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Flashcards in Lower Regional Deck (37)
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1
Q

Lumbar plexus

Located within __ __ muscle and __ to transverse processes

A

Psoas major, anterior

2
Q

Ilioinguinal and iliohypogastric in __ branch of __ and __

Genitofemoral in __ branch of __ and a branch of __

A

Upper, L1, T12

Lower, L1, L2

3
Q

Obturator in __ divisions of __, __, and __

A

Anterior, L2, L3, L4

4
Q

Femoral
Large branches of __ divisions of __ and __
__ division of __

A

Posterior, L2, L3

Posterior, L4

5
Q

Lateral femoral cutaneous- __ branches of the __ division of __ and __

A

Small, posterior, L2, L3

6
Q

Femoral nerve

Formed by __ divisions of __ rami of __-__

A

Dorsal, anterior, L2-L4

7
Q

Femoral nerve
Descends through the __ muscle __ border
Enters thigh underneath the __ ligament
Divides into __ and __ branches

A

Psoas, lateral
Inguinal
Anterior and posterior

8
Q

Femoral nerve
Anterior branch
motor innervation of 2, sensory innervation of 2 places

A

Motor: sartorius and pectineus

Sensory: skin of anterior and medial thigh

9
Q

Femoral nerve
Posterior branch
Motor innervation to: 4
Sensory to 1

A

Rectus femoris, vastus intermedius, vastus lateralis, vastus medius

Medial part of lower leg by saphenous nerve

10
Q

Femoral nerve block indications

  • surgery of __ __
  • __ muscle biopsy
  • skin graft for __ __
  • __ arthroscopy
  • __ __ fractures
  • completely blocks lower extremity when combined with __ __ block
A
Anterior thigh 
Quadriceps 
Anterior thigh 
Knee 
Femoral shaft 
Sciatic nerve
11
Q

Contraindications to femoral nerve block

  • pre existing femoral ___
  • local ___ or enlarged __ __
A

Neuropathy

Infection, lymph nodes

12
Q

Femoral nerve block landmarks
Position:
Landmarks: 4
Femoral nerve lies 1-2 cm __ of __ __

A

Supine
ASIS, line between ASIS and PS (inguinal ligament), femoral artery, femoral nerve
Lateral, femoral artery

13
Q
Femoral nerve block 
Depth 
\_\_g stim needle or \_\_g touhy needle directed \_\_
\_\_ stim with patellar snap. 
Volume
A

1-3 cm
22, 18, cephalad
Quadriceps
20-40 ml

14
Q
Saphenous nerve 
From \_\_-\_\_ nerve roots 
\_\_ sensory nerve branch of femoral nerve
Only nerve below knee not derived from \_\_ nerve 
Continuation of \_\_ nerve
A

L3-L4
Largest
Sciatic
Femoral

15
Q

Saphenous nerve
Continuous innervation of __, __, and __ of __ leg
Can be anesthetized with __ nerve block
Frequently blocked with __ nerve for complete block below knee

A

Medial, anteromedial, posteromedial, lower
Femoral
Sciatic

16
Q

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

A

Supine
Tibial condyle
22, 4, b, anterior and distal, 5
5, medial, dorsomedial

17
Q

Transsartorial saphenous nerve block
Position: __ with __ __
Landmark: __ muscle just above __
__g __ tip needle through __ muscle

A

Supine, leg extended
Sartorius, patella
22, blunt, sartorius

18
Q

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
A

First and second, sartorius

  • loss of resistance and gentle aspiration
  • 1.5-3 cm
  • 10 ml
19
Q

Adductor canal block done through __-__ __ nerve

A

Mid thigh saphenous

20
Q

Sciatic nerve
Provides anesthesia to leg __ __
Complete lower block requires additional block of __ nerve

A

Below knee

Femoral/saphenous

21
Q

Sciatic nerve is __ nerve in the body
Formed by __ rami of __-__
Contains most of the __ plexus __-__

