Regional Quiz #2 Flashcards
What are indications for a Femoral Nerve Block?
For surgeries on:
- Anterior aspect of thigh or medial aspect of lower leg
(ex: repair of quadriceps tendon, quadricep muscle bx, saph vein stripping, BKA, ACL repair, TKA, Femoral shaft fracture)
What nerve innervates the ability to extend the leg/knee?
Femoral Nerve
What nerve innervates the ability to bend knee/flex leg?
Sciatic Nerve
If you needle is too anterior and medially what 2 muscles will you see twitches on?
- Sartorius
- Pectineus
T or F: The anterior and posterior component of the femoral nerve are BOTH below the Fascia Iliaca.
True
If you are attempting to reach the posterior compartment(branch) of Femoral nerve and you have twitches in the Sartorial and Pectinous muscles, what should you do?
-redirect your needle laterally and insert 1-3 mm deep to reach the posterior component
T or F: In some individuals, the Inguinal Ligament and the Femoral crease will not be the same.
- true
- thin people more same
Where is the Inguinal Ligament?
-it attaches anteriorly to the anterior superior iliac spine and the pubic tubercle
While doing a femoral nerve block, should you be above or below the inguinal ligament?
- Below
- If above, you are in the bowel
Do femoral nerve block serve as the sole anesthetic?
Almost always a FNB only is an adjunct to anesthesia
Is there any single nerve blockade that can block the entire leg?
no, have to be coupled with other blocks
What Plexus does the femoral nerve come off from?
- The Lumbar Plexus
- The Anterior Plexus of the lower limb
What are the contraindications for a femoral nerve block?
- refusal
- infection
- previous femoral vascular graft
- large inguinal lymph nodes or tumor
- preexisting femoral neuropathy
If a patient is admitted to the hospital, has a +MRSA nasal swab is it ok to do a femoral nerve block?
-as long as the patient doesn’t have an active outbreak of infection at the site
If you perform a regional anesthetic and decrease neural flow/sensation/movement to an area that has already been compromised, it is called what?
- Double Crush Syndrome
- If this happens, probably will not return to baseline
Which nerve is the largest nerve of the lumbar plexus?
Femoral nerve
What forms the femoral nerve?
-the dorsal divisions of the anterior rami of the L2, L3 and L4 spinal nerves
What are the two branches that the femoral nerve divides into?
- Anterior branch
- Posterior branch
- both are located BELOW the fascia iliaca
What does the posterior branches of the femoral nerve innervate?
- quadriceps muscle
- knee joint, patellar twitch
- saphenous nerve
What does the saphenous nerve innervate?
the skin of the medial aspect of the leg below the knee joint
What is the largest nerve in the body?
Sciatic nerve
Where does the femoral saphenous nerve originate?
L3-L4
How should you position a patient before a femoral nerve block?
supine with ipsilateral(same leg) extremity slightly abducted
Explain the site of needle insertion for femoral nerve block.
- located at the femoral crease
- below the inguinal crease
- immediately lateral(1 cm) to the pulse of the femoral artery
- femoral nerve is beneath the fascia illiaca
What twitch signifies a successful femoral nerve block?
When performing a femoral nerve block, you advance needle through the fascia late until the quad muscle contracts(i.e.—>PATELLAR TWITCH)
What is the typical dose of LA with femoral nerve block?
20 ml
What is the onset and duration of anesthesia and analgesia of 20 ml 0.5% ropivacaine in a femoral nerve block?
onset: 15-30 min
anesthesia: 4-8 hours
analgesia: 5-12 hours
What is the onset and duration of anesthesia and analgesia of 20 ml 0.5% bupivacaine in femoral nerve block?
onset: 15-30 min
anesthesia: 5-15 hours
analgesia: 8-30 hours
What are 5 femoral nerve block complications?
- hematoma
- vascular puncture
- nerve injury
- catheter infection
- instruct patient on the inability to bear weight on the blocked extremity
During a femoral nerve block, a vein or artery is punctured. Should you redirect the needle medially or laterally?
Laterally, NEVER medially
How many peripheral nerves are blocked to have a complete foot/ankle block for foot anesthesia?
5
Do you use a PNS to perform an ankle block?
no
How long do ankle blocks usually last?
15-20 hours
What are some indications for foot/ankle block(6)?
- all types of foot surgeries
- Hallux valgus repair(Bunion)
- foot reconstruction
- arthroplasty
- osteotomy
- amputation
What are the contraindications of ankle blocks(8)?
- patient refusal
- infection
- edema
- burns
- soft tissue trauma
- distorted anatomy with scarring in area to be blocked
- vascular compromise
- severe coagulopathy
List the 5 nerves blocked with ankle blocks.
- saphenous
- posterior tibial
- superficial peroneal
- sural
- deep peroneal
What does the superficial peroneal nerve innervate?
the dorm of the foot(top of the foot)
What are 3 possible complications of ankle blocks?
- paresthesias
- LAST
- Vasovagal reaction
The 3 branches of the tibial nerve primarily innervate?
plantar surface of the foot(bottom of the foot)
The saphenous nerve innervates what?
the medial aspect of the foot
The dural nerve innervates?
lateral edge of the foot
What 2 nerves will completely block the big toe?
deep peroneal nerve
superficial peroneal nerve
Where is the location of the tibial nerve?
travels just posterior to the posterior tibial artery in the space between the medial malice and the achilles tendon
The deep peroneal nerve is between which 2 tendons?
extensor hallucis longus tendon
tibialis anterior tendon(extensor digitorum longus)
The dural nerve is located between?
- the achilles tendon(Tendocalcaneus)
- the lateral melleolus
How many mls of LA for each nerve in the ankle block?
5-8 mls
Why should you not add epi to LA with ankle blocks?
- it is a circumferential block
- it will decrease blood flow to the foot
Are ankle blocks sole or adjunct anesthetics?
They are usually the sole anesthetic
