TEST 2 - lower extremity stuff

Question 1

sciatic n. block root levels & landmarks and technique for needle insertion

Answer 1

L4-S3, lateral sims, draw line b/t posterior superior iliac spine and greater trochanter; at the midpoint, draw perpendicular to this line ~5cm caudomedially for needle insertion point

Question 2

As sciatic n. moves distal from cords, what two branches/nerves jump off?

Answer 2

tibial n. and peroneal n.

Question 3

At the needle insertion site for the sciatic n. what muscle does it lie posterior to?

Answer 3

piriformis

Question 4

femoral n. block root levels & position, landmarks and technique for needle insertion

Answer 4

L2-L4, supine, draw line b/t ant. superior iliac spine and pubic tubercle, palpate fem. artery, just lateral to FA is needle insertion point

Question 5

NAVEL stands for>

Answer 5

nerve, artery, vein, empty space, lymphatics

Question 6

At the needle insertion site for the femoral n. what ligament does it lie posterior to?

Answer 6

inguinal

Question 7

sciatic n. motor innervation (of the foot) indicated by?

Answer 7

plantar flexion of the foot (posterior tibial nerve) or dorsiflexion of the foot (common perineal nerve)

Question 8

femoral n. motor innervation indicated by?

Answer 8

twitching of quadriceps

Question 9

obturator n. motor innervation indicated by?

Answer 9

Obturator – twitching of adductor muscles on the medial side of the leg.

Question 10

lateral femoral cutaneous n. motor innervation indicated by?

Answer 10

Lateral femoral cutaneous – none

Question 11

obturator n. block root levels & position, landmarks and technique for needle insertion

Answer 11

L2-L4, 1.5 cm lateral to pubic tubercle, 1.5 cm inferior for needle insertion point

Question 12

obturator n. passes through what part of pelvis?

Answer 12

obturator foramen

Question 13

lumbar plexus n. block root levels & position, landmarks and technique for needle insertion

Answer 13

L1-L4, lateral decubitus, draw line b/t iliac crest, spinous processes (MIDLINE), 4cm lateral to spinous process is needle insertion point

Question 14

lumbar plexus covers what (AKA 3 in 1)

Answer 14

A lumbar plexus block provides anesthesia for the anterolateral and medial thigh, knee, and the saphenous nerve below the knee (lateral femoral cutaneous, obturator & femoral nerves). When combined with a sciatic nerve block, anesthesia of the entire leg can be achieved.

Question 15

lumbar plexus motor innervation is indicated by what?

Answer 15

quadriceps twitching

Question 16

name 5 nerves involved in foot block

Answer 16

saphenous, sural, tibial (posterior/deep) and superficial and deep peroneal n.

Question 17

nerves of the foot are branches of which 3 major nerves?

Answer 17

SCIATIC - TIBIAL, sural, COMMON PERONEAL - deep peroneal, superficial peroneal
FEMORAL - saphenous is the terminal branch

Question 18

what block provides anesthesia/analgesia to anterior thigh and knee?

Answer 18

femoral block

Question 19

what block is best for ACL repair?

Answer 19

femoral as adjunct to GA for KNEE region

Question 20

what nerves provide coverage ABOVE the knee?

Answer 20

femoral, sciatic, lat. femoral cut., and obturator

Question 21

what is the “3 in 1” block, WHAT nerves does it cover.

Answer 21

LUMBAR PLEXUS, lateral femoral cutaneous, obturator & femoral nerves

Question 22

terminal branch of femoral n.?

Answer 22

saphenous

Question 23

what n. blocks lower leg and foot?

Answer 23

sciatic

Question 24

of 5 nerves in foot, which 3 are superficial

Answer 24

superficial peroneal, saphenous, sural AKA “Tres S’s”

Question 25

which n. in foot does not arise from sciatic n.?

Answer 25

saphenous (FEMORAL)

Question 26

sural n. is branch of

Answer 26

TIBIAL (SCIATIC)

Question 27

THE FIVE NERVES of the foot have what function? WHICH DO FLEXION/EXTENSION?

Answer 27

sural - lateral sensation
tibial - sensation of heel, medial/lateral sole
sup. peroneal - sensation to dorsum & toes
deep peroneal - medial half & dorsum & toe extension
saphenous - superficial sensation anteromedial foot
TIBIAL - FLEXION, EXTENSION - PERONEAL

Question 28

SURAL n. is blocked b/t which structures

Answer 28

lat. malleolus & Achilles tendon

Question 29

general C.I. for lower extremity blocks

Answer 29

Infection at the injection site
Anticoagulant therapy
persistent peripheral neuropathies and/or paresthesias
High risk of developing compartment syndrome post-operatively
Surgical intervention on lower extremity nerves (i.e. need for neuromonitoring like SSEP, MEP, EMG, etc.)

Question 30

which lower extremity block has highest risk for systemic toxicity and why

Answer 30

lumbar pleuxus d/t placement deep in muscle beds, place w/ appropriate training only

Question 31

sciatic n. blocks best for which type of procedures?

Answer 31

knees and other lower leg, ankle or tibial fractures, and for patients in whom it may be desirable to avoid the sympathectomy accompanying neuraxial block, sciatic block combined with femoral nerve block often allows ankle and foot procedures to be carried out.

Question 32

obturator n. blocks best for which type of procedures

Answer 32

medial thigh and combined w/ others it is best for KNEES

Question 33

femoral n. block best for which type of procedures

Answer 33

anterior thigh, knee, femur, and combined w/ other regional technique/therapies for lower legs, and femoral fractures

Question 34

lateral cutaneous n. block best for which procedures/anatomical location?

Answer 34

lateral thigh