Lower Extremity Block. A.Ghaleb,M.D. Associate professor Medical director Acute and chronic Pain management Dept. of Anesthesiology UAMS. Lumbar plexus. The lumbar plexus is formed by the ventral rami of the first three lumbar nerves and the greater part of the fourth
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Lower Extremity Block
Acute and chronic Pain management
Dept. of Anesthesiology
one with a branch of the last thoracic nerve
and another between the fourth and fifth lumbar nerves
give birth respectively to the :
Lumbosacral trunk which contributes to the sacral plexus.
It can be used for hip or knee surgery
The lumbar plexus block can be used for most surgeries involving the lower limb
The patient lays on the side opposite to the block (thigh flexion: 30°; knee flexion: 90°)
while the physician stands behind. An assistant facing the patient with hands on the
upper thorax and thigh will help maintain correct position and identify thigh
movements during neurostimulation.
Vertical paravertebral opacity from L2 to L5.
Bundle-shaped, which parallels the Psoas major location
Fascia Iliaca Block
Connect & divide into thirds Junction of lateral 1/3rd & medial 2/3rd
1 cm inferior to mark
Femoral Nerve Block
provides sensory anesthesia of :
the anterior thigh
medial aspect of the calf, ankle and foot
The point of needle insertion is marked 1.5 cm
lateral and 1.5 cm distal to the intersection of
the inguinal ligament and the femoral artery
tibial (plantar flexion +Inversion )
common peroneal (dorsiflexion + eversion)
Tibial nerve Posterior to posterior tibial artery Contact bone and withdraw needle by 1mm 5ml LA