Lower extremity blocks 3 (new)

Question 1

Match each nerve block with the region that it anesthetizes:
deep peroneal nerve
superficial peroneal nerve
sural nerve
tibial nerve
heel dorsum of foot
lateral aspect of foot
web space between 1st and 2nd toe

Answer 1

Deep peroneal nerve- web space between 1st and 2nd toe
tibial nerve- heel
superficial peroneal nerve- dorsum of foot
sural nerve- lateral aspect of foot

Question 2

The foot and ankle are innervated by 5 nerves:

Answer 2

saphenous nerve
sural nerve
superficial peroneal nerve
deep peroneal nerve
posterior tibial nerve

Question 3

What nerves of the foot and ankle are purely sensory nerves?

Answer 3

the three nerves that begin with an ‘S’
saphenous nerve
sural nerve
superficial peroneal nerve

Question 4

Where do the nerves of the foot and ankle arise from?

Answer 4

all of them arise from the sciatic nerve, except for the saphenous nerve which arises from the femoral nerve

Question 5

Which nerves contribute to inversion/eversion?

Answer 5

TIPPED
tibial inversion plantar flexion + peroneal eversion dorsiflexion

Question 6

The saphenous nerve innervates the

Answer 6

medial aspect of the ankle and foot

Question 7

The sural nerve innervates the

Answer 7

posterior portion of the heel
lateral sole of the foot
Achilles tendon above the ankle

Question 8

The superficial peroneal nerve innervates the

Answer 8

dorsum of the foot

Question 9

The deep peroneal nerve innervates the

Answer 9

lateral side of the great toe
medial side of the second digit

Question 10

The posterior tibial nerve innervates the

Answer 10

sole of the foot

Question 11

In the foot, the posterior tibial nerve divides into the

Answer 11

medial calcaneal
lateral plantar
& medial plantar nerves

Question 12

Injecting a ring of local anesthetic from the midpoint of the distal tibia toward the inferior border of the medial malleolus will most likely anesthetize the:
a. sural nerve
b. posterior tibial nerve
c. saphenous nerve
d. superficial peroneal nerve

Answer 12

c. saphenous nerve

Question 13

Indications for an ankle block include

Answer 13

foot surery

Question 14

Complications of an ankle block include

Answer 14

nerve compression/ischemia
hematoma
LAST

Question 15

To minimize the risk of nerve compression and ischemia, you should avoid

Answer 15

excessive volumes of local anesthetic or vasoconstrictors such as epinephrine

Question 16

Which nerve is not immediately adjacent to a vascular structure (reducing the potential of bleeding, hematoma, & LAST)

Answer 16

superficial peroneal nerve

Question 17

Describe the landmark technique to anesthetize the posterior tibial nerve.

Answer 17

Draw a line connecting the superior portion of the medial malleolus and the Achilles tendon
palpate the posterior tibial artery
insert needle perpendicular to the skin, posterior to the tibial artery
if the patient experiences paresthesia, inject and slowly withdraw
if there’s no paresthesia, advance until it contacts the medial malleolus and then withdraw 2-3 mm

Question 18

Describe the landmark technique to anesthetize the sural nerve.

Answer 18

draw a horizontal line from the superior aspect of the lateral malleolus to the Achilles tendon
insert the needle in the plane of the line between the Achilles tendon and the lateral malleolus

Question 19

You can block the following nerves without removing the needle:

Answer 19

deep peroneal
superficial peroneal
saphenous nerve

Question 20

Describe the landmark technique to anesthetize the deep peroneal nerve.

Answer 20

With the patient in the supine position, draw a line from the superior border of the medial malleolus to the superior border of the lateral malleolus across the anterior aspect of the ankle
ask the patient to dorsiflex the foot
insert the needle perpendicular to the skin at the midpoint between the anterior tibial muscle and long muscles of the great toe
advance until you elicit paresthesia

Question 21

Describe the landmark technique to anesthetize the superficial peroneal nerve.

Answer 21

block the deep peroneal nerve and then redirect the needle tip toward the inferior border of the lateral malleolus in the subcutaneous tissue and block the superficial peroneal nerve

Question 22

Describe the landmark technique to anesthetize the saphenous nerve.

Answer 22

after blocking the deep peroneal and superficial peroneal nerves return to the midpoint and redirect the needle to the inferior border of the medial malleolus
find the saphenous nerve in the subcutaneous tissue adjacent to the saphenous vein and inject