Hip and Lower Extremity Overview

Question 1

What are the 4 major nerves of the leg?

Answer 1

Femoral
Lateral femoral cutaneous
Obturator
Sciatic

Question 2

Femoral nerve innervates what?

Answer 2

Anterior thigh and knee
(the medial lower leg through the saphenous nerve branch of the femoral nerve)

Question 3

Sciatic nerve innervates what

Answer 3

Posterior thigh
Posterior knee
Everything below the knee execpt the medial portion (covered by the saphenous branch)

Question 4

Sciatic branches into 4 nerves

Answer 4

1. Deep peroneal
2. Superficial peroneal
3. Tibial
4. Sural

Question 5

What is the largest branch of the lumbar plexus?

Answer 5

Femoral nerve

Question 6

Is the femoral nerve motor or sensory?

Answer 6

Both

Question 7

Is the saphenous branch of the femoral nerve motor or sensory?

Answer 7

Sensory

Question 8

What is the longest spinal nerve in the body?

Answer 8

Sciatic

Also provides motor innervation to the leg

Question 9

Obturator nerve

Answer 9

Covers the upper medial portion of the thigh

Anterior branches can also innervate the hip and knee joints

Question 10

Lateral Femoral Cutaneous Nerve

Answer 10

Hip and upper lateral portion of the thigh

Question 11

Innervation of the foot

Answer 11

Sciatic Nerve

Common Peroneal Nerve
Superficial and Deep Peroneal

Tibial Nerve
Posterior Tibia
Sural

Question 12

Femoral and Fascia Iliaca Block tries to cover what?

3 things

Answer 12

1. Femoral and saphenous (reliably blocked)
2. Lateral femoral cutaneous (L2-L3) [reliably blocked]
3. Obturator (L2-L4) [not reliable]

Blocks everything but sciatic innervaiotn

Question 13

Femoral Nerve block

Answer 13

• Uses smaller amount of local (~20mL) around the femoral nerve
• Infrequently blocks obturator

Question 14

FICB (Fascia Iliaca Compartment Block)

Answer 14

• More lateral than the femoral block
• Larger volume of LA (~40mL)
• More success at blocking obturator
• Further away from the artery than the femoral block
• Better at blocking the lateral femoral cutaneous nerve, good for hip and femoral neck fractures

Question 15

Good and Bad for the Femoral Block and FICB?

Answer 15

Good:
Great coverage for the knee
Bad:
Also blocks motor function so patients can not ambulate

Question 16

Saphenous Nerve Block

Answer 16

• Can be blocked at the groin level by the femoral and FICB
• Can also be blocked more distal mid-thigh (at this lvl it is also called an adductor canal block)

Question 17

Spahenous Nerve Block Advantage

Answer 17

Preserves all motor function

Question 18

Spahenous Nerve Block Disadvantage

Answer 18

Only blocks the medial aspect of the knee and lower leg/foot

Question 19

Obturator Nerve Block Indications

Answer 19

Cysto: TURBT

Prevent movement if patient not paralyzed

Question 20

Does spinal anesthesia reliably block the oburator nerve reflex?

Answer 20

NO

Question 21

Sciatic Nerve Block: Transgluteal

Answer 21

Sedation is needed due to patient discomfort (pain and butt exposure)

High block that is able to cover the:
Posterior thigh and knee
Part of the hip
Everything below the knee execpt the medial portion (covered by the saphenous branch)

Question 22

Sciatic Nerve Block: Popliteal

Answer 22

• When the block is in the popliteal fossa it anesthetizes everything in the lower leg except for the medial aspect.
• Does not block the knee or posterior thigh
• Most common block for sciatic nerve blockade

Question 23

Sciatic popliteal fossa anatomy

Answer 23

Sciatic nerve branches into the medial (tibial nerve) and lateral (common peroneal nerve)

Question 24

The popliteal block is indicated for what surgeries?

Answer 24

Ankle

Question 25

How is complete anesthesia of the leg achieved?

Answer 25

Combinaiton block: Sciatic + fermoral or FICB

Question 26

IPACK Block?

Answer 26

**I**nfiltration Between the **P**opliteal **A**rtery and **C**apsule of the Posterior **K**nee Block

Question 27

IPACK advantages

Answer 27

Sensory not Motor blockade of the posterier knee ## Footnote Sciatic blocks motor and sensory of posterior knee

Question 28

IPACK disadvantage

Answer 28

Only blocks posterior knee, need to combine with another block for complete coverage of the knee

Question 29

Block of Choice: Hip

Answer 29

Fascia Iliaca

Question 30

Block of Choice: Anterior Thigh

Answer 30

Fasica Iliaca or Femoral

Question 31

Block of Choice: Knee

Answer 31

* Fascia Iliaca or Femoral (motor block) * Saphenous (motor sparring) * +/- IPACK (motor sparring)

Question 32

Block of Choice: Tibia

Answer 32

Popliteal

Question 33

Block of Choice: Ankle

Answer 33

Popliteal +/- Saphenous

Question 34

Block of Choice: Foot

Answer 34

Ankle or Popliteal