Lower Regional Flashcards
(37 cards)
Lumbar plexus
Located within __ __ muscle and __ to transverse processes
Psoas major, anterior
Ilioinguinal and iliohypogastric in __ branch of __ and __
Genitofemoral in __ branch of __ and a branch of __
Upper, L1, T12
Lower, L1, L2
Obturator in __ divisions of __, __, and __
Anterior, L2, L3, L4
Femoral
Large branches of __ divisions of __ and __
__ division of __
Posterior, L2, L3
Posterior, L4
Lateral femoral cutaneous- __ branches of the __ division of __ and __
Small, posterior, L2, L3
Femoral nerve
Formed by __ divisions of __ rami of __-__
Dorsal, anterior, L2-L4
Femoral nerve
Descends through the __ muscle __ border
Enters thigh underneath the __ ligament
Divides into __ and __ branches
Psoas, lateral
Inguinal
Anterior and posterior
Femoral nerve
Anterior branch
motor innervation of 2, sensory innervation of 2 places
Motor: sartorius and pectineus
Sensory: skin of anterior and medial thigh
Femoral nerve
Posterior branch
Motor innervation to: 4
Sensory to 1
Rectus femoris, vastus intermedius, vastus lateralis, vastus medius
Medial part of lower leg by saphenous nerve
Femoral nerve block indications
- surgery of __ __
- __ muscle biopsy
- skin graft for __ __
- __ arthroscopy
- __ __ fractures
- completely blocks lower extremity when combined with __ __ block
Anterior thigh Quadriceps Anterior thigh Knee Femoral shaft Sciatic nerve
Contraindications to femoral nerve block
- pre existing femoral ___
- local ___ or enlarged __ __
Neuropathy
Infection, lymph nodes
Femoral nerve block landmarks
Position:
Landmarks: 4
Femoral nerve lies 1-2 cm __ of __ __
Supine
ASIS, line between ASIS and PS (inguinal ligament), femoral artery, femoral nerve
Lateral, femoral artery
Femoral nerve block Depth \_\_g stim needle or \_\_g touhy needle directed \_\_ \_\_ stim with patellar snap. Volume
1-3 cm
22, 18, cephalad
Quadriceps
20-40 ml
Saphenous nerve From \_\_-\_\_ nerve roots \_\_ sensory nerve branch of femoral nerve Only nerve below knee not derived from \_\_ nerve Continuation of \_\_ nerve
L3-L4
Largest
Sciatic
Femoral
Saphenous nerve
Continuous innervation of __, __, and __ of __ leg
Can be anesthetized with __ nerve block
Frequently blocked with __ nerve for complete block below knee
Medial, anteromedial, posteromedial, lower
Femoral
Sciatic
Saphenous nerve block
Position
Landmark
__g __cm __bevel needle inserted __ and __ to landmark, inject __ ml
Inject __ ml as a ring deeply SQ starting at __ surface and ending at __ aspect of upper calf
Supine
Tibial condyle
22, 4, b, anterior and distal, 5
5, medial, dorsomedial
Transsartorial saphenous nerve block
Position: __ with __ __
Landmark: __ muscle just above __
__g __ tip needle through __ muscle
Supine, leg extended
Sartorius, patella
22, blunt, sartorius
Transsartorial saphenous nerve block
- __ and __ pop as needle passes through __
- get 2
- loss of resistance usually - cm from skin to posterior body of muscle
- __ ml of local anesthetic
First and second, sartorius
- loss of resistance and gentle aspiration
- 1.5-3 cm
- 10 ml
Adductor canal block done through __-__ __ nerve
Mid thigh saphenous
Sciatic nerve
Provides anesthesia to leg __ __
Complete lower block requires additional block of __ nerve
Below knee
Femoral/saphenous
Sciatic nerve is __ nerve in the body
Formed by __ rami of __-__
Contains most of the __ plexus __-__
Largest
Anterior, l4-s3
Sciatic, l4-s4
Sciatic nerve Exits the pelvis where Travels under what Contains the \_\_ and \_\_ \_\_ nerves Nerve bundle separates where
Greater sciatic foramen
Gluteus Maximus
Tibial and common peroneal
Mid thigh
Sciatic nerve
Motor to : 3
Sensory to: 4
Motor of posterior thigh, leg, and foot muscles
Posterior thigh, anterior/lateral leg, foot
Sciatic nerve block Position \_\_ decubitus Lower leg slightly \_\_ at \_\_ Upper leg (block side) \_\_ so foot is near knee of lower leg
Labats classic approach
Lateral
Flexed at knee
Flexed
