Lower extremity blocks 2 (new)

Question 1

A pericapsular nerve group block would be MOST effective for perioperative pain management for which patient scenario?
a. ORIF of a distal femur fracture
b. total knee arthoplasty
c. ankle arthoplasty
d. nailing of a hip fracture

Answer 1

d. nailing of a hip fracture

Question 2

A pericapsular nerve group block is also known as

Answer 2

PENG

Question 3

Indications for a pericapsular nerve group block include

Answer 3

hip fracture and arthoplasty

Question 4

The objective of the pericapsular nerve group block is to inject LA

Answer 4

deep into the psoas tendon at the level of the iliopubic eminence

Question 5

Complications of the PENG block include

Answer 5

ureter injury
LAST
injection directly into the psoas muscle may increase the risk of quadriceps weakness

Question 6

The hip joint is innervated by the following nerves:

Answer 6

femoral, obturator, & sciatic nerves

Question 7

Key anatomic landmarks of the PENG block include

Answer 7

the femoral vein, artery, and nerve
the iliopsoas muscle and tendon
anterior inferior iliac spine
iliopubic eminence

Question 8

What type of block is the PENG block?

Answer 8

sensory only (preserves quadriceps function)

Question 9

When combined with a ____________________________ block, the PENG offers an alternative to the femoral and fascia iliaca block.

Answer 9

lateral femoral cutaneous nerve

Question 10

Which of the following nerves is NOT blocked when performing a fascia iliaca block?
a. femoral nerve
b. lateral femoral cutaneous nerve
c. obturator nerve
d. posterior femoral cutaneous nerve

Answer 10

d. posterior femoral cutaneous nerve

Question 11

The objective of a fascia iliaca block is to

Answer 11

deposit LA below fascia iliaca that travels towards the lumbar plexus

Question 12

A fascia iliaca block is indicated for

Answer 12

procedures involving the femur, quadriceps, and knee
acute pain management for hip fractures

Question 13

Complications of a fascia iliaca block include

Answer 13

LAST

Question 14

What nerves does the fascia iliaca block target

Answer 14

femoral nerve
obturator nerve
lateral femoral cutaneous nerve

Question 15

When compared to the lumbar plexus block, the fascia iliaca block provides a

Answer 15

faster and more consistent blockade of the femoral and lateral femoral cutaneous nerves

Question 16

If using a landmark technique & nerve stimulator for the fascia iliaca block, you should see

Answer 16

patellar snap

Question 17

If using a landmark technique with nerve stimulator for the fascia iliaca block and you cause stimulation of the sartorius muscle,

Answer 17

it will cause inner thigh twitching if the needle is inserted too superficially and medially to the femoral nerve

Question 18

Local anesthetic injected above the fascia iliaca frequently results in

Answer 18

a failed or incomplete block

Question 19

Due to the large volume of local anesthetic injected with a fascia iliaca block, you may see

Answer 19

quadriceps weakness

Question 20

The objective of the femoral nerve block is to deposit local anesthetic around the

Answer 20

femoral nerve

Question 21

Indications for performing a femoral nerve block include

Answer 21

procedures involving the hip, femur, quadriceps, and knee

Question 22

Complications of a femoral nerve block include

Answer 22

LAST
nerve injury

Question 23

The femoral triangle borders include

Answer 23

Sartorius muscle
Adductor longus muscle
Inguinal ligament
(SAIL)

Question 24

The anterior branch of the femoral nerve provides innervation for the

Answer 24

ventral surface of the thigh and sartorius muscle

Question 25

The posterior branch of the femoral nerve provides innervation to the

Answer 25

quadriceps muscles, knee joint, and its medial ligament

Question 26

When used alone, the femoral nerve block

Answer 26

does not provide sufficient coverage for surgical anesthesia (must be combine with a sciatic nerve block)

Question 27

The femoral nerve is most compact

Answer 27

just distal to the inguinal ligament

Question 28

With the femoral block, local anesthetic injected above the fascia iliaca frequently results in

Answer 28

a failed or incomplete block

Question 29

Because of associated quadriceps weakness, FNB contributes to the

Answer 29

rate of falls following lower extremity total joint surgery

Question 30

What is the advantage of performing an adductor canal block over a femoral nerve block as part of a multimodal pain management plan?
a. prevents foot drop
b. limits quadriceps weakness
c. reduces plantar flexion
d. provides both motor and sensory nerve block

Answer 30

b. limits quadriceps weakness

Question 31

What is the objective of the adductor canal block?

Answer 31

to deposit LA around the saphenous nerve in the adductor canal

Question 32

Indications for an adductor canal block include

Answer 32

ACL & MCL repair
vein stripping and harvesting
supplementation to a sciatic nerve block for foot/ankle surgery
patella fracture

Question 33

Complications of an adductor canal block include

Answer 33

Nerve injury, LAST

Question 34

The adductor canal starts at the ____________ and ends at the _____—

Answer 34

base of the femoral triangle & ends at the adductor hiatus

Question 35

The roof of the adductor canal is the

Answer 35

sartorious

Question 36

The lateral wall of the adductor canal is the

Answer 36

vastus medialis

Question 37

The remainder of the canal is the

Answer 37

adductor longus or magnus

Question 38

Quadriceps weakness with the adductor canal block is more likely with

Answer 38

proximal injections and local anesthetic volumes that exceed 20 mLs

Question 39

Stimulation of the tibial nerve in the popliteal fossa causes:
a. plantar flexion and inversion of the foot
b. plantar flexion and eversion of the foot
c. dorsiflexion and inversion of the foot
d. dorsiflexion and eversion of the foot

Answer 39

a. plantar flexion and inversion of the foot

Question 40

The objective of a popliteal nerve block is to

Answer 40

deposit LA around the common peroneal and tibial nerves located between the biceps femoris & the semimembranosus and semitendinosus

Question 41

Indications for a popliteal nerve block include

Answer 41

procedures on the lower leg, ankle, and foot

Question 42

Complications of a popliteal nerve block include

Answer 42

Foot drop
LAST
hematoma

Question 43

Key landmarks of the popliteal fossa include

Answer 43

popliteal artery and vein
biceps femoris, semitendinosus, and semimembranosus muscles
bifurcation of the sciatic nerve into the common tibial nerve and common peroneal nerves

Question 44

What is the popliteal nerve block used for?

Answer 44

provides pain control for below-the-knee surgical procedures such as ankle surgeries, achilles tendon repair, and foot surgeries

Question 45

Describe the landmark technique for the popliteal bloc,

Answer 45

Patient in prone position with slight extremity flexion
draw a line from the biceps femoris medially to the smitendinosus at the popliteal crease
at the midpoint, extend a perpendicular line approx 10 cm. cephalad
needle insertion point is 1 cm lateral to this line

Question 46

What does the mnemonic TIPPED stand for?

Answer 46

Tibial Inversion Plantar flexion + Peroneal Eversion Dorsiflexion

Question 47

The main drawbacks of the peroneal nerve block include

Answer 47

foot drop & numbness of the sole which can lead to patient falls