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2nd Quarter > Regional Quiz #2 > Flashcards

Regional Quiz #2 Flashcards

1
Q

What are indications for a Femoral Nerve Block?

A

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)
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2
Q

What nerve innervates the ability to extend the leg/knee?

A

Femoral Nerve

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3
Q

What nerve innervates the ability to bend knee/flex leg?

A

Sciatic Nerve

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4
Q

If you needle is too anterior and medially what 2 muscles will you see twitches on?

A
  • Sartorius

- Pectineus

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5
Q

T or F: The anterior and posterior component of the femoral nerve are BOTH below the Fascia Iliaca.

A

True

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6
Q

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?

A

-redirect your needle laterally and insert 1-3 mm deep to reach the posterior component

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7
Q

T or F: In some individuals, the Inguinal Ligament and the Femoral crease will not be the same.

A
  • true

- thin people more same

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8
Q

Where is the Inguinal Ligament?

A

-it attaches anteriorly to the anterior superior iliac spine and the pubic tubercle

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9
Q

While doing a femoral nerve block, should you be above or below the inguinal ligament?

A
  • Below

- If above, you are in the bowel

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10
Q

Do femoral nerve block serve as the sole anesthetic?

A

Almost always a FNB only is an adjunct to anesthesia

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11
Q

Is there any single nerve blockade that can block the entire leg?

A

no, have to be coupled with other blocks

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12
Q

What Plexus does the femoral nerve come off from?

A
  • The Lumbar Plexus

- The Anterior Plexus of the lower limb

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13
Q

What are the contraindications for a femoral nerve block?

A
  • refusal
  • infection
  • previous femoral vascular graft
  • large inguinal lymph nodes or tumor
  • preexisting femoral neuropathy
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14
Q

If a patient is admitted to the hospital, has a +MRSA nasal swab is it ok to do a femoral nerve block?

A

-as long as the patient doesn’t have an active outbreak of infection at the site

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15
Q

If you perform a regional anesthetic and decrease neural flow/sensation/movement to an area that has already been compromised, it is called what?

A
  • Double Crush Syndrome

- If this happens, probably will not return to baseline

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16
Q

Which nerve is the largest nerve of the lumbar plexus?

A

Femoral nerve

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17
Q

What forms the femoral nerve?

A

-the dorsal divisions of the anterior rami of the L2, L3 and L4 spinal nerves

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18
Q

What are the two branches that the femoral nerve divides into?

A
  • Anterior branch
  • Posterior branch
  • both are located BELOW the fascia iliaca
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19
Q

What does the posterior branches of the femoral nerve innervate?

A
  • quadriceps muscle
  • knee joint, patellar twitch
  • saphenous nerve
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20
Q

What does the saphenous nerve innervate?

A

the skin of the medial aspect of the leg below the knee joint

21
Q

What is the largest nerve in the body?

A

Sciatic nerve

22
Q

Where does the femoral saphenous nerve originate?

A

L3-L4

23
Q

How should you position a patient before a femoral nerve block?

A

supine with ipsilateral(same leg) extremity slightly abducted

24
Q

Explain the site of needle insertion for femoral nerve block.

A
  • 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
25
Q

What twitch signifies a successful femoral nerve block?

A

When performing a femoral nerve block, you advance needle through the fascia late until the quad muscle contracts(i.e.—>PATELLAR TWITCH)

26
Q

What is the typical dose of LA with femoral nerve block?

A

20 ml

27
Q

What is the onset and duration of anesthesia and analgesia of 20 ml 0.5% ropivacaine in a femoral nerve block?

A

onset: 15-30 min
anesthesia: 4-8 hours
analgesia: 5-12 hours

28
Q

What is the onset and duration of anesthesia and analgesia of 20 ml 0.5% bupivacaine in femoral nerve block?

A

onset: 15-30 min
anesthesia: 5-15 hours
analgesia: 8-30 hours

29
Q

What are 5 femoral nerve block complications?

A
  1. hematoma
  2. vascular puncture
  3. nerve injury
  4. catheter infection
  5. instruct patient on the inability to bear weight on the blocked extremity
30
Q

During a femoral nerve block, a vein or artery is punctured. Should you redirect the needle medially or laterally?

A

Laterally, NEVER medially

31
Q

How many peripheral nerves are blocked to have a complete foot/ankle block for foot anesthesia?

A

5

32
Q

Do you use a PNS to perform an ankle block?

A

no

33
Q

How long do ankle blocks usually last?

A

15-20 hours

34
Q

What are some indications for foot/ankle block(6)?

A
  1. all types of foot surgeries
  2. Hallux valgus repair(Bunion)
  3. foot reconstruction
  4. arthroplasty
  5. osteotomy
  6. amputation
35
Q

What are the contraindications of ankle blocks(8)?

A
  1. patient refusal
  2. infection
  3. edema
  4. burns
  5. soft tissue trauma
  6. distorted anatomy with scarring in area to be blocked
  7. vascular compromise
  8. severe coagulopathy
36
Q

List the 5 nerves blocked with ankle blocks.

A
  1. saphenous
  2. posterior tibial
  3. superficial peroneal
  4. sural
  5. deep peroneal
37
Q

What does the superficial peroneal nerve innervate?

A

the dorm of the foot(top of the foot)

38
Q

What are 3 possible complications of ankle blocks?

A
  • paresthesias
  • LAST
  • Vasovagal reaction
39
Q

The 3 branches of the tibial nerve primarily innervate?

A

plantar surface of the foot(bottom of the foot)

40
Q

The saphenous nerve innervates what?

A

the medial aspect of the foot

41
Q

The dural nerve innervates?

A

lateral edge of the foot

42
Q

What 2 nerves will completely block the big toe?

A

deep peroneal nerve

superficial peroneal nerve

43
Q

Where is the location of the tibial nerve?

A

travels just posterior to the posterior tibial artery in the space between the medial malice and the achilles tendon

44
Q

The deep peroneal nerve is between which 2 tendons?

A

extensor hallucis longus tendon

tibialis anterior tendon(extensor digitorum longus)

45
Q

The dural nerve is located between?

A
  • the achilles tendon(Tendocalcaneus)

- the lateral melleolus

46
Q

How many mls of LA for each nerve in the ankle block?

A

5-8 mls

47
Q

Why should you not add epi to LA with ankle blocks?

A
  • it is a circumferential block

- it will decrease blood flow to the foot

48
Q

Are ankle blocks sole or adjunct anesthetics?

A

They are usually the sole anesthetic

2nd Quarter (27 decks)

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