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Travis > Lower Extremity Blocks > Flashcards

Lower Extremity Blocks Flashcards

1
Q

Lumbar plexus block can be performed with which two techniques?

A

Psoas compartment or inguinal perivsscular

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2
Q

What areas does a lumbar plexus block cover?

A

Femoral
Lateral femoral cutaneous
Obturator

(FLO)

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3
Q

What surgeries are appropriate for a lumbar plexus block?

A

Surgery on hip, knee, and anterior thigh

Complete anesthesia of the knee requires addition of sciatic nerve block

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4
Q

Which lumbar plexus block is more appropriate for analgesia vs surgical anesthesia?

A

Inguinal perivascular

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5
Q

Which block is called a 3 & 1 block?

A

The inguinal perivascular (femoral, lateral femoral cutaneous, and obturator)

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6
Q

Which landmarks are identified in an inguinal perivascular block?

A

Femoral artery and inguinal ligament

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7
Q

Correct needle placement during inguinal perivascular block found by dividing the inguinal ligament into thirds is where?

A

2cm distal to junction of middle and outer thirds

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8
Q

Two pops during inguinal perivascular block indicate puncture of what structures?

A

Fascia lata (superficial) and fascia iliaca (deep)

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9
Q

Alternative landmark for needle placement during inguinal perivascular block?

A

1cm lateral to femoral artery and 1cm inferior to inguinal ligament.

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10
Q

Peripheral nerve stimulation of correct needle placement of inguinal perivascular block results in twitch in which muscle?

A

Quadriceps extension/twitch

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11
Q

Correct needle measurements for inguinal perivascular block

A

4cm 22g

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12
Q

Correct amount of local for inguinal perivascular block?

A

30-40 mL

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13
Q

Major 3 nerves of the lumbar plexus

A

Lateral femoral cutaneous (superior L2 and L3)
Femoral (inferior L2, L3, and superior L4)
Obturator (L2, L3, and L4 roots)

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14
Q

Lumbar plexus involves which spinal nerves?

A

L1-L4 with some T12

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15
Q

Which nerve gives rise to the saphenous nerve?

A

Femoral

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16
Q

What lies between the quadratis lumbarum and behind the psoas major?

A

Lumbar plexus

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17
Q

What is the correct position for psoas compartment block?

A

Lateral decubitus with operative side up and knees flexed.

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18
Q

Psoas compartment block is also known as…

A

Posterior LP block

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19
Q

Correct needle selection for psoas compartment block?

A

4 inch needle

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20
Q

What is the correct dose of LA for a psoas compartment block?

A

20-30 mL

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21
Q

Which block is associated with the highest complication rate?

A

Psoas compartment block

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22
Q

What are the common complications of psoas block?

A

Hematoma
LAST
intrathecal/epidural injection
renal capsule puncture

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23
Q

What is the correct needle placement for psoas compartment block?

A

5cm lateral and 3cm caudal to L4; advance until appropriate motor response of quadriceps muscle is elicited.

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24
Q

Where is L5 typically encountered when performing a psoas compartment block?

A

Around 5-10 cm; walk off superior edge and reposition more cephelad, advance to 8-12cm

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25
Q

Name the two ways a femoral nerve block can be performed.

A

Ultrasound and nerve stimulator

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26
Q

Femoral knee blocks are used for which procedures?

A

Knee and anterior thigh

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27
Q

Does the femoral block provide surgical or analgesic control of post op pain?

A

Post op pain control

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28
Q

Femoral nerve block provides anesthesia to what areas?

A

Entire anterior thigh and most of the femur and knee

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29
Q

Femoral block provides anesthesia to anterior thigh, most of the femur and knee with what dose of local?

A

30-40mL

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30
Q

What landmark is used for femoral nerve block?

A

Femoral artery in inguinal crease

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31
Q

Nerve stimulation of the femoral artery can achieved by placing ____ inch needle in a ______ direction at ___ degree angle until ____ muscle twitch is elicited.

A

2 inch needle, cephelad direction, at a 45 degree angle until quadriceps muscle twitch is elicited.

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32
Q

Ultrasound for femoral nerve block is placed where?

