Morning Report: 4/24/2012

Here’s Dr. Caputo with a Morning Report on lower extremity nerve blocks:

MASTERING NERVE BLOCKS OF THE LEG

1)KNOW THE 2 MAIN NERVES GOING INTO LEG: FEMORAL AND SCIATIC

2)FEMORAL NERVE: HIP, ANTERIOR THIGH, QUADRACEPS, AND HAS SAPHENOUS NERVE BRANCH

3)TIBIAL AND COMMON FIBULAR ARE BRANCHES OF SCIATIC

4) TIBIAL NERVE IS POSTERIOR LOWER LEG MUSCLES AND SOLE OF FOOT

5) FIBULAR NERVES DO LATERAL LOWER LEG AND DORSAL FOOT.

6) SAPHENOUS NERVE INNERVATES OVER PATH OF GREAT SAPHENOUS NERVE

FEMORAL NERVE

Femoral Nerve:

– Supplies Quadriceps muscles- Goes deep

into Hip Joint ( Great for Elderly Hip fractures)

– Cutaneous branches (Blue)

– SAPHENOUS NERVE (Cutaneous innervation – Green)

– 3 Articular branches to the knee joint

FEMORAL NERVE BLOCK: AT FEMORAL TRIANGLE

APPROACH:OPPOSITE SIDE OF VESSELS

SAPHENOUS NERVE BLOCK:

WHEN? IF COMPLETE ANESTHESIA AT THE ANKLE IS DESIRED

WHERE? INFERIOR POLE OF PATELLA ON MEDIAL ASPECT OF KNEE

HOW? APPLY TOURNIQUET TO THIGH AND VISUALIZE GREAT SAPHENOUS VEIN ON ULTRASOUND. INJECTING AROUND THE SAPHENOUS VEIN AT THE INFERIOR POLE OF THE PATELLA WITH SURROUND THE SAPHENOUS N.

SCIATIC NERVE: POSTERIOR TIBIAL AND COMMON FIBULAR

Supplies motor and sensory innervation to the posterior aspect of the thigh as well as the entire lower leg, except for the medial leg, which is supplied by the saphenous nerve

For complete anesthesia of the leg below the knee the saphenous nerve must also be blocked, either directly or via a femoral nerve block.

TIBIAL NERVE:

-Supplies muscles of both posterior compartments

CUTANEOUS: Almost entire SOLE OF FOOT with Tibial: Heel and branches: Sural Nerve (Lateral Heel) and Medial and Lateral Plantar

PUTTING IT TOGETHER, TIBIAL NERVE BLOCK IS GREAT FOR LACERATIONS/ABSCESSES/FB’S TO SOLE OF FOOT!

COMMON FIBULAR (PERONEAL) NERVE: SUPERFICIAL AND DEEP FIBULAR NERVES