Regional- lower body

Question 1

Summary chart: Interscalene, supraclavicular, infraclavicular, axiallary, bier

List the brachial plexus part

volume

indications

and notes

Answer 1

Question 2

TAP block:

indications

Answer 2

• Somatic sensation of anterior abdominal wall
• Subcostal TAP- upper abdomen
  
  • dermatomes T6-T9
• Lateral TAP- lower abdomen
  
  • dermatomes T10-T12
• Open abdominal surgeries
• C-section, total abdominal hysterectomy
• renal transplants
• nephrectomy
• illiostomy
• exploratory laparotomy

Question 3

Lumbar Plexus

What major nerves are involved?

Affects motor and sensory to what?

Answer 3

• Nerves:
  
  • ventral rami of L1-L4
    
    • within psoas muscle
  • Femoral L2-L4
  • lateral femoral cutaneous L1-L3
  • Obturator L2-L4
• Motor to:
  
  • hip
  • anterior thigh
  • knee
• sensory to:
  
  • medial upper and lower leg/ankls

Question 4

Femoral Nerve Block

motor innervation

sensory innervation

indications

Answer 4

• Motor: quads and sartorious
• sensory:
  
  • anterior thigh
  • anterior/medial knee
  • medial lower leg/ankle (saphenous nerve)
• Indications:
  
  • surgery to anterior thigh
  • quadriceps muscle biopsy
  • knee arthroscopy/ACL
  • complete blockade of lower expremity when combined with sciatic nerve block

Question 5

Femoral Nerve block:

disadvantages

contraindications

Answer 5

• Disadvantage:
  
  • loss of quadriceps (motor) strength and control
  • limits early postoperative ambulation and physical therapy
  • falling out of favor and being replaced by adductor canal block
• Contraindications:
  
  • pre-existing femoral neuropathy
  • local infection/enlarged groin lymph nodes

Question 6

What is the femoral 3-in-1 block?

Answer 6

• by injecting enough local, you can anesthetize the lateral femoral cutaneous, femoral, and obturator nerves with a single injection below the inguinal ligament
• out-dated and mostly abandoned
• little evidence to being successful

Question 7

Adductor canal block

nerve

indications

advantages

Answer 7

• Saphenous nerve- sensory branch of femoral
  
  • anterior and medial knee
  • medial lower leg and ankle
• indications-
  
  • knee analgesia (TKA, ACL, Foot/ankle)
• advantages:
  
  • spares motor of quadricepts
  • allows for early ambulation and physical therapy

Question 8

Sacral plexus

nerves

Answer 8

• L4-5 and S1-4
• posterior thigh
  
  • posterior femoral cutaneous nerve S1-S3
• Posterior knee, lower leg and foot
  
  • sciatic nerve L4-S4
• Does NOT include anterior thigh

Question 9

Sciatic nerve

roots

Where does it travel?

motor

sensory

Answer 9

• Nerve roots L4-5 and S1-3
• Exits the pelvis at the greater sciatic forament. travels under gludeus maximus
• separates mid-thigh into tibial and common peroneal nerves
• motor:
  
  • posterior thigh, leg, and fot
• sensory
  
  • skin of posterior thigh/knee, lateral leg and foot

Question 10

Sciatic nerve block

indications

advantages

disadvantages

Answer 10

• indications:
  
  • anesthesia/analgesia to posterior distal thigh, posterior knee, lower leg/ankle/foot
• advantages
  
  • complete blockade of leg in combination with femoral nerve block
• disadvantages
  
  • deep nerve sructure, difficult to identify
  • motor blockade can limit ambulation/physical therapy

Question 11

Popliteal nerve block

which nerves?

indications

advantages

Answer 11

• Tibial and common peroneal nerves
• indications
  
  • ankle and foot surgery
• advantages
  
  • spares posterior thigh muscle
  • facilitates early physical therapy/ambulation

Question 12

Ankle block

nerves (5)

indications

Answer 12

• nerves
  
  • posterior tibial
  • deep peroneal
  • superficial peroneal
  • sural
  • saphenous
• indications
  
  • procedures that involve the foot/toes

Question 13

Summary chart of lower extremity blocks

Know: plexus, volume, indications, and notes

for: TAP, femoral, adductor canal, sciatic, popliteal, ankle

Answer 13