerves branch off the sciatic & femoral
A
Saphenous
Deep Peroneal
Superficial Perineal
Sural
Posterior Tibial
12
Q
Which is the largest nerve of the body?
A
Sciatic
13
Q
The pudendal nerve is innervated from
A
S2-S4
14
Q
Where is your sciatic nervep
A
Posterior
15
Q
What are the 4 major nerves of the lumbosacral plexus
A
Lateral Femoral Cutaneous
Femoral
Obturator
Saphenous
Sciatic
16
Q
Why isn’t the femoral block performed much?
A
The persistent weakness (quad weakness)
17
Q
If you block the femoral & sciatic nerve, then
A
The leg will be completely numb
18
Q
Which blocks are for the hips
A
Fascia Iliaca
PENG
19
Q
Which nerve is for the knee
A
Saphenous
Femoral nerve block
20
Q
What are the indications for femoral nerve
A
Femur
Patella
Quadricep
Knee
21
Q
Iliopsoas muscle lies
A
Underneath the femoral nerve
22
Q
In what order lies the femoral nerve, artery & vein
A
In that sequence
23
Q
Iliopsoas muscle is important to what nerve
A
Femoral
24
Q
The Iliopsoas muscle is directly
A
Below the pectineus muscle
25
The Iliopsoas muscle is directly
Below the pectineus muscle
26
When looking at the femoral block, the sartorius muscle lays
Laterally
27
What muscle is used to describe an adductor canal block?
Sartorius muscle
28
How many mL for fascia iliaca
20-40mL
29
How much local for femoral
10-20
30
A fascia iliaca block is indicated for
Anterior thigh
Knee
Hip& knee analgesia
31
With the fascia iliaca, are you aiming for a specific nerve?
No, just placing local under fascia
32
Inguinal ligament is associated with
AIIS
33
The fascia iliaca can be performed
Above or below inguinal ligament
34
What is at a greater risk when placing local under inguinal ligament
Greater change of femoral nerve involvement, leading to weakness with fascia iliaca block
35
Is there motor innervation with PENG
No, it’s sensory
36
What needs to be blocked to be successful for a hip fracture
Anesthetize the Obturator nerve
37
The sartorius muscle attaches to the
Lateral side of the hip at greater trochanter, crosses over leg & attaches to inside of knee
38
The iliopectal eminence & AIIS are
Easy to fine
39
ASIS & AIIS is
Anterior Inferior Iliac Crest
Anterior Superior Iliac Crest
40
Hat structures are important with a PENG block
Inject under psoas, just past the AIIS
41
What is important to note with the PENG BLOCK
Does not cover lateral thigh
42
The lateral femoral cutaneous nerve local amount
5mL
43
What are the indications for a lateral femoral cutaneous nerve
Decrease cutaneous sensation of the lateral thigh
Postoperative analgesia for hip surgery
44
What is the dose of Saphenous adductor canal block
10-20ml
45
Where does the Obturator nerve end
Inner knee
46
The PENG block is indicated for
Hip analgesia
47
How much anesthetic is give with a PENG block
20-30mL
48
What is the anatomy of the adductor canal block?
Sartorius
Vastus Medialis
Adductor longus
49
What is the anatomy of the PENG block
Articular branches of the femoral nerve
Obturator Nerve
Accessory Obturator Nerve
50
The lateral femoral cutaneous nerve takes how much local
5mL
51
52
What are the indications for a Saphenous (adductor canal block?
Medial leg, ankle, foot surgery, knee analgesia
53
Vastus Mesialis innervates
Posterior knee
54
How many mL for a sciatic nerve
15-20mL
55
Indications for sciatic block
Foot & ankle surgery, BKA, lower leg anesthesia, posterior upper leg anesthesia
56
Posterior leg is innervated by
Sciatic
57
The popliteal fossa is key for identifying
The sciatic nerve & vice versa
58
59
Common Peroneal beaches out to
Lateral knee
60
For ankle blocks, how many mL per block?
3-5mL
61
From medial to lateral, name the nerves in the ankle
Posterior Tibial
Saphenous
Deep Peroneal
Superficial Peroneal
Sural
62
Which are the 2 deepest nerves in the ankle
Deep Peroneal
Posterior Tibial
63
What are the main terminal nerves of the sacral plexus?
Sciatic & Pudendal
64
What are the 2 trunks of the sciatic nerve
Lateral Trunk which emerges as the common perennial nerve
Medial trunk which becomes the tibial nerve
65
The 2 trunks of the sciatic nerve are enveloped in a
Common sheath
66
The sacral plexus, which contains the sciatic nerve & pudendal nerve pass in close relation to the
Piriformis muscle under the gluteus Maximus & then descends adjacent to the femur
67
Where does the sciatic nerve bifurcate?
