Regional Quiz #2

Question 1

What are indications for a Femoral Nerve Block?

Answer 1

For surgeries on:

• Anterior aspect of thigh or medial aspect of lower leg
  (ex: repair of quadriceps tendon, quadricep muscle bx, saph vein stripping, BKA, ACL repair, TKA, Femoral shaft fracture)

Question 2

What nerve innervates the ability to extend the leg/knee?

Answer 2

Femoral Nerve

Question 3

What nerve innervates the ability to bend knee/flex leg?

Answer 3

Sciatic Nerve

Question 4

If you needle is too anterior and medially what 2 muscles will you see twitches on?

Answer 4

• Sartorius

- Pectineus

Question 5

T or F: The anterior and posterior component of the femoral nerve are BOTH below the Fascia Iliaca.

Answer 5

True

Question 6

If you are attempting to reach the posterior compartment(branch) of Femoral nerve and you have twitches in the Sartorial and Pectinous muscles, what should you do?

Answer 6

-redirect your needle laterally and insert 1-3 mm deep to reach the posterior component

Question 7

T or F: In some individuals, the Inguinal Ligament and the Femoral crease will not be the same.

Answer 7

• true

- thin people more same

Question 8

Where is the Inguinal Ligament?

Answer 8

-it attaches anteriorly to the anterior superior iliac spine and the pubic tubercle

Question 9

While doing a femoral nerve block, should you be above or below the inguinal ligament?

Answer 9

• Below

- If above, you are in the bowel

Question 10

Do femoral nerve block serve as the sole anesthetic?

Answer 10

Almost always a FNB only is an adjunct to anesthesia

Question 11

Is there any single nerve blockade that can block the entire leg?

Answer 11

no, have to be coupled with other blocks

Question 12

What Plexus does the femoral nerve come off from?

Answer 12

• The Lumbar Plexus

- The Anterior Plexus of the lower limb

Question 13

What are the contraindications for a femoral nerve block?

Answer 13

• refusal
• infection
• previous femoral vascular graft
• large inguinal lymph nodes or tumor
• preexisting femoral neuropathy

Question 14

If a patient is admitted to the hospital, has a +MRSA nasal swab is it ok to do a femoral nerve block?

Answer 14

-as long as the patient doesn’t have an active outbreak of infection at the site

Question 15

If you perform a regional anesthetic and decrease neural flow/sensation/movement to an area that has already been compromised, it is called what?

Answer 15

• Double Crush Syndrome

- If this happens, probably will not return to baseline

Question 16

Which nerve is the largest nerve of the lumbar plexus?

Answer 16

Femoral nerve

Question 17

What forms the femoral nerve?

Answer 17

-the dorsal divisions of the anterior rami of the L2, L3 and L4 spinal nerves

Question 18

What are the two branches that the femoral nerve divides into?

Answer 18

• Anterior branch
• Posterior branch
• both are located BELOW the fascia iliaca

Question 19

What does the posterior branches of the femoral nerve innervate?

Answer 19

• quadriceps muscle
• knee joint, patellar twitch
• saphenous nerve

Question 20

What does the saphenous nerve innervate?

Answer 20

the skin of the medial aspect of the leg below the knee joint

Question 21

What is the largest nerve in the body?

Answer 21

Sciatic nerve

Question 22

Where does the femoral saphenous nerve originate?

Answer 22

L3-L4

Question 23

How should you position a patient before a femoral nerve block?

Answer 23

supine with ipsilateral(same leg) extremity slightly abducted

Question 24

Explain the site of needle insertion for femoral nerve block.

Answer 24

• located at the femoral crease
• below the inguinal crease
• immediately lateral(1 cm) to the pulse of the femoral artery
• femoral nerve is beneath the fascia illiaca

Question 25

What twitch signifies a successful femoral nerve block?

Answer 25

When performing a femoral nerve block, you advance needle through the fascia late until the quad muscle contracts(i.e.--->PATELLAR TWITCH)

Question 26

What is the typical dose of LA with femoral nerve block?

Answer 26

20 ml

Question 27

What is the onset and duration of anesthesia and analgesia of 20 ml 0.5% ropivacaine in a femoral nerve block?

Answer 27

onset: 15-30 min anesthesia: 4-8 hours analgesia: 5-12 hours

Question 28

What is the onset and duration of anesthesia and analgesia of 20 ml 0.5% bupivacaine in femoral nerve block?

Answer 28

onset: 15-30 min anesthesia: 5-15 hours analgesia: 8-30 hours

Question 29

What are 5 femoral nerve block complications?

Answer 29

1. hematoma 2. vascular puncture 3. nerve injury 4. catheter infection 5. instruct patient on the inability to bear weight on the blocked extremity

Question 30

During a femoral nerve block, a vein or artery is punctured. Should you redirect the needle medially or laterally?

Answer 30

Laterally, NEVER medially

Question 31

How many peripheral nerves are blocked to have a complete foot/ankle block for foot anesthesia?

Answer 31

5

Question 32

Do you use a PNS to perform an ankle block?

Answer 32

no

Question 33

How long do ankle blocks usually last?

Answer 33

15-20 hours

Question 34

What are some indications for foot/ankle block(6)?

Answer 34

1. all types of foot surgeries 2. Hallux valgus repair(Bunion) 3. foot reconstruction 4. arthroplasty 5. osteotomy 6. amputation

Question 35

What are the contraindications of ankle blocks(8)?

Answer 35

1. patient refusal 2. infection 3. edema 4. burns 5. soft tissue trauma 6. distorted anatomy with scarring in area to be blocked 7. vascular compromise 8. severe coagulopathy

Question 36

List the 5 nerves blocked with ankle blocks.

Answer 36

1. saphenous 2. posterior tibial 3. superficial peroneal 4. sural 5. deep peroneal

Question 37

What does the superficial peroneal nerve innervate?

Answer 37

the dorm of the foot(top of the foot)

Question 38

What are 3 possible complications of ankle blocks?

Answer 38

- paresthesias - LAST - Vasovagal reaction

Question 39

The 3 branches of the tibial nerve primarily innervate?

Answer 39

plantar surface of the foot(bottom of the foot)

Question 40

The saphenous nerve innervates what?

Answer 40

the medial aspect of the foot

Question 41

The dural nerve innervates?

Answer 41

lateral edge of the foot

Question 42

What 2 nerves will completely block the big toe?

Answer 42

deep peroneal nerve | superficial peroneal nerve

Question 43

Where is the location of the tibial nerve?

Answer 43

travels just posterior to the posterior tibial artery in the space between the medial malice and the achilles tendon

Question 44

The deep peroneal nerve is between which 2 tendons?

Answer 44

extensor hallucis longus tendon | tibialis anterior tendon(extensor digitorum longus)

Question 45

The dural nerve is located between?

Answer 45

- the achilles tendon(Tendocalcaneus) | - the lateral melleolus

Question 46

How many mls of LA for each nerve in the ankle block?

Answer 46

5-8 mls

Question 47

Why should you not add epi to LA with ankle blocks?

Answer 47

- it is a circumferential block | - it will decrease blood flow to the foot

Question 48

Are ankle blocks sole or adjunct anesthetics?

Answer 48

They are usually the sole anesthetic