Lower Extremity Blocks

Question 1

What are your four quadriceps muscles?

Answer 1

Vastus Lateralis
Vastus Medialis
Rectus Femoris
Vastus Intermedias

Question 2

What is the adductor canal?

Answer 2

An intermuscular tunnel in the anteromedial thigh that lies posterior to the sartorius muscle.
Proximal origin = femoral triangle
Termination = adductor hiatus

Question 3

What passes through the adductor canal?

Answer 3

The saphenous nerve and the nerve to the vastus medialis.

Question 4

What does the saphenous nerve do?

Answer 4

The terminal branch of the femoral nerve that is purely sensory.

Medial aspect of the leg

Question 5

What does the adductor canal block?

Answer 5

sapphenous and vastus medialis

Question 6

ACB technique

Answer 6

Patient supine w/slight external rotation of extremity
Transducer placed mid to distal third of thigh
Short-axis, in-plane
LA placed in the fascial plane separating the sartorius and vastus medialis lateral to the femoral vessels

Question 7

What do you NOT get w/PENG block?

Answer 7

posterior cap coverage

Question 8

Absolute contradindications (4)

Answer 8

patient refusal
active bleeding in anticoagulated patient
allergy
local infection

Question 9

Lumbar plexus is:

Answer 9

L1-L4

Question 10

What do you block for hernia repairs?

Answer 10

Iliohypogastric & Ilioinguinal

Question 11

Lumbarsacral plexus is:

Answer 11

L4 - S3

Question 12

What are the two most important nerves for hip procedures?

Answer 12

Femoran nerve and lateral femoral cutaneous

Question 13

Nerve stimulation of the femoral nerve causes

Answer 13

patellar snap d/t quadriceps pulling patella upwards

Question 14

Name the four lumbar plexus blocks

Answer 14

femoral
fascia iliaca
adductor canal
saphenous (thigh + ankle)

Question 15

Name the four lumbosacral plexus blocks

Answer 15

sciatic (subgluteal)
sciatic (popliteal)
iPACK
ankle

Question 16

What does the lumbar plexus supply?

Answer 16

Sensory + motor innervation to thigh, anterolateral knee, Sensory innervation to medial aspect of LE below knee

Question 17

Femoral Nerve Block provides anesthesia to?

Answer 17

anterior thigh
knee
medial aspect of LL

Question 18

FNB Technique

Answer 18

patient supine, slight external rotation of extremity
transducer placed over inguinal crease, over femoral pulse
nerve = hyperechoic ovoid lateral to femoral artery, beneath fascia lata and iliaca

Question 19

FNB what size needle

Answer 19

5 cm B-bevel

Question 20

FNB how much LA

Answer 20

20 mL

Question 21

what is the ligament that stretches from anterior superior iliac spine to pubic tubercle

Answer 21

inguinal ligament

Question 22

where do you place LA for FNB

Answer 22

between fascia lata and fascia iliaca

Question 23

What does the fascia iliaca block

Answer 23

Femoral, obturator, LFC

Question 24

how much volume for a fascia iliaca block

Answer 24

40 mL

Question 25

where does the LFC traverse?

Answer 25

LFC goes across sartorius

Question 26

what makes the femoral triangle

Answer 26

inguinal ligament sartorius medial aspect of adductor longus

Question 27

saphenous nerve block

Answer 27

distal to the adductor canal, the saphenous courses superficially in the distal thigh

Question 28

What does the saphenous nerve innervate

Answer 28

sensory aspect to medial LE below the knee

Question 29

saphenous nerve block technique

Answer 29

patient supine w/slight external rotation transducer at distal thigh LA deposited in fascial plane separating the adductor longus and vastus medialis below SQ

Question 30

how much do you inject for saphenous

Answer 30

5 - 10 mL LA

Question 31

sciatic block (subgluteal) anatomy

Answer 31

sciatic nerve deep to the gluteus maximus between ischial tuberosity and greater trochanter

Question 32

what does the subluteal block result in

Answer 32

sensorh + motor blockade of LE below knee EXCEPT SENSORY INNERVATION OF MEDIAL LOWER EXTREMITY

Question 33

what innervates posterior thigh

Answer 33

femorocutaneous nerve and it may be missed w/subgluteal approach

Question 34

subgluteal block

Answer 34

patient prone or lateral low frequency curvilinear LA deposited in fascial plane separting the adductor longus & vastus medialis

Question 35

how much LA for subgluteal bock?

Answer 35

20 mL

Question 36

what causes dorsiflexion?

Answer 36

peroneal

Question 37

what causes plantar flexion?

Answer 37

tibial

Question 38

what will you get w/ns for subgluteal block?

Answer 38

plantar flexion or dorsiflexion

Question 39

what does the popliteal nerve target

Answer 39

sciatic nerve above the knee

Question 40

popliteal fossa, the sciatic nerve is bordered

Answer 40

superiorly by semitendinosus and semimembranosus | and superior / laterally by biceps femoris

Question 41

usg technique for popliteal fossa

Answer 41

patient supine, operative leg elevated | tibial nerve is superior to popliteal artery + vein, scan cephalad to locate bifurcation w/popliteal n.

Question 42

explain the spread for popliteal

Answer 42

cicumferencial spread around the nerves

Question 43

IPACK is?

Answer 43

infiltration between the popliteal artery and posterior capsul of the knee to block the terminal branches, sparing the distal innervation of tibial and peroneal branches

Question 44

IPACK covers

Answer 44

posterior knee pain congtrol for TKA

Question 45

IPACK benefits

Answer 45

preserves foot drop, helps postop ambulation

Question 46

IPACK technique

Answer 46

lateral decub transverse plane above popliteal crease identify space btw popliteal artery + vein and intercondylar notch

Question 47

how much LA for iPACK

Answer 47

15 - 20 mLwhile withdrawing needle

Question 48

five nerves to foot

Answer 48

``` sural deep peroneal superficial peroneal posterior tibial sapphenous ```

Question 49

what nerve do you always block w/foot

Answer 49

TIBIAL

Question 50

how to treat LAST

Answer 50

1. airway management 2. benzos for seizures 3. treat hypotension and bradycardia 4. lipid emulsion 5. vasopressors epi < 1 mg/kg

Question 51

how much lipid emulsion for last

Answer 51

> 70 kg 100 mL over 2-3m | 200 over 20 minutes

Question 52

how much lipid emulsion for pt < 70

Answer 52

1. 5 mL/kg over 2- 3 m | 0. 25 mL/kg/m (IBW)

Question 53

max dosing of lipids

Answer 53

12 / kg