Femoral nerve block

Question 1

femoral nerve block alone will generally not provide surgical analgesia for what areas

Answer 1

hip, thigh, knee and or ankle

Question 2

femoral nerve block risk of complicaions

Answer 2

low risk

Question 3

what does the term 3-in-1 block refer to

Answer 3

anesthetizing the femoral, lateral femoral cutaneous, and obturoator nerves with a single injection below the inguinal ligament.

Question 4

is the 3-in-1 block always successful

Answer 4

not always it is difficult to get all 3 nerves with one single injection

Question 5

the femoral nerve innervates

Answer 5

main hip flexors

knee extensions

provides much of the sensory innervation to the high and thigh.

Question 6

how much local anesthetic is injected into the femoral nerve

Answer 6

30-40ml of la

Question 7

position for femoral nerve block

Answer 7

supine

Question 8

palpate femoral artery at level of inguinal ligament (may use US to view structures- femoral vein, artery and femoral nerve- what does the femoral nerve look like

Answer 8

spindle shaped structure with a honey comb texture

Question 9

what size needle is used and how long for a femoral nerve block

Answer 9

short 5cm insulated needle 22g

Question 10

what angle do you insert the needle for a femoral nerve block. what muscle will twitch

Answer 10

45 degree angle in a cephalad direction until a quadriceps twitch is elicited at a current of 0.5mA

Question 11

indications for femoral nerve blocks

Answer 11

post op pain relief of knee surgeries

Surgical indications include soft tissue exploration, biopsy, and repair of lacerations of the anterior thigh.

Complete or partial analgesia may be produced to provide relief for painful conditions of the upper leg, including femoral shaft and neck fractures, as well as knee surgery

Question 12

where is the needle directed for femoral block

Answer 12

except needle is directed cephalad and distal pressure given while injecting local

Question 13

Lat Femoral Cutaneous: uses

Answer 13

Used in conjunction with blockade of other nerves to provide anesthesia for surgical procedures involving the leg.

Alone, it is used to provide anesthesia for superficial procedures on the lateral thigh, such as skin grafting.

It is also used in the diagnosis and treatment of meralgia paresthetica, a pain syndrome involving the lateral femoral cutaneous nerve.

Question 14

Lat Femoral Cutaneous-position

Answer 14

Supine (or lateral) position

Question 15

how much local is injected lateral cutaneous nerve

Answer 15

After careful aspiration, 10 to 15 ml of LA is injected which is deposited above and below the fascia lata (in a medial‑to‑lateral fan-like distribution to ensure “painting” the nerve branches at this level)

Question 16

how is the fascia lata identified in the lateral cutaneous femoral block

Answer 16

The fascia lata is identified by a “release” or a “pop” as a needle passes through it

Question 17

how short is the needle and what size is used for lateral cutaneous needle

Answer 17

A short (3‑4 cm) 22 G needle is inserted through a skin wheal and directed laterally

Question 18

injection site of the lateral cutaneous femoral nerve

Answer 18

The injection site is identified at a point 2 cm medial and 2 cm distal to the anterior superior iliac spine (if using US, place in femoral crease)

Question 19

the lateral femoral cutaneous nerve- side effects

Answer 19

In theory, direct nerve injury is possible, but in clinical practice this is one of the few nerve blocks with no side effects or complications

Question 20

obturators nerve

Answer 20

Both a motor and a sensory nerve
Sensory branches to the hip & knee joints, medial thigh
Innervates the adductors of the hip

Question 21

obturators nerve blockade produces anesthesia where

Answer 21

Blockade produces anesthesia over the medial aspect of the distal thigh and paresis of the leg adductors

Question 22

when is the obturators nerve most often performed

Answer 22

in combination with femoral and sciatic nerve block for anesthesia of the knee

Question 23

the obturator nerve exits the pelvis and enters the medial thigh through the

Answer 23

Exits the pelvis & enters the medial thigh through the obturator foramen (which lies beneath the superior pubic ramus)

Question 24

in the thigh the obturator nerve divides into what two branches

Answer 24

anterior and posterior branches

Question 25

the obturator nerve accompanies what two things to the obturator foramen

Answer 25

obturator artery and vein to the obturator foramen and through the obturator canal into the thigh.

Question 26

the obturator block when used alone is useful in aiding in the diagnosis and treatment of

Answer 26

pain syndromes involving the hip join

Question 27

the obturator block when used to relieving

Answer 27

adductor spasms of the hip

Question 28

obturator injection site landmarks

Answer 28

The injection sight is identified at a point 1 to 2 cm lateral and 1 to 2 cm (1.5 cm) inferior and 1.5 cm lateral to the tubercle

Question 29

obturator nerve la amount

Answer 29

After negative aspiration, inject 15-20 mL of LA

Question 30

technique needle for obturator what muscle is elicited

Answer 30

10cm block needle is inserted until bone is contacted- then redirected laterally and caudally the needle is advanced an additional 2-4cm until a motor response thigh adduction is elicited and maintained <0.5ma

Question 31

obturator side effects

Answer 31

Intravascular injection may rarely occur into either the obturator artery or vein Careful aspiration before injection nearly eliminates this potential complication. Careful attention to the bony landmarks and the depth of needle insertion reduces the chance of needle placement into surrounding structures such as the bladder, rectum, vagina, or spermatic cord