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APA Fundamentals > Lower Extremity PNB > Flashcards

Lower Extremity PNB Flashcards

1
Q

Where is the lumbosacral plexus located?

A

L1-S5 (may include T12).

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2
Q

Where is the iliohypogastic nerve formed?

A

T12-L1

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3
Q

Where does the iliohypogastric nerve travel?

A

In abdominal wall to level of the symphysis pubis.

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4
Q

What does the iliohypogastric nerve innervate?

A

Muscle, skin, and patietal peritoneum.

Skin over inferior abdomen and buttocks.

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5
Q

What PNB should be done for inguinal hernias?

A

May need both ilioinguinal and iliohypogastric blocks.

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6
Q

Where is the ilioinguinal nerve formed?

A

T12-L1.

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7
Q

Where does the ilioinguinal nerve travel to and from?

A

Travels in abdominal wall, pierces posterior wall of the inguinal canal, passes through superficial inguinal ring, terminates on the anterior scrotum/labia majora.

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8
Q

What does the ilioinguinal nerve innervate?

A

Muscle, skin, parietal peritoneum.. Skin of superior/medial thigh, portions of external genitalia.

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9
Q

Where is the genitofemoral nerve formed?

A

L1-L2

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10
Q

Where does the genitofemoral nerve travel to and from?

A

Travels in abdominal wall. Though deep inguinal canal and through superficial inguinal ring. Terminates on anterior scrotum/labia majora.

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11
Q

What does the genitofemoral nerve innvervate?

A

Skin covering femoral hiatus. Skin on the scrotum and labia majora

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12
Q

What type of procedures is the genitofemoral nerve typically blocked for?

A

Mostly urinary and genital procedures

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13
Q

What are the three muscles layers on our sides/front flanks?

A

External oblique, internal oblique, and transverse abdominus.

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14
Q

In between what two muscle layers do most of the nerves run in between?

A

Between the internal oblique and transverse abdominus.

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15
Q

After coming to the front of the body, where do the nerves lie?

A

Right over top the rectus abdominus

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16
Q

Which block is used for episiotomy?

A

Pudendal nerve block.

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17
Q

Where does the pudendal nerve originate?

A

S2-S4.

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18
Q

Where does the pudendal nerve travel from and to?

A

Passes from pelvis through greater sciatic foramen into gluteal region. Passes posterior to ischial spine and into perineum.

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19
Q

What does the pudendal nerve innervate?

A

Muscle and skin of perineum.

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20
Q

Where does the lateral femoral cutaneous nerve originate from?

A

Posterior division of L2-L3.

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21
Q

Where does the lateral femoral cutaneous nerve travel from and to?

A

Descends posterior abdominal wall, crosses iliac crest into pelvis and down to inguinal ligament and anterior iliac spine.

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22
Q

What does the lateral femoral cutaneous nerve innervate?

A

Skin- lateral aspect of thigh to the level of the knee.

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23
Q

Where is the block typically performed at for lateral femoral cutaneous nerve block?

A

In the lateral groin area.

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24
Q

Where does the posterior femoral cutaneous nerve originate?

A

Anterior and Posterior division of S1-S3

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25
Q

Where does the posterior femoral cutaneous nerve travel from and to?

A

Passes from pelvis into gluteal region to posterior thigh.

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26
Q

What does the posterior femoral cutaneous nerve innervate?

A

Skin of posterior thigh (hip to mid-calf).

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27
Q

Which nerve actually innervates the hip and controls adduction, flexion, and extension of hip?

A

Obturator nerve

28
Q

Where does the obturator nerve originate?

A

Anterior division of L2-L4

29
Q

What does the obturator nerve innervate?

A

Many muscles in thigh. Articular branches to hip= controls adduction, flexion, and extension of hip.
Skin of medial thigh.

30
Q

Where does the femoral nerve originate?

A

Posterior division of L2-L4

31
Q

Where does the femoral nerve split into anterior and posterior branches?

A

Below inguinal ligament

32
Q

Which split (anterior/posterior) of the femoral nerve contains the saphenous nerve?

