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Levi's Class 2014 > Week 13 Lower Block Extremity > Flashcards

Week 13 Lower Block Extremity Flashcards

1
Q

What action will the tibial nerve control?

A

-Plantar Flexion (Push the gas pedal)

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2
Q

What action will the common peroneal nerve control?

A

-Dorsiflex the foot

Pull up toward your nose

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3
Q

What action will the lateral femoral cutaneous control?

A

Pinch the lateral thigh

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4
Q

What action will the femoral nerve control?

A

-Place hand under popliteal fossa and raise leg and then have the patient raise the knee. (Punt the ball)

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5
Q

What action will the obturator control?

A

-Abduct leg at hip and have patient adduct against pressure.

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6
Q

A lumbar plexus block will be in what position, needle dimension, and volume of LA block?

A
  • Lateral decubitus with slight forward tilt
  • 10 cm long needle
  • 25 to 35 cc
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7
Q

What are the landmarks for a lumbar plexus?

A
  • Mindline of the spinous process
  • iliac crest
  • Line drawn from iliac crest to intersect midline
  • 4 cm from midline is needle insertion point and be superior to PSIS
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8
Q

What is the minimum mA used for a lumbar plexus stimulator?

A

0.5 mA

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9
Q

What would be the indication for a obturator nerve block?

A
  • Hip pain
  • Procedure in knee and thigh with femoral block
  • Prevent movement during TURBT
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10
Q

What would be the contraindications for a obturator nerve block?

A
  • inguinal lymphadenopathy
  • perineal infection
  • Hematoma at site
  • Coagulopathy
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11
Q

What is the landmark for the obturator nerve?

A
  • Anterior Superior iliac spine
  • Pubic tubercle
  • Inguinal ligament
  • Femoral artery
  • femoral crease
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12
Q

How much LA would be used on a obturator nerve?

A

5 to 7 mL

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13
Q

What is the complication of an obturator nerve block?

A
  • possible intraperitoneal puncture

- Damage to bladder rectum and spermatic cord

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14
Q

What would be the indications for a femoral nerve block?

A
  • Anterior aspect of thigh
  • Superficial surgery on medial aspect of leg and below knee
  • Knee arthroscopy
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15
Q

What would be the contraindications for femoral nerve block?

A 
-Previous ilioinguinal surgery
     Femoral vascular graft, kidney transplant
-Large inguinal lymph nodes or tumor
-Local infection 
-Neuropathy
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16
Q

What are the landmarks for a femoral nerve block?

A
  • inguinal ligament
  • Inguinal crease
  • Femoral Artery
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17
Q

How much local is used on a femoral nerve block?

A

-15 to 20

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18
Q

What is the technique for a femoral nerve block?

A
  • Supine, remove pannus from area
  • Palpate femoral artery in crease
  • Needle inserted 1 cm lateral to pulse
  • Angled 45 degrees cephelad
  • Quadriceps contraction ((patellar twitch))
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19
Q

The three in one femoral block gets what nerves?

A
  • femoral nerve
  • lateral femoral cultaneous nerve
  • Obturator nerve
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20
Q

What is the proper technique for a femoral 3 in 1 block?

A
  • Same as a femoral nerve block

- Distal pressure 2-4cm from needle insertion held for 30 seconds

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21
Q

T/F: The femoral 3 in 1 block will always get the obturator if done right.

A

False

22
Q

What are the indication for a femoral 3 in 1 block?

A
  • lower limb surgery
  • Often combined with other blocks (femoral)
  • Lower leg, preferable to go lower for block
23
Q

What are the landmarks for a sciatic block?

A

-Greater trochanter
-PSIS
(Draw a line between greater trochanter and PSIS, mark midpoint and 4 cm perpendicular and distal for insertion of needle)

24
Q

What is the correct technique for sciatic block?

A
  • Apply pressure with free hand
  • Needle perpendicular to insertion
  • Depth is 5 to 8 cm
25
Q

How much local is used for a sciatic block?

A

-15 to 25 cc

26
Q

T/F: You know you have a good sciatic block when you see a gluteal twitch with the nerve stimulator.

A

FALSE

27
Q

What muscle will you see twitch with a sciatic nerve block?

A
  • Hamstring
  • calf
  • foot
  • toes
28
Q

What are the indications for a popliteal block?

A
  • Lower leg surgery

- Surgery on foot and ankle

29
Q

What other nerve may need to be blocked with a popliteal block?

