Regional anaesthesia

Question 1

Indications of Lumbar Plexus Block

Answer 1

Operations of:

• Groin
• Neck/shaft of femur
• Anterior thigh
• Knee.

Question 2

What areas are commonly missed in the axillary brachial plexus block?

Answer 2

• Musculocutaneous nerve (supplying the lateral aspect of the forarm) as it sits outside the facial plane
• Intercostobrachial nerve (supplying medial aspect of the upper arm) as it isn’t a branch of the brachial plexus

Question 3

What is the proceedure for a lumbar plexus block?

Answer 3

• SLIMRAG
• Position laterally, operative side up
• Find insertion point, 4-5cm laterally from midline at L3
• Enter perpendicular to the skin
• Aim cephalad over the transverse process
• Maximum depth 8-12 cm
• Inject 20-30 mL
• Observe for twitch of patella

Question 4

What are the complications of a lumbar plexus block?

Answer 4

• As for any regional +
• Intra/retroperitoneal bleeding/haematoma
• Damage to intra/retroperitoneal organs
• Epidural/Intrathecal injection

Question 5

What are the indications for a femoral nerve block (3-in-1 block)?

Answer 5

• Surgery on:
  
  • The anteriomedial thigh
  • Knee (obturator/lateral cuteaneous nerve of the thigh are frequently missed, so may need topping up)
  • Quadriceps surgery

Question 6

What are the components of “Stop before you block”?

Answer 6

• Immediately prior to needle insertion, stop and check:
  
  • The surgical site marking
  • The site and side of the block

Question 7

What areas are commonly missed in the supraclavicular brachial plexus block?

Answer 7

• Ulnar nerve distribution often missed