APEX REGIONAL - III: Lower Extremity Flashcards
(75 cards)
1
Q
Which nerve arises from the lumbar plexus?
A
FOL
Femoral
Obturator
Lateral femoral cutaneous
2
Q
Lumbar plexus arises from the ______rami of what level
A
L1-L4
3
Q
Lumbar plexus gives rise to 6 nerves
A
IhIIGLOF
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral cutaneous
Obturator
Femoral
4
Q
Sciatic PLEXUS gives rise to the
A
Sciatic and posterior femoral cutaneous
5
Q
Coccygeal plexus gives rise to the
A
Pudental nerve
6
Q
Mnemonic To remember Lumbar Plexus
A
I Invariably Get Lazy On Fridays
7
Q
Corresponding nerve roots to Sciatic nerve
A
L4-S3
8
Q
Corresponding nerve roots to Femoral nerve
A
L2-L4
9
Q
Corresponding nerve roots to Lateral femoral cutaneous
A
L2-L3
10
Q
Corresponding nerve roots to Posterior Femoral cutaneous
A
S1-S3
11
Q
Common peroneal nerve other name
A
Common fibular nerve
12
Q
Lateral Femoral cutaneous motor
A
NONE
13
Q
Lateral femoral cutaneous nerve sensation
A
Lateral nerve
14
Q
First nerve to leave the lumbar plexus
A
Lateral femoral cutaneous
15
Q
What is the largest of these 3 nerves?
A
Femoral nerves
16
Q
Femoral nerve forms near the
A
Middle and lower third of the psoas muscle
17
Q
Femoral nerve It splits into an
A
anterior and posterior branch
18
Q
Femoral Nerve MOTOR: Anterior branch
A
Sartorius
19
Q
Femoral Nerve MOTOR: Posterior branch
A
Quadriceps
20
Q
Femoral Nerve SensoRy:
A
Anterior thigh
21
Q
The obsturator nerve arises from the
A
Medial border of the psoas muscle at the level of the sacroilliac joint
22
Q
Obturator Motor
A
HIp adductors
23
Q
Sensory of Obturator
A
Distal inner thigh and part of the hip
24
Q
The largest nerve in the body is the
A
SCIATIC nerve
25
Sciatic nerve provides motor innervation
Posterior thigh as well motor and sensory innervation to the vast majority to the lower level and foot via its branches (tibial and common peroneal nerves)
26
Posterior Femoral Cutaneous supplies sensory information to the
Posterior aspect of the thigh.
27
Area of Inner aspect of kne
Obturator
28
Psoas compartment block anesthesizes
Saphenous
Obturator
Lateral femoral cutaneous
29
Complications: Blockade of the lumbar plexus creates a
sympathectomy of the ipsilateral extremity.
30
Local anesthetic volumes greater than 20 mL for blockade of lumber plexus
increase the risk of bilateral spread and contralateral limb involvement. This creates a bilateral sympathectomy.
31
Of all lower extremity peripheral nerve blocks, which block has one of the highest complication rates including retroperitoneal hematoma and renal capsular injection.
the lumbar plexus block
32
Lumbar plexus highest complication of
retroperitoneal hematoma and renal capsular injection.
33
Is a contraindication to the psoas compartment block.
Coagulopathy
34
Median to lateral femoral anatomy (VAN)
Vein
Artery
Nerve
35
What is the most common lower extremity block?
The femoral block
36
FEMORAL BLOCK used alone?
When used alone, it does not provide sufficient coverage for surgical anesthesia, but it's useful as part of a multi-modal approach for procedures involving the thigh, knee, and medial aspect of the lower extremity.
37
When combined with a sciatic nerve block, it provides almost complete surgical coverage to the lower extremity.
Femoral nerve block
38
The femoral nerve arises from the posterior divisions of. After these nerve roots exit the spinal column, they give rise to the femoral nerve within the_____The femoral nerve stays in the groove between the psoas major and iliac muscles before entering the
L2-L4; psoas major. femoral triangle.
39
Inside the triangle, the femoral nerve runs:
Deep to the inguinal ligament
Anterior to the iliopsoas muscle
Inferior to the fascia lata and fascia iliaca
40
FEMORAL nerve: The triangle is shaped like the "SAIL" of a ship, so we can use this as a mnemonic to remember its borders:
S = Sartorius muscle
A = Adductor longus muscle
IL = Inguinal ligament
41
The 3-in-1 block is a different approach to a femoral nerve block. It is designed to anesthetize three nerves with one injection: the nerves are
Femoral n.
Lateral femorcutaneous n.
Obturator n. (most commonly missed)
42
Adductor Canal Block
The adductor canal block can be thought of as a femoral nerve block lower in the thigh (the femoral nerve is beneath the sartorius muscle at this location). Many of the motor nerves of the femoral n. branch above the level of the adductor canal, which means that you can provide analgesia for knee surgery without affecting quadriceps function. This helps patients ambulate faster after surgery.