A

Parallel in inguinal crease

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33
Q

Femoral nerve will have what appearance under US

A

Honeycomb

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34
Q

Name landmarks of inguinal fold from lateral to medial

A

Nerve, artery, vein, empty space, lymphatics (NAVEL)

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35
Q

Saphenous nerve blocks are primarily used in conjunction with which block?

A

Sciatic

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36
Q

Sciatic + saphenous nerve blocks are used to provide anesthesia to what area?

A

Entire area below the knee

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37
Q

Saphenous block can be used alone to cover what area?

A

Medial lower leg

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38
Q

Saphenous nerve block can be performed how many different ways?

A

3 (trans sartorial, proximal saphenous, distal saphenous techniques)

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39
Q

Describe trans sartorial technique to saphenous nerve block

A

Needle inserted medial to lateral at junction of sartorius, versus medialis, and adductor muscles slightly above the knee 10-20 mL of local given (30 in Madisonville to cover medial thigh, knee and lower extremity)

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40
Q

Which plexus provides most innervation to lower leg?

A

Sacral plexus with exception of saphenous (femoral/lumbar plexus via femoral nerve)

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41
Q

Trans sartorial is also often referred to as what?

A

Adductor canal

42
Q

What is the benefit of using adductor canal (trans sartorial) block vs femoral, thus decreasing risk of post operative complications?

A

Less motor block, can ambulate sooner

43
Q

Describe proximal saphenous technique

A

Needle inserted 2cm distal to tibial tuberosity and directed medially with deposit of 5-10 mL local (lower leg)

44
Q

How much local is used in a proximal saphenous block?

A

5-10 mL

45
Q

Distal saphenous block provides anesthesia to what area?

A

Foot

46
Q

Describe distal saphephenous technique

A

Medial malleolus is identified and 5mL infiltrated in a line running anteriorly around the ankle

47
Q

How much local is required for distal saphenous block?

A

5mL

48
Q

Which block is referred to as the “sav-y” block?

A

Adductor canal: sartorius, adductor longus, vastus medialis (Nerve is where the sartorius and vastus medialis)

49
Q

Which block provides anesthesia to the lateral thigh?

A

Lateral femoral cutaneous

50
Q

When is it appropriate to use a lateral cutaneous block?

A

To supplement femoral or limited anesthesia for the lateral thigh

51
Q

What position is the patient placed in for lateral femoral cutaneous?

A

Supine or lateral

52
Q

What is correct needle placement for lateral femoral cutaneous block?

A

2cm medial and 2cm distal to anterior superior iliac spine

53
Q

What needle is appropriate for lateral femoral cutaneous blocks?

A

22g

54
Q

What is the best needle direction for lateral femoral cutaneous blocks?

A

Laterally to observe pop as it goes through the fascia lata

55
Q

How much local is required for a lateral femoral nerve blocks?

A

10-15mL

56
Q

Sciatic nerve blocks provide anesthesia to what areas?

A

Knee, hip, thigh, lower leg, and foot; most often performed with femoral or saphenous nerve blocks or lumbar plexus for complete lower extremity anesthesia

57
Q

What are the landmarks required for obturator nerve blocks?

A

Pubic tubercle (Needle placed 1.5cm inferior and 1.5cm lateral to the tubercle, once bone is contacted needle is redirected laterally and caudally and advanced 2-4cm until motor response is elicited)

58
Q

How much local is required for an obturator nerve block?

A

15-20 mL

59
Q

Obturator nerve block provides anesthesia to what area?

A

Knee; most often performed with femoral or sciatic nerve blocks.

60
Q

Sciatic nerve block is indicated for what procedures?

A

Hip, Knee, thigh, lower legs, and foot depending on the level where nerve is blocked.

61
Q

What position is required to posterior (Labat) approach of sciatic block?

A

Lateral with affected side bent at the knee and pelvis rolled forward (Sims position)

62
Q

What landmarks are identified for posterior sciatic nerve blocks?

A

Trochanter, posterior superior iliac spine,and sacral hiatus identified.

63
Q

Where are the lines drawn for posterior sciatic nerve blocks?

A

Trochanter to posterior superior iliac spine drawn caudally; then caudally from midpoint; then line from trochanter to sacral hiatus

64
Q

What is correct needle placement for posterior sciatic nerve block?

A

Right side of “A”

65
Q

How much local is required for posterior sciatic block?

