Morning Report: 4/24/2012

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!

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.