A

The posterior

33
Q

Describe the femoral nerve’s relation to femoral artery and vein.

A

Nerve is most lateral to femoral artery and vein.

34
Q

What is the mnemonic to remember femoral nerve location?

A

VAN
Vein,
Artery,
Nerve

V=venous penis or V=Vagina.

35
Q

Which muscle wraps from lateral to medial across the thigh?

A

Sartorius

36
Q

Which muscle goes straight down the thigh?

A

Rectus femoris.

37
Q

Which nerve is typically blocked within the adductor canal directly under the sartorius muscle?

A

Saphenous nerve

38
Q

Which muscles are innervated by the femoral nerve?

A 
Rectus femoris.
Vastus lateralis.
Vastus intermedius.
Vastus medialis.
Sartorius.
39
Q

Where does the saphenous nerve originate?

A

Posterior cutaneous branch from femoral nerve.

40
Q

What nerve would be stimulated if sartorius muscle contraction or patellar twitch occurs?

A

Femoral nerve.

41
Q

If saphenous nerve is blocked, will it be motor block/sensory block/or both?

A

Sensory block

42
Q

What structure does the saphenous nerve follow/accompany?

A

Saphenous vein/artery

43
Q

What does the saphenous nerve innervate?

A

Medial leg from knee to the arch of the foot.

44
Q

What two nerves form the sciatic nerve?

A

Tibial Nerve and Common Peroneal Nerve.

45
Q

Where does the sciatic nerve branch off again?

A

Popliteal fossa.

46
Q

Where does the popliteal nerve originate?

A

Trick question. No popliteal nerve.

47
Q

What is a popliteal block?

A

Block of the sciatic nerve at the popliteal fossa which is near the popliteal artery.

48
Q

Where does the tibial nerve originate from?

A

Anterior division of L4-S3.

49
Q

What does the common peroneal nerve branch into?

A

Superficial and Deep.

50
Q

Which branch of the common peroneal nerve passes in front of the ankle and terminates between great toe and second toe?

A

Deep peroneal nerve

51
Q

Where does the superficial peroneal nerve run?

A

Stays at the front of the leg into the front of the foot.

52
Q

Which nerve is formed from the union of the tibial and common peroneal?

A

Sural Nerve.

53
Q

What nerve does the sural nerve travel with?

A

Saphenous nerve.

54
Q

What does the sural nerve innervate?

A

Posterior sole of foot.
Posterior heel.
Achilles tendon above ankle.

55
Q

What five nerves extend all the way to the ankle?

A

Sural, deep peroneal, tibial, saphenous, superficial peroneal.

56
Q

Which of the five nerves that extend to the ankle run subcutaneously and which run deep?

A

The “S”s are superficial
Sural.
Saphenous.
Superficial peroneal.

Non-“S”s run deep.
Deep Peroneal and tibial.

57
Q

Where does the sural nerve terminate in the ankle?

A

Posterior to lateral malleolus

58
Q

Which nerve runs posterior to the medial malleolus?

A

Tibial nerve.

59
Q

Which two nerves run at the front of the ankle?

A

Deep peroneal (deeper) and Superficial peroneal (subcutaneous).

60
Q

Stimulation of deep peroneal will cause what foot response?

A

Straight up.

61
Q

Stimulation of tibial nerve will cause what foot response?

A

Down and inward.

62
Q

Which nerve stimulation will cause outward and upward foot movement?

A

Superficial peroneal.

63
Q

T/F: Femoral nerve block is good for knee arthroscopy?

A

True; but not good for knee arthroplasty

64
Q

What are contraindications for femoral nerve block?

A

Previous ilioinguinal surgery.
Large inguinal lymph node/tumor.
Local infection.
Neuropathy

65
Q

What are indications for femoral nerve block?

A

Anterior aspect of thigh.
Superficial surgery on medial aspect of leg and below knee.
Knee arthroscopy

66
Q

What are indications for popliteal block?

A

Lower leg surgery especially lateral.
Especially foot and ankle.
May also require saphenous coverage.

APA Fundamentals (10 decks)

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