Term
| The Lumbo-Sacral Plexus involves what spinal cord segments |
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Definition
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Term
| The Lumbo-Sacral Plexus is 'sandwiched' between what 3 muscles? |
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Definition
psoas
quadratus lumborum
iliac |
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Term
| T/F: The lumbo-sacral anatomy is not as conducive to plexus anesthesia as in the neck, and therefor is sometimes unreliable. |
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Definition
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Term
| These nerve roots are known as the "upper nerve roots" |
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Definition
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Term
| Form the lumbar portion of the Lumbar Plexus |
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Definition
| L2 - L4, upper nerve roots |
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Term
| The Lumbar Plexus gives off what 3 nerves? |
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Definition
Lateral Femoral Cutaneous
Femoral Nerve
Obturator Nerve |
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Term
| What spinal segments form the Lateral Femoral Cutaneous (LFC) nerve? |
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Definition
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Term
| What spinal segments form the Femoral nerve? |
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Definition
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Term
| What spinal segments form the obturator nerve? |
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Definition
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Term
| T/F: The femoral and obturator nerves are formed by the same spinal segments. |
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Definition
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Term
| What 3 nerves supply the upper, anterior leg? |
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Definition
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Term
| What branch of the Femoral nerve extends medially below the knee to the foot? |
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Definition
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Term
| What nerve roots, known as the "lower Nerve roots" form the sacral plexus? |
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Definition
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Term
| The sciatic nerve is formed by what 5 spinal segments? |
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Definition
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Term
| The sciatic nerve divides to form what 2 nerves? |
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Definition
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Term
| This nerve is often injured while a patient's leg is placed in stirrups |
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Definition
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Term
| These nerves provide the bulk of innervation below the knee |
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Definition
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Term
| This nerve and its branches supply the posterior leg |
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Definition
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Term
| The Lumbo-Sacral plexus is wedged between the fascia of the quadratus lumborum and the iliacus ___________, and the psoas ____________. |
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Definition
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Term
| Arises from the posterior divisions of L2, L3, & L4 |
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Definition
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Term
| Enters the thigh beneath the inguinal ligament |
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Definition
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Term
| The femoral nerve sends fibers to what 3 muscles? |
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Definition
sartorius
quadriceps
pectineus |
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Term
| T/F: The femoral nerve lies anterior and slightly lateral to the femoral artery. |
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Definition
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Term
| The main trunk of the femoral nerve |
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Definition
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Term
| Provides sensory innervation to the medial calf all the way to the medial aspect fo the foot |
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Definition
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Term
| Formed by the posterior divisions of L2 and L3 within the substance of the psoas muscle |
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Definition
| Lateral Femoral Cutaneous nerve |
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Term
| Passes laterally just beneath the rim of the pelvis to enter the thigh close to the ASIS beneath and medial to the inguinal ligament |
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Definition
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Term
| Sensory branches of what nerve are distributed to the lateral buttock and thigh and occasionally as far as the knee? |
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Definition
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Term
| Arises from the anterior branches of L2, L3, & L4 |
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Definition
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Term
| Forms a common trunk in the substance of the psoas |
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Definition
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Term
| Emerges from the medial border of the psoas to enter the pelvis |
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Definition
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Term
| Leaves the pelvis through the obturator foramen/canal to enter the thigh |
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Definition
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Term
| Terminates by giving sensory innervation to most of the medial portion of the thigh |
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Definition
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Term
| The obturator nerve gives branches to what 3 muscles and what joint? |
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Definition
external obturator
gracilis
adductor muscles
hip |
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Term
| T/F: The posterior division of the obturator nerve supplies an articular branch to the knee joint. |
