1 / 31

Lower Extremity Peripheral Nerve Blocks

Lower Extremity Peripheral Nerve Blocks. Yefim Bogomolny, M.D . General Considerations for Lower Extremity Blocks. LE blocks are not difficult to perform.

adamdaniel
Download Presentation

Lower Extremity Peripheral Nerve Blocks

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Lower Extremity Peripheral Nerve Blocks Yefim Bogomolny, M.D.

  2. General Considerations for Lower Extremity Blocks • LE blocks are not difficult to perform. • Alternative to GA, Spinal, and Epidural. Examples – intubation might represent a problem, or unilateral anesthesia is indicated, or NA anesthesia is contraindicated. • Can be used in combination with GA and NA. • The nerves of LE are often blocked much higher than their terminal divisions (exception – blocks for foot surgery). This produces extended single shot motor and sensory blocks. • Several LE blocks are amendable to catheter insertion which results in superior analgesia when compared to epidural. • There is a clear consensus favoring the use of nerve stimulator versus paresthesia for LE blocks. Also US is used to localize the nerves.

  3. Lumbosacral plexus

  4. Lumbosacral plexus

  5. Lumbosacral plexus • Innervates the LE and perineal area. • Its fibers are extensions of ventral rami of L2-L5 and S1-S3. • L2-L4 form the lumbar plexus, which divides into lateral femoral cutaneous, femoral, and obturator nn. Supply the upper leg with the branch of femoral (saphenous n.) extending medially below the knee. • L4-S3 form two major trunks of the sciatic n., the tibial and the common peroneal nn. They provide the bulk of innervation below the knee.

  6. Lumbosacral plexus • The lumbosacral plexus has a broader origin than the brachial plexus. • Roots emerge from their foramina into the fascial plane between quadratus lumborum and psoas m. • The lumbar roots form lateral femoral cutaneous, femoral, and obturator nn. Can be blocked by an injection into the psoas compartment (Lumbar plexus block). • Lower sacral roots form the sciatic n. They lie in a compartment with bony posterior and can be reached by parasacral approach. • Conclusion - separate injections are needed for anterior (lumbar plexus) and posterior (sacral) branches.

  7. Innervation of Lower Extremity

  8. Lower extremity innervation • Femoral n. - courses behind the psoas m. and passes under inguinal l. posterior and just lateral to the femoral a. – reliable landmark. • Below or sometimes slightly above the ligament, it branches. The main trunk going medially across the knee, medial calf all the way to the medial ankle and foot – saphenous n. • Lateral femoral cutaneous n. – Leaves the fascial sheath early, migrates laterally and emerges under inguinal l. medial to ASIS. Provide sensory supply to lateral thigh. • Obturator n. – emerges under superior ramus of the pubis and branches. Supply motor and sensory fibers to the hip, knee, medial thigh, adductor mugnus m.

  9. Dermatomes and peripheral nerve branches

  10. Obturator nerve

  11. Lower extremity innervation • Sciatic n. – exits the pelvis through sciatic notch, lies below piriformis and gluteus maximus mm., sends a branch to the hip (quadratus femoris m.), travels behind the femur, splits into the commonperoneal and tibial nn. 7-10 cm above popliteal crease. • Common peroneal n. – winds around the neck of the fibula posterior to lateral. Divides into superficial peroneal and deep peroneal nn. • Innervates knee joint. • Stimulation – dorsiflexion of the foot and eversion.

  12. Lower extremity innervation • Tibial n.- lies between semitendineus and biceps femoris mm. lateral to popliteal artery. • Branches – Sural n., medial and lateral plantar nn., calcaneal n. • Plantar flexion, flexion of the toes, inversion. • Innervates ankle joint.

  13. Stimulation of the Sciatic nerve

  14. Motor functions impaired with injury

  15. Examine before blocking

  16. LUMBAR PLEXUS BLOCK

  17. Femoral block

  18. Sciatic nerve – Parasacral approch

  19. Sciatic nerve – Posterior Approach

  20. Sciatic nerve – Posterior Approach

  21. Sciatic nerve – Anterior Approach

  22. Sciatic nerve – Anterior Approach

  23. Sciatic nerve – Subgluteal Approach

  24. Sciatic nerve – Lateral and Popliteal Approach

  25. Ankle block

  26. Ankle block (no epi)

  27. Ankle block

  28. Ankle block

  29. Which nerve is blocked?

  30. Which nerve is blocked?

  31. ?????????????????????

More Related