A

25mL

66
Q

Where is the correct needle placement for anterior approach sciatic nerve block?

A

Inserted through anterior thigh medial to lesser trochanter

67
Q

What direction may make anterior sciatic block easier?

A

External rotation of leg to identify nerve under US

68
Q

Where is the probe placed for anterior approach to sciatic nerve block?

A

Transverse to medial thigh at level of lesser trochanter

69
Q

How is nerve identified under ultrasound for anterior sciatic block?

A

Hyperechoic

70
Q

How many mLs of local is required for anterior sciatic nerve block?

A

25mL

71
Q

Subgluteal approach to sciatic nerve blocks require patient to be in what position?

A

Sims (lateral affected side slightly bent at the knee and pelvis rolled forward)

72
Q

What landmarks are utilized for subgluteal approach to sciatic nerve block?

A

Greater trochanter and ischial tuberosity

73
Q

How is the correct needle placement identified for subgluteal approach to sciatic nerve block?

A

Line drawn from greater trochanter to ischial tuberosity; second line caudally down 4cm from midpoint of first line

74
Q

When can you assume you have correct needle placement for a subgluteal sciatic block?

A

Plantar flexion or inversion

75
Q

How much local is required for a subgluteal sciatic block?

A

25 mL

76
Q

Popliteal nerve blocks are still what kind of block?

A

Sciatic

77
Q

What surgeries are indications for popliteal nerve blocks?

A

Knee, tibia, ankle or foot

78
Q

What does the sciatic nerve divide into?

A

Tibial and common peroneal

79
Q

Where does the sciatic nerve divide?

A

Within or proximal to popliteal fossa

80
Q

The upper fossa is bound laterally where?

A

Biceps femoris tendon

81
Q

Upper fossa is bound medially by?

A

Semitendinosus and semimembranosus tendons

82
Q

What position is a patient placed in for a posterior approach of popliteal nerve blocks?

A

Prone and flex knee against resistance to identify fossa and where biceps femoris and semimembranous/semitendinosus join.

83
Q

Where is needle inserted during posterior approach to popliteal nerve blocks

A

1cm caudal to apex of fossa

84
Q

When will you know you have correct needle placement during posterior approach popliteal block?

A

Plantar flexion or inversion

85
Q

How much local is required for posterior approach popliteal block?

A

30-40 mL

86
Q

What position is the patient placed in for lateral approach popliteal block?

A

Supine knee extended and intertendinous grove palpated

87
Q

Where is needle inserted for lateral popliteal nerve block?

A

10cm proximal to the superior notch of the patella

88
Q

What direction is the needle advanced in a lateral popliteal block?

A

30 degrees posteriorly until motor response

89
Q

What size needle is appropriate for lateral approach popliteal block?

A

10cm

90
Q

What position is a patient placed in for ultrasound guided popliteal blocks?

A

Supine, prone, or lateral

91
Q

Where is ultrasound probe placed for popliteal block?

A

Transverse at the crease of knee and popliteal artery identified and nerve can be traced up to where it divides

92
Q

Where is nerve typically found for us guided

Popliteal block?

A

Lateral

93
Q

What can you have patient do to better local popliteal nerve with US?

A

Plantar Flex

94
Q

All nerves used in ankle block is ____ with the exception of the saphenous?

A

Sacral plexus

95
Q

What nerves are blocked for ankle block?

A 
Deep peroneal
Superficial peroneal 
Posterior tibial
Saphenous 
Sural
96
Q

Bottom of the foot is what nerve?

A

Tibial *medial and lateral *

97
Q

How much local is given at each location for an ankle block?

A

5mL

98
Q

Deep peroneal is located where?

A

Groove lateral to extensor hallucis longus muscle and injected lateral to dorsalis pedis at level of bone

99
Q

Superficial peroneal is located where?

A

30 degrees lateral at depth of tibia

100
Q

Saphenous nerve is where?

A

30 degrees medial at depth of medial malleolus of tibia

101
Q

Posterior tibial is located where?

A

Medial to Achilles tendon, and posterior to medial malleolus posterior to posterial tibial pulse

102
Q

Sural nerve is where?

A

Lateral to Achilles tendon and posterior to lateral malleolus

Travis (5 decks)

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