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Definition
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Term
| T/F: The sciatic nerve is the largest nerve in the body at approximately 4 cm wide. |
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Definition
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Term
| This nerve passes out of the pelvis through the greater sciatic notch |
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Definition
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Term
| The sciatic nerve is composed of what 2 major nerve trunks? |
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Definition
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Term
| Formed from the nerve roots of L4-S2, and eventually becomes the common peroneal nerve |
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Definition
| Lateral trunk (of sciatic nerve) |
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Term
| Formed from the nerve roots of L3 - S3, and eventually becomes the tibial nerve |
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Definition
| Medial Trunk (of the Sciatic nerve) |
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Term
| These combined nerves exit through the sciatic notch and pass anteriorly to the piriformis muscle between the ischial tuberosity and the greater trochanter of the femor |
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Definition
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Term
| Divide into their respective nerves at about the lower-third of the thigh |
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Definition
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Term
| Curve caudad and descend to the posterior thigh immediately behind the femor |
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Definition
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Term
| What are the landmarks for a lumbar plexus block and where is the needle insertion point? |
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Definition
spinous process in the midline
iliac crest
needle insertion point --> 4 cm lateral to the intersection of the the above landmarks |
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Term
| This perivascular approach to blocking the lumbar plexus involved a single injection below the inguinal ligament |
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Definition
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Term
| The 3-in-1 block entails blocking what nerves? |
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Definition
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Term
| In combination with _____________________, the 3-in-1 technique will anesthetize the entire lower extremity. |
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Definition
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Term
| How is the patient positioned for a 3-in-1 block? |
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Definition
| Supine, with thigh abducted ~ 15 degrees |
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Term
| How is the patient positioned for a lumbar plexus block? |
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Definition
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Term
| List 4 common drugs and their dosages for the 3-in-1 technique per Winnie |
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Definition
1.5% Lidocaine 25-30 mL
1.5% Mepivacaine 25-30 mL
0.5% Bupivicaine 25-30 mL
1.0% Etidocaine 25-30 mL (no longer used) |
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Term
| Catheter is inserted cephalad effectively anesthetizes the iliohypogastic and genitofemoral nerves (branches of T12 & L1 respectively) |
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Definition
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Term
| Two disadvantages of 3-in-1 block |
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Definition
in combo with sciatic nerve block may lead to systemic reactions --> large volumes of local anesthestics
nerve damage if intraneural injection |
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Term
| Why may the 3-in-1 block be more appropriately called the 2.5-in-1 block? |
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Definition
| Because the posterior branch of the obturator nerve is seldom blocked. |
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Term
| The 3-in-1 block is the simplest to perform use a/an ________________ technique. |
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Definition
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Term
| What block, when used alone, is well suited for procedures of the anterior aspect of the thigh and for postop pain relief after femur and knee surgery? |
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Definition
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Term
| Where is the needle inserted when performing a femoral nerve block |
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Definition
| The needle is inserted below the inguinal crease and immediately lateral (~ 1 cm) to the pulse of the femoral artery. |
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Term
| Where is the needle inserted when performing a block of the LFC? |
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Definition
Inserted perpendicular to the skin at a point ~0.5 - 1 inch medial to the ASIS and just inferior to the inguinal
ligament
(medial and deep to ASIS) |
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Term
| Anesthesia of this nerve is necessary for surgery of the knee, but is more challenging because of its deeper location and early branching pattern. |
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Definition
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Term
| A valuable technique in diagnosing painful conditions of the hip and in relief of adductor spasm of the hip. |
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Definition
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Term
| Provides motor function to the adductor muscles and cutaneous sensation to a small area behind the knee. |
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Definition
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Term
| Describe the patient positioning for obtuator nerve block. |
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Definition
| Supine with legs slightly spread |
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Term
| What landmark is first identified when performing an obturator nerve block? |
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Definition
| Lateral pubic turbercle on side to be blocked |
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Term
| Describe the steps of blocking the obturator nerve. |
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Definition
1) 22g, 3-in needle is introduced at a point ~1.5 cm below and 1.5 lateral to the pubic tubercle.
