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
-Muscles of LATERAL (Superficial Fibular – Eversion) and ANTERIOR (Deep Fibular – Dorsiflexion of foot) COMPARTMENTS OF THE LOWER LEG
-SENSORY: Lateral Sural cutaneous nerve
GIVES: Sensory to dorsum of foot and lateral part of lower leg
SURAL NERVE: formed from branches of tibial and common fibular nerves
SCIATIC NERVE BLOCK AT POPLITEAL
FOSSA:
ANATOMY:
STEPS: PATIENT PRONE EASIER
-LOOK LATERAL TO POPLITEAL VESSELS
– TRACK NERVE AND LOOK FOR SPLIT INTO TIBIAL AND COMMON FIBULAR
– INJECT BUPIVICAINE OR LIDOCAINE
-SOAK TIME
Thanks Dr. Caputo for a great overview! Leave any thought or comments below!
Jay Khadpe MD
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