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Lower Extremity and Trunk Ultrasound Guided Blocks

Lower Extremity and Trunk Ultrasound Guided Blocks. Andrew Biegner CRNA, FAAPM Anesthesia Staffing Consultants Hillsdale Community Health Center Hillsdale, MI. Lower Extremity Regional Anesthesia Blocks. Lumbar Plexus Psoas Compartment Nerve Block Sciatic Nerve Block

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Lower Extremity and Trunk Ultrasound Guided Blocks

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  1. Lower Extremity and Trunk Ultrasound Guided Blocks Andrew Biegner CRNA, FAAPM Anesthesia Staffing Consultants Hillsdale Community Health Center Hillsdale, MI

  2. Lower Extremity Regional Anesthesia Blocks • Lumbar Plexus • Psoas Compartment Nerve Block • Sciatic Nerve Block • *Femoral Nerve Block • *Saphenous nerve • Lateral Femoral Cutaneous Nerve Block • Fascia Iliaca Block • *PoplitealFossa Block • Obturator Nerve Block • Ankle Block

  3. Lumbar Plexus Anatomy • Genitofemoral • Lower branch L1 and branch of L2 • Obturator • Anterior divisions of L2, L3 and L4 • Femoral • Large branches of the posterior divisions L2 and L3 • Posterior division of L4 • Lateral Femoral Cutaneous • Small branches of the posterior division of L2 and L3

  4. Femoral Nerve Block

  5. Femoral Nerve Block • Produces anesthesia to the anterior portion • Upper leg • Medial calf • Results in inability • Abduct the leg • Extend the lower leg • Adjunct for postoperative pain relief

  6. Femoral Nerve Block Indications • Surgical procedures of the anterior thigh • Complete or partial analgesia to: • Painful conditions of the upper leg • Femoral shaft and neck fractures • Knee surgery

  7. Femoral Nerve Anatomy 1. Inguinal ligament 3. Femoral vein 4. Femoral artery 5. Femoral nerve 10. Adductor longus muscle

  8. Femoral U/S Nerve Block • Patient position • Supine or recumbent with groin exposed • Transducer location • Placed axially between the inguinal crease to the inguinal ligament • In-Plane approach • Needle size • 100mm • LA volume • 20 ml

  9. Femoral Nerve Block Landmarks

  10. Femoral Nerve Block* • Landmarks

  11. Femoral Nerve Block Complications • Intravascular injection • Hematoma • Direct nerve injury

  12. PoplitealFossa Nerve Block

  13. Popliteal Fossa • Diamond-shaped area bounded • Provides innervation to distal lower extremity • Except medial aspect of the leg • Saphenous nerve • Contains • Posterior tibial nerve • Common peroneal nerve • Abundance of fat • Connective tissue • Popliteal vessels

  14. PoplitealFossa Nerve Block • Indications • Foot and Ankle Surgery • Improved tourniquet tolerance over ankle block for foot surgery • For complete anesthesia / analgesia below the knee combine with • Femoral nerve block or • Saphenous nerve block

  15. PoplitealFossa U/S Nerve Block • Patient position • Supine, prone or lateral decubitus • Transducer location • Poplitealfossa crease • In-Plane approach • Needle size • 50 mm • LA volume • 20 ml

  16. Popliteal Nerve Block: Anatomy External & Internal Landmarks

  17. Popliteal Nerve Block: Anatomy External & Internal Landmarks

  18. PoplitealFossa Ultrasound Nerve Block: Positioning Prone Lateral

  19. PoplitealFossa Nerve Block Complications Intravascular injection Intraneural injection Block failure

  20. Saphenous Nerve Block

  21. Saphenous Nerve Block Indications • Medial lower leg surgery • Ankle surgery • Medial • Used with poplitealfossa block for complete anesthesia / anesthesia of lower leg

  22. Saphenous U/S Nerve Block • Patient position • Supine with thigh and leg externally rotated • Transducer location • Transverse • In-Plane approach • Needle size • 50 mm • LA volume • 10 ml

  23. Saphenous Nerve Block Anatomy

  24. Saphenous Nerve Block*

  25. Blocks of the Trunk TAP Para vertebral Intercostal Rectus sheath block

  26. TransversusAbdominusPlane Block (TAP)

  27. TransversusAbdominus Plane Block (TAP) Indications • Lower abdominal procedures • Hysterectomy • C- section under GA • Abdominoplasty

  28. TransversusAbdominusPlane Block (TAP) • Landmarks • Triangle of Petit • Anteriorly • External Oblique • Posteriorly • LatissimusDorsi • Inferiorly • Illiac Crest http://www.usra.ca/sb_tap

  29. TransversusAbdominus Plane Block • Patient position • Supine • Transducer location • Transverse between the margin of the 12th rib and superior iliac spine • In-Plane approach • Needle size • 100 mm • LA volume • 20 - 30 ml bilaterally

  30. TransversusAbdominus Plane Block http://www.usra.ca/sb_tap

  31. TransversusAbdominus Plane Block http://www.usra.ca/sb_tap

  32. Successful U/S Regional Anesthesia • Time management • Monitoring • Use 27g needle and pH adjusted local for skin wheels • Music....headphones for the patient • Use a Ultrasound machine

  33. Successful U/S Regional Anesthesia • Needle selection • Small movements of the needle • Evaluate frequently and touch-up early • Identification of difficult landmarks

  34. Successful U/S Regional Anesthesia • Use rabbits feet, rubbing stones, beads, and other totally ridiculous luck charms.

  35. Questions / Comments mnnavycrna@aol.com C: 517-607-5969

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