Peripheral Nerve Blocks Part 3 Flashcards
Indications for a fascia iliaca block
anesthesia to hip, anterolateral thigh, and anterior knee to provide analgesia for hip fractures, THR, and hip scope
What does the lumbar plexus branch into in the lower extremity?
lateral femoral cutaneous, femoral, and obturator
What is not reliably blocked in a fascia iliaca block?
obturator nerve (located along medial border of psoas)
Describe how to perform a fascia iliaca block
supine, transducer placed in parasagittal plane over ASIS, slide transducer medial along inguinal ligament to identify inferior border of IOM and superior border of SM (iliacus muscle is deep to them), insert needle in-plane until is passes through fascia iliaca (feel pop), and inject LA after negative aspiration- iliacus should separate from fascia iliaca
How much volume of LA do you use with a fascia iliaca block?
40-60 mL
Indications for a transversalis fascia plane block
anesthesia of anterolateral abdominal wall at L1 (ideal for inguinal hernia repair, iliac crest bone graft)- does NOT prevent visceral pain
What nerves are blocked with a transversalis fascia plane block?
ilioinguinal and ilihypogastric nerves
Describe how to perform a transversalis fascia plane block
pt lateral or supine, transducer placed transverse between costal margin and iliac crest along mid-axillary line, slide transducer posterior until TAM tapers off, insert needle 2-3 cm anterior to transducer and advance in posterior direction until tip lies within plane between deep fascia of the TAM and transversalis fascia, inject LA after negative aspiration to dissect plane between TAM and trasnversalis fascia
Volume used for a transversalis fascia plane block
20 mL (per side if doing bilaterally)
Indications for a femoral nerve block
surgery of anterior thigh and knee
Landmarks for a femoral nerve block
femoral (inguinal) crease, femoral artery pulse
Desired response to nerve stimulation for femoral nerve block
twitch of patella/quadriceps
Volume used for femoral nerve block
15-20 mL
Describe where the femoral nerve is in relation to the femoral artery
Immediately lateral to the vessel (and deep to the fascia iliaca)
Describe how to perform a femoral nerve block
pt supine, ID femoral artery on US with transducer in femoral crease (nerve should be lateral to it), guide needle tip immediately adjacent to lateral aspect of femoral nerve into the wedge-shaped tissue space- inject LA after negative aspiration (femoral nerve should be lifted off surface of iliopsoas m)
Indications for saphenous nerve block
medial ankle, foot surgery, saphenous vein stripping/harvesting
What are the two approaches for a saphenous nerve block?
infiltrate medial aspect of knee at level of tibial tuberosity or adductor canal block
Volume of LA used for a saphenous nerve block
5-10 mL
What is different about a saphenous nerve block when using US?
visualization of the nerve is not necessary- it is not always well imaged (injecting 5-10 mL of LA next to the artery should suffice)
Indications for adductor canal block
lower limb, foot and ankle surgery (usually in combo with popliteal bock)
Where is the LA injected for an adductor canal block?
into the adductor canal deep to the sartorius muscle
How much LA volume is used for a low volume adductor canal block? What is a low volume block used for?
5-10 mL; knee scope, ACL reconstruction, lower leg, foot and ankle surgery
How much LA volume is used for a high volume adductor canal block? What is it used for
20-30 mL; total and uni-compartmental knee replacement
Describe how to perform an adductor canal block
US probe on anterior aspect of patient’s thigh, mid-point between inguinal crease and medial condyle; identify femur and move probe medially until traspezoid shaped sartorius muscle is visualized and the femoral artery is in the middle of it; insert needle and inject next to the artery
What area does an iPACK provide anesthesia to?
posterior knee joint
What area does a local infiltration anterior (LIA) provide anesthesia to?
anterior knee
What does an iPACK/LIA avoid blockade of?
common peroneal nerve
Describe how to perform an iPACK
position patient with leg externally rotated and slightly flexed, place transducer in transverse position along medial thigh just above medial condyle of femur, ID popliteal artery, insert needle 2-3 cm medial to transducer until tip extends 3 cm beyond lateral border of the artery and inject after negative aspiration
How much LA is used in an iPACK?
up to 30 mL
Describe how to perform a LIA
transducer positioned over anterior distal thigh, insert needle 2-3 cm medial to transducer, advance needle over top of femur deep within muscle, administer 20 mL as needle is slowly withdrawn, reposition needle superficially and inject additional 20 mL (??)