43
The fascia iliaca block is similar to the femoral nerve block, however the approach is slightly different. The needle insertion point is
more lateral and distant from the femoral neurovascular bundle.
44
This block has been used for analgesia following hip fractures, as well as surgical procedures of the hip, femur, and knee in adult and pediatric patients.
Fascia Illiaca Block
45
Nerve stimulation or ultrasound is not required when performing this block, and reliable anesthesia can be accomplished with a sound understanding of the anatomical landmarks and tactile sensation.
Fascia Illiaca Block
46
A successful block for FASCIA illiaca block is more dependent on the needle
passing through both fascial layers (fascia lata and fascia iliaca), so that the local anesthetic is deposited inferior to the fascia iliaca but superior to the iliopsoas muscle.
47
Volume injected for the fascia illiaca block
Following negative aspiration, incremental injections of 5 mL of local anesthetic (each followed by negative aspiration) are administered until a total volume of 30-40 mL is injected.
48
The saphenous nerve is the
terminal branch of the posterior division of the femoral nerve.
49
It provides sensory innervation from the medial aspect of the knee to the medial malleolus.
Saphenous Nerve
50
Purely sensory nerve
SAPHENOUS There is no motor component.
51
This block is useful when combined with a popliteal or ankle block, as these don't capture the
saphenous distribution.
Saphenous nerve block
52
Saphenous nerve block amount of LA
A small skin wheal is raised at the needle insertion point, and the needle is passed using an in-plane approach, medial to lateral, with 5-10 mL deposited within the fascial plane between the muscles.
53
The sciatic nerve arises from
L4-5 and S1-3.
54
The sciatic nerve is actually two nerves contained within a sheath
Tibial nerve
Peroneal Nerve
55
Sciatic nerve exits sheath
It exits the pelvis inferior to the piriformis muscle via the great sacrosciatic foramen.
56
As it continues caudally, it passes between the major trochanter and the tuberosity of the ischium into the lower third of the thigh. This is where the sciatic nerve divides into
tibial and common peroneal nerves.
57
By itself, the sciatic nerve block is useful for procedures on the back of the
thigh, lower leg, ankle, and foot.
58
Combining the sciatic nerve block with a lumbar plexus block provides anesthesia where?
complete anesthesia to the lower extremity and may be useful in the patient who may not tolerate sympathectomy from a neuraxial block.
59
The popliteal block targets the
sciatic nerve in the proximal popliteal fossa
60
At this location, the sciatic nerve is posterior and lateral to the popliteal artery and vein, and is bordered medially by the _____and laterally by the ______
semitendinosus and semimembranosus muscles and laterally by the biceps femoris muscle.
61
Triangle of the popliteal include
Biceps femoris
Semitendinous muscles.
62
Mnemonic: Ankle BLock
TIPPED (Tibial Inversion Plantar Flexion + Peroneal Eversion Dorsiflexion
63
Anatomy Tibial nerve is _____of the ______of the ____nerve
The tibial nerve is the larger of the two branches of the sciatic nerve.
64
Several branches leave the tibial nerve at the level of the medial malleolus, most notably _____ and_____the which provide innervation to the
medial and lateral plantar nerves; sole of the foot.
65
The sural nerve is formed from branches of the
It travels superficially as it courses distally behind the lateral malleolus of the ankle, providing sensation to the
tibial and common peroneal nerves; posterior portion of the heel and sole of the foot, as well as part of the Achilles tendon above the ankle.
66
The superficial peroneal nerve, also a branch of the common peroneal nerve, becomes superficial in the
It courses subcutaneously anterior to the lateral malleolus, providing several branches to the
lower two-thirds of the leg; dorsum of the foot.
67
The deep peroneal nerve is a branch of the
common peroneal nerve.
68
At the level of the ankle, it lies lateral to the anterior tibial artery and medial to the
long extensor muscle of the great toe.
69
It is responsible for innervating the short extensors of the toes, and provides sensory innervation to the skin on the lateral side of the hallux and medial side of the second digit.
Deep peroneal nerve
70
It travels distally below the knee between the anterior tibial muscle and the long extensor muscle of the great toe into the ankle.
Deep peroneal nerve.
71
The saphenous nerve is the terminal branch of the
It follows the greater saphenous vein distally along the anterior aspect of the medial malleolus.
femoral nerve and courses subcutaneously along the medial aspect of the knee.
72
It provides sensory innervation to the medial aspect of the lower extremity below the knee.
Saphenous nerve
73
At the level of the ankle the saphenous nerve is located in the subcutaneous tissue,
superficial to the vein.
74
The ankle block, usually performed by infiltration technique, can be challenging, as it requires identification and injection of local anesthetic at multiple sites. Four of these nerves are located close to_____
either arteries or veins, increasing the potential for vascular injection.
75
Additionally, because the nerves of the ankle are confined within tight spaces between ligaments and tendons, excessive local anesthetic volumes and vasoconstrictors such as_______ should be avoided to minimize______complications.
epinephrine should be avoided to minimize the risk of ischemic complications.