High in the popliteal fossa, Turing into the tibial & common Peroneal nerves
68
The common Peroneal nerve descends on the
Lateral lower leg, providing cutaneous & motor innervation to the lateral leg & foot
69
The tibial nerve descends with the tibia and supplies
Cutaneous & motor branches to lower leg & ankle
70
The lumbar plexus supplies the
Lateral femoral cutaneous nerve
Femoral nerve which branches into Saphenous nerve
Obturator nerve
71
Obturator & femoral nerve innervation
L2-L4
72
The lateral femoral cutaneous nerve supplies cutaneous innervation to the skin over the
Anterior & lateral aspect of the thigh
73
The femoral nerve supplies
Muscle & skin on the anterior aspect of the thigh, distal to the femoral triangle
74
The femoral nerve branches into the
Anterior & posterior division
75
The anterior femoral nerve supplies
The pectineus & sartorius muscle as well as skin on the thigh
76
The posterior division of the femoral nerve supplies
The muscle of the quadriceps & Saphenous nerve
77
The Saphenous nerve follows the
Femoral artery through the abductor or Hunter’s canal
78
Where does the Saphenous nerve end
Medial aspect of the knee & supplies the skin of medial leg & foot
79
Which nerves are sensory only
Lateral femoral cutaneous
Saphenous
Sural
80
The Obturator nerve supplies the
Inner knee
81
The femoral, tibial & common personal nerve give branches to innervate
The skin & muscles of the foot
82
The Saphenous nerve supplies the
Medial surface of the lower leg & front of the heel
83
The deep Peroneal nerve lies
Anterior to the tibial, supplying the web space between the 1st & 2nd digits
84
What are the characteristics of the superficial Peroneal
It is lateral & superficial to the deep perineal. It supplies cutaneous nerves of the dorsal foot
85
The Sural nerve supplies the
Lateral malleolus & lateral aspect of the dorsal surface of the foot
86
The tibial nerve or posterior tibial nerve innervates the
Ankle & heel
87
Blocking the lumbosacral plexus provides
Anesthesia of the entire lower extremity
88
What are the 4 terminal branches of the lumbar plexus
Lateral Femoral Cutaneous
Femoral
Obturator
Saphenous
89
The Obturator nerve supplies sensation to the
Hip joint & variable sensory innervation to the knee
90
The Saphenous nerve provides sensation to the
Knee & medial lower leg, ankle & foot
91
A femoral nerve block will block sensation to the
Anterior thigh & follow the Saphenous nerve distribution of the knee as well as the medial lower leg & ankle
92
The femoral nerve will be covered by the
Fascia Iliaca
93
What muscle is underneath the femoral nerve
Iliopsoas
94
What lies over the iliopsoas muscle
Fascia iliaca
95
The femoral nerve is surrounded by
Fascia iliaca
96
What muscle is lateral to the femoral nerve which is on top of the iliac muscle
Sartorius
97
The needle should be placed though what structure for a femoral nerve block
Fascia iliaca
98
The fascia iliaca block provides anesthesia to the
Anterior thigh & knee
Analgesia of the hip & knee
99
What is specific about the fascia iliaca block
It is a compartment block or a facial plane, so no nerve is visualized
100
Where is the anesthetic placed for a fascia iliaca block
Through the fascia iliaca & on top of the iliopsoas muscle
101
The suprainguinal technique is more
Proximal in spread
102
The lateral femoral cutaneous nerve passes
Under the inguinal ligament & lies on top of the sartorius muscle before passing to the lateral thigh
103
The lateral cutaneous nerve will appear
Hyperacoic & oval shaped
104
The Saphenous nerve is the terminal
Sensory branch of the femoral nerve which branches
105
The Saphenous nerve block is useful for
Medial leg & ankle surgery as well as analgesia of the knee
106
When obtaining a Saphenous nerve block, what is its orientation to the artery & vein
The structure make a triangle. The femoral artery is above the femoral vein & the Saphenous nerve is medial
107
What are the muscles for a Saphenous block
Sartorius
Vastus Medialis
Adductor Longus
108
What is the muscle above the adductor canal
Sartorius/Boat
109
The sartorius starts on the
Lateral hip & ends on the medial knee
110
The adductor canal is in between the
Vastus Medialis anteriorly
Adductor longus posterior
Sartorius is the roof
111
112
What is the best location for place g a Saphenous nerve block
When the artery is directly in the middle of the sartorius muscle
Best sensory & least motor
113
The Vastus Medialis, sometimes labeled MRN, can provide
Some sensory information o the posterior knee
114
Placing LA in the Vastus Medialis can result in
Weakness
115
What is the dose of LA & indications for a sciatic block
15-20
Foot & ankle
BKA
Lower leg
Posterior upper leg
116
The sciatic nerve descends below the
Gluteus until it splits into the common Peroneal & tibial nerve at the popliteal triangle
117
What are the landmarks for sciatic block
Popliteal artery
Femur
Semi membranous muscle
Semi tendinosus
118
What are the 2 deep nerves of the ankle
Tibial & deep perennial
119
What are the 3 superficial nerves of the ankle
Saphenous
Superficial
Sural
120
What are terminal branches of a he sciatic nerve
Tibial & deep perennial
121
The deep ankle blocks cover the
Posterior tibial, Sural & deep Peroneal
122
The PENG block blocks the
Articular branches of the femoral nerve, the Obturator nerve & accessory Obturator nerve
123
The PENG block supplies analgesia to the
Anterior hip capsule
124
The needle for a PENG blocks is placed
Over the iliopectineal eminence, deep into the psoas muscle & the psoas muscle tendon
125
The needle when placing the PENG block will come from
Lateral to medial compass over the iliac spine & touch the lexical eminence below the psoas muscle tendon
126
Which block is hard for pushed LA
PENG