2) The needle is slowly advanced until it contacts bone (inferior ramus of the pubis)
3)Redirecting the needle slightly lateral and caudad will move it off the bone and into the obturator foramen
4)The needle is advanced further 2-3 cm and after careful aspiration, 10-15 mL of local anesthetic is injected as the needle is withdrawn and again as it is reinserted with a slight lateral direction. |
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Term
| Provides innervation to the posterior aspect of the lower extremity |
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Definition
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Term
| The classical posterior approach to blocking the sciatic nerve requires that the patient.... |
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Definition
| be able to lie in the lateral position and flex the hip & knee. |
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Term
| Name the 3 landmarks when blocking the Sciatic nerve using the classical posterior approach? |
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Definition
The greater trochanter of the femur
Posterior Superior Iliac Spine (PSIS)
Tip of the Coccyx (or sacral hiatus) |
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Term
| Name the 3 landmarks when blocking the Sciatic nerve using the classical posterior approach? |
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Definition
The greater trochanter of the femur
Posterior Superior Iliac Spine (PSIS)
Tip of the Coccyx (or sacral hiatus) |
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Term
| In the popliteal fossa, the sciatic nerve is positioned between the _______ and __________________ muscles. |
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Definition
| biceps and semitendinosus muscles |
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Term
| What size stimulating needle is used when using a lateral mid-femoral approach to block the sciatic nerve? |
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Definition
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Term
| What the 3 landmarks for a lateral mid-femoral approach/popliteal block? |
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Definition
popliteal fossa crease
vastus lateralis muscle
bicpes femoris muscle |
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Term
| Where is the needle inserted when performing a lateral mid-femoral approach/popliteal block? |
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Definition
| In the groove between the vastus lateralis and biceps femoris muscles. |
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Term
| Twitches of the ____ or _____ denote correct needle placement when performing a lateral mid-femoral approach/popliteal block. |
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Definition
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Term
| T/F: The tibial nerve is larger than the common peroneal nerve. |
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Definition
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Term
| Posteriorly in the popliteal fossa, the sciatic nerve components are ________ and ______________ to the popliteal artery and vein. |
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Definition
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Term
| Where is the needle insertion site when performing a posterior approach/popliteal fossa block? |
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Definition
| 7 cm above the popliteal fossa crease at the midpoint between the biceps femoris tendon and semitendinosus muscle tendon |
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Term
| What are the 4 P's of assessing blockade of the lower extremity? |
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Definition
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Term
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Definition
| to evaulate sciatic nerve anesthesia |
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Term
|
Definition
| to evaluate obturator nerve anesthesia |
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Term
|
Definition
| to evaulate LFC nerve anesthesia |
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Term
|
Definition
| to evaluate femoral nerve anesthesia |
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Term
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Definition
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Term
| Evaluates plantar flexion which is controlled by the sciatic nerve |
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Definition
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Term
| To assess ____________ nerve function, the clinician abducts the patient's leg and then asks them to PULL the leg back toward the midline against resistance. |
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Definition
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Term
| Sensory innervation to the lateral buttcocks and lateral thigh |
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Definition
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Term
| The inability of the patient to detect a PINCH on the proximal thigh signals successful conduction block of the _______. |
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Definition
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Term
| Provides motor innervation to the quadriceps and sartorius muscles. |
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Definition
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Term
| Provides sensory innervation to the anterior thigh, branches of the hip joint and the majority of the knee joint. |
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Definition
|
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Term
| "Punt an imaginary football" against resistance |
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Definition
| Assesses femoral nerve function |
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Term
| T/F: The 4-P's take advantage of the principle that outer 'mantle' fibers (i.e., "motor) are anesthetized first, before the 'core' fibers which are sensory and located more distally. |
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Definition
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|
Term
The sciatic nerve is formed by all of the following nerve roots EXCEPT
A) L3
B) L4
C) L5
D) S1
E) S2 |
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Definition
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Term
The obturator nerve
A) is unimportant in arthoscopic surgery of the knee
B) supplies motor innervation to the adductor muscles of the hip
C) supplies sensory innervation to the skin overlying the patella
D) is derived from the first and second sacral roots
E) supplies sensory innervation to the lateral aspect of the knee |
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Definition
| B) The obturator nerve supplies motor innervation to the adductor muscles of the hip and sensory innervation to the medial aspect of the knee. |
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|
Term
The relationship of the femoral nerve in the inguinal area is that it lies
1) superficial to the inguinal ligament
2) lateral to the femoral artery
3) medial to the femoral vein
4) lateral to the obturator nerve |
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Definition
| C) The femoral nerve lies lateral to the femoral artery and lateral to the obturator nerve. The femoral vein lies medial to the femoral nerve, and the inguinal ligament is superficial to the femoral nerve. |
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