Episode 271: Keywords Part 25: Lower Extremity Nerve Blocks
Dec 18, 2023
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Topics include lower extremity nerve blocks, anatomy knowledge in performing procedures, differences between popliteal and higher approaches for sciatic nerve blocks, femoral nerve block and its role in lower extremity nerve blocks, strategies for multiple choice questions, and random recommendations for a Trinidadian cooking YouTube channel and a word game called Connections.
Ankle blocks are a safe and effective regional anesthetic technique for foot operations, targeting five peripheral nerves and having minimal side effects.
Popliteal blocks, targeting the sciatic nerve, provide surgical anesthesia for the lower leg, ankle, and foot, and require proper needle placement at the popliteal fossa.
Deep dives
Ankle Block
An ankle block is a regional anesthetic technique used for foot operations. It is technically easy, highly safe, and has minimal side effects. Ankle blocks target the five peripheral nerves that provide sensory innervation to the foot: the sural, deep peroneal, superficial peroneal, posterior tibial, and saphenous nerves. The cutaneous innervation of the foot, as well as indications, contraindications, and alternatives to ankle blocks, are common test questions.
Popliteal Block
A popliteal block, also targeting the sciatic nerve, is useful for lower extremity surgeries below the knee. It is performed at the popliteal fossa and provides surgical anesthesia for the lower leg, ankle, and foot. Key points to know include the origin of the sciatic nerve from the L4-S3 spinal nerves, the sensory innervation provided by its terminal branches (posterior tibial, peroneal, and saphenous nerves), and the anatomical landmarks for proper needle placement.
Femoral Nerve Block
A femoral nerve block is indicated for surgeries on the anterior aspect of the thigh and can provide complete lower extremity coverage below the knee when combined with a sciatic nerve block. The femoral nerve arises from the lumbar nerve roots L2-L4 and primarily provides sensation to the anterior and medial thigh. It is important to understand the sensory and motor innervation of the femoral nerve, proper needle placement techniques, and contraindications.
Sciatic Nerve Block
A sciatic nerve block is performed for lower extremity surgeries of the thigh, knee, leg, ankle, and foot. It provides sensory loss to the posterior thigh and the majority of the leg below the knee. Understanding the anatomy, sensory distribution, and proper needle placement for a sciatic nerve block is essential for anesthesia providers. Additionally, knowing indications, techniques, and alternative nerve blocks, such as femoral and obturator blocks, are important for comprehensive knowledge.