A

Largest
Anterior, l4-s3
Sciatic, l4-s4

22
Q
Sciatic nerve 
Exits the pelvis where
Travels under what
Contains the \_\_ and \_\_ \_\_ nerves 
Nerve bundle separates where
A

Greater sciatic foramen
Gluteus Maximus
Tibial and common peroneal
Mid thigh

23
Q

Sciatic nerve
Motor to : 3
Sensory to: 4

A

Motor of posterior thigh, leg, and foot muscles

Posterior thigh, anterior/lateral leg, foot

24
Q
Sciatic nerve block 
Position 
\_\_ decubitus 
Lower leg slightly \_\_ at \_\_ 
Upper leg (block side) \_\_ so foot is near knee of lower leg
A

Labats classic approach
Lateral
Flexed at knee
Flexed

25
Q

Sciatic nerve block
Landmarks: 3
Lines drawn between __ __ and __ and __ __ and __ __

A

Greater trochanter, PSIS, sacral hiatus

Greater trochanter and PSIS, sacral hiatus

26
Q

Sciatic nerve block
Perpendicular line drawn from___ of __ __
Needle insertion is __-__ cm __ to a midpoint between first two landmarks

A

Midpoint, first line

4-5, distal

27
Q

Sciatic nerve
Initial settings __-__ ma
Expect stim of __ __ prior to __ __ stim
Observe for 2
Volume given __-__ ml after identified with __ma or less

A

1.5-1
Gluteus Maximus, sciatic nerve
Plantar flexion/inversion, dorsiflexion/eversion
20-30, 0.5

28
Q

Sciatic nerve block with ultrasound
__ frequency __ probe __-__ MHz
Landmarks 2
Position

A

Low, curvilinear, 2-5
Greater trochanter and ischial tuberosity
Lateral decubitus

29
Q

Sciatic nerve block with ultrasound
Place probe where
Greater trochanter and ischial tuberosity appear ___
Sciatic nerve is __ __ structure. Needle directed in __ plane, __ plane.
__-__ approach to avoid __ artery

A

Line between landmarks
Hyperechoic
Hyperechoic, elliptical, lateral, in
Lateral to medial, gluteal

30
Q

Popliteal nerve anatomy

__ nerve supplies motor innervation via __ __ nerve and __ nerves

A

Sciatic, posterior tibial, peroneal

31
Q

Popliteal nerve anatomy
Popliteal fossa bordered by __ __ laterally and __ muscle medially
Sciatic nerve splits __-_ cm from popliteal crease
__ nerve and __ __ nerve

A

Biceps femoris, semimembranosus
5-10
Tibial, common peroneal

32
Q

Popliteal nerve

Superficial to __ __ and __ and slightly __

A

Popliteal artery and vein, lateral

33
Q

Popliteal nerve block
Indications for __ or __ surgery
Offers improved __ tolerance over __ block
Must combine with __ or __ block to complete anesthesia below the knee

A

Foot and ankle
Tourniquet, ankle
Saphenous or femoral

34
Q

Popliteal nerve block
Needle insertion __-__ cm above the __ __
__cm lateral to midpoint between two tendons
__g __cm __ needle, __ to skin

A

7-10, popliteal fossa
1
22, 5, perpendicular

35
Q

Popliteal nerve block
Place hand over __ __, __, and __ muscles
Twitch of __ or __ at __-__ ma

A

Biceps femoris, semitendinosus, semimembranosus

Foot or toes, 0.3-0.4

36
Q

Popliteal block
Deep peroneal- __ and __
Posterior tibial- __ __ and __

A

Dorsiflexion and eversion

Plantar flexion and inversion

37
Q

Popliteal block
__ inject __-__ ml anesthetic
Injection on __ nerve may be more reliable
Consider __ __ technique

A

Incrementally, 35-45
Tibial
Double injection