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37 Cards in this Set
- Front
- Back
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What are the Lumbar Plexus Nerve Blocks (7)?
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- Lumbar Plexus Block
- Femoral Nerve Block - Saphenous Nerve Block - Lateral Femoral Cutaneous Block - Obturator Nerve Block - Ilioinguinal and Iliohypogastric Blocks - Genitofemoral Block |
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What are the indications for a lumbar plexus block?
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Hip, anterior thigh, and knee surgery
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What are the two techniques for the Lumbar plexus block?
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Inguinal Perivascular Block
Psoas Compartment Block |
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What are the landmarks for the Lumbar plexus block (inguinal perivascular technique)?
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Femoral artery
Inguinal ligament |
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How do you determine how much local to dose for a lumbar plexus block (inguinal perivascular technique)?
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Height (inches) / 3 = mL of local
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What position does the patient need to be in for a lumbar plexus block (inguinal perivascular technique)?
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Supine
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what size needle do you need for a lumbar plexus block (inguinal perivascular technique)?
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Needle: 5cm
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Which nerve of the lumbar plexus can get damaged from long periods in lateral decubitus position?
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Lateral Femoral Cutaneous nerve
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Where does the femoral nerve innervate?
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- Anterior muscles of the thigh (sartorius & quadriceps)
- Adductors of the thigh (outer thigh) - Skin over the anteromedial surface of the thigh, medial surface of leg and foot |
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Where does the Obturator nerve innervate?
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- The adductors of the thigh (inner thigh)
- Skin over medial surface of the thigh |
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Where does the Lateral Femoral Cutaneous Nerve innervate?
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The skin over the anterior, lateral, and posterior surface of the thigh
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Where does the saphenous nerve innervate?
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The skin over the medial surface of the leg
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What is the technique for performing an inguinal perivascular lumbar plexus block?
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- insert needle lateral to femoral artery
- caudal to inguinal ligament - "two POPs" or femoral nerve paresthesia - local injected into fascial plane |
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What is the position for psoas compartment technique for lumbar plexus block?
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Lateral decubitus (operative side up) with thighs flexed.
"fetal position" |
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What size needle do you use for psoas compartment technique for lumbar plexus block?
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15cm needle
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What are your landmarks for psoas compartment technique for lumbar plexus block?
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Iliac crests & L4 spinous process
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What is a risk with performing the psoas compartment technique?
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Epidural or Subarachnoid spread
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Can the inguinal perivascular technique be used for surgical anesthesia?
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It is best used for an analgesic block and not a surgical block because it is unpredictable.
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What is the technique for performing the psoas compartment technique for lumbar plexus block?
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- Mark the skin 5cm lateral to L4 spinous process and 3cm caudal.
- insert needle perpendicular to skin until L5 transverse process is encountered (usually 8-10cm deep) - Withdrawl needle slightly and redirect cephalad until quadriceps twitch or loss of resistance encountered (usually 10-12cm deep) - Remove hand from needle with maintained twitch that is lost between 0.5-1.0 mA (**No Lower**) |
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What are 3 complications of a Lumbar Plexus block?
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- infection
- hematoma - vascular puncture - local toxicity - nerve injury - hemodynamic consequences - epidural/subarachnoid injection/spread (occurs in 15% of pts) |
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What are the indications for a Femoral nerve block?
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anterior thigh and knee surgery.
- provides anesthesia of the entire anterior thigh, most of the femur, knee joint, and medial leg |
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What are the landmarks for a femoral block?
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Femoral (inguinal) crease
-- anterior superior iliac spine -- pubic tubercle Femoral artery pulse |
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Where will nerve stimulation cause twitching during a femoral nerve block?
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Twitch of the patella (quadriceps)
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What is the desired mA current for Femoral blocks?
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You want the twitch to go away between 0.2 and 0.5 mA.
- if it continues at 0.2 or below you are in the nerve - if it stops above 0.5 you are not close enough to the nerve |
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How much local do you inject for a Femoral block?
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20-30 ml
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What size needle do you need for a Femoral block?
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4cm insulated nerve stimulating needle
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Where is the needle inserted for a femoral block?
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- draw a line connecting the anterior superior iliac spine and the pubic tubercle
- palpate the femoral artery at this line - insert needle parellel and slightly lateral to the femoral pulse. |
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What are the indications for a saphenous nerve block?
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For anesthesia of the medial lower leg for various vascular, orthopedic, and podiatry procedures.
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What are the landmarks for a saphenous nerve block?
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Tibial condyle and Medial malleolus
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How much local is used for a saphenous nerve block?
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10-15ml
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What is the technique for performing a saphenous nerve block?
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Inject a line of local from the medial aspect of the tibial condyle to the dorsomedial aspect of the upper calf. OR
- inject a line of local in a ring-like fashion just above the medial malleolus |
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What are the indications for a lateral femoral cutaneous nerve block?
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- myalgia paresthetica
- skin graft harvesting on lateral thigh, combined w/other blocks for tourniquet pain. - covers anesthesia of the entire anterior thigh and most of the femur and knee joint and medial leg |
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What are the landmarks for a lateral femoral cutaneous nerve block?
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Anterior superior iliac spine
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How much local is used for a lateral femoral cutaneous nerve block?
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10-15ml
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What position is the patient in for a lateral femoral cutaneous nerve block?
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Supine
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What size needle is used for a lateral femoral cutaneous nerve block?
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4cm needle
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What is the technique for performing a lateral femoral cutaneous nerve block?
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- insert needle 2cm medial and 2cm caudal from anterior superior iliac spine
- advance needle until a pop is felt as it passes through the fascia lata (?) - Local injected in a fanlike manner from medial to lateral |