A

-Saphenous coverage

30
Q

What position is best for a popliteal block?

A
  • posterior

- lateral

31
Q

How should the leg be positioned for a posterior popliteal block?

A

-foot dangling on pillow off end of bed

32
Q

What are the land marks for a posterior popliteal block?

A
  • popliteal crease
  • Tendon of biceps (laterally)
  • Tendons of semitendinosus and semimembranosus (medially)
  • MARK THESE AREAS AND DRAW 7CM PROXIMAL BOX.
33
Q

What is the correct technique for a posterior popliteal block?

A
  • Needle insertion medially of the 7cm proximal box made

- Depth 3 to 5 cm

34
Q

What type of muscle twitches will be seen with a nerve stimulator with a posterior popliteal block?

A
  • Tibial plantar flexion and inversion

- Common peroneal: dorsiflexion and eversion

35
Q

What are the landmarks for a lateral popliteal block?

A
  • popliteal fossa crease
  • vastus lateralis muscle
  • Biceps femoris muscle
  • Groove between mmuscles noted
36
Q

What is the correct lateral popliteal technique?

A
  1. Needle insertion is 8 cm above popliteal crease between muscles
  2. Needle inserted and strikes femur
  3. The nerve should be 1 to 2 cm deeper then bone contact
  4. Redirect needle 30 degrees posterior to stimulate nerve this is usually at 5 to 7 cm depth
  5. Twitches will be in the foot
37
Q

Where will twitches be seen in a lateral popliteal approach?

A

Foot

38
Q

T/F: the saphenous block is used to supplement the popliteal block?

A

TRUE

39
Q

What is the correct landmarks for a transsartorial approach for a saphenous block?

A
  • Sartorius muscle on medial aspect of leg

- Patella

40
Q

What is the correct technique for a transsartorial saphenous block?

A
  1. Insert needle through sartorius muscle 1 to 2 cm above patella
  2. Loss of resistence felt at 1.5 to 2 cm depth
  3. aspirate and inject 10 mL of local
41
Q

How would you do a paravenous approach for a saphenous block?

A
  1. Tourniquet placed on leg to ID saphenous vein

2. Inject 5 cc of local on both aspect of the vein in the subcutaneous tissue just below the patella

42
Q

How would you do a below the knee block approach for a saphenous nerve block?

A
  • ID tibial tuberosity
  • Inject 5 to 10 mL local in sub Q between medial aspect of tibial tuverosity and medial aspect of calf (GASTROCNEMIUS MUSCLE)
43
Q

What would be the indication for a ankle block?

A

FOOT

44
Q

What are the landmarks for a foot block?

A
  • Medial and lateral malleoli
  • Achilles tendon
  • extensor longus tendon
  • Posterior tibial and dorsalis pedis arteris
  • Sustentaculum Tali
45
Q

What is the correct technique for a ankle block?

A

-Saphenous,superficial, and sural
blocked with subcutaneous infiltration around line with 10 to 15 mL
-Deep Peroneal
Lateral to extensor halluces longus tendon and inject with 5 to 8 cc
-Tibial
Just posterior to posterior tibial artery or midway between achilles tendon and medial malleolus then insert needle to bone and inject 5 to 8 mL

46
Q

What are the indications for a bier block?

A

-anesthesia of extremity up to an hour

47
Q

What are the complication of a bier block?

A

-High risk for local toxicity (leakage under tourniquet, unexpected tourniquet release, not enough time for tourniquet release)

48
Q

What is the minimum amount of time before you can release the tourniquet on a bier block?

A

-20 minutes (preferably 30 minutes)

49
Q

List in order the correct way to administer a bier block?

A
  1. Position patient comfortably
  2. IV placed as far distally as possible in hand or foot
  3. Place double cuff tourniquet high on extremity
  4. elevate extremity and wrap extremity tightly form distal to proximal
  5. Manually compress artery
  6. Inflate tourniquet proximal cuff 50 to 100 mmHg above systolic pressure
  7. Inject with 30 to 50 cc of 0.5% lidocaine for arm (50 to 100 for leg)
  8. IV withdrawal
  9. GIVE TIME TO SET UP 15 TO 20 MINUTE
50
Q

What are the indications for a ilioinguinal iliohypogastric block?

A
  • C section

- Lower abdominal wall/inguinal region

51
Q

What is a complication of a ilioinguinal iliohypogastric block?

A

perforation of bowel

Levi's Class 2014 (16 decks)

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