lower extremity and trunk ultrasound guided blocks andrew biegner crna, faapm anesthesia staffing...
TRANSCRIPT
Lower Extremity and Trunk Ultrasound
Guided BlocksAndrew 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
*Femoral Nerve Block *Saphenous nerve
Lateral Femoral Cutaneous Nerve Block
Fascia Iliaca Block
*Popliteal Fossa Block
Obturator Nerve Block
Ankle Block
Lumbar Plexus AnatomyGenitofemoral
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
Femoral Nerve Block
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
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
Femoral Nerve Anatomy
1. Inguinal ligament
3. Femoral vein
4. Femoral artery
5. Femoral nerve
10. Adductor longus muscle
Femoral U/S Nerve BlockPatient 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
Femoral Nerve Block Landmarks
Femoral Nerve Block* Landmarks
Femoral Nerve Block Complications
Intravascular injection
Hematoma
Direct nerve injury
Popliteal Fossa Nerve Block
Popliteal FossaDiamond-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
Popliteal Fossa 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
Popliteal Fossa U/S Nerve Block Patient position
Supine, prone or lateral decubitus
Transducer location Popliteal fossa crease
In-Plane approach
Needle size 50 mm
LA volume 20 ml
Popliteal Nerve Block: Anatomy External & Internal Landmarks
Popliteal Nerve Block: Anatomy
External & Internal Landmarks
Popliteal Fossa Ultrasound Nerve Block: Positioning
Prone Lateral
Popliteal Fossa Nerve Block Complications
Intravascular injection
Intraneural injection
Block failure
Saphenous Nerve Block
Saphenous Nerve Block Indications
Medial lower leg surgery
Ankle surgery Medial
Used with popliteal fossa block for complete anesthesia / anesthesia of lower leg
Saphenous U/S Nerve BlockPatient position
Supine with thigh and leg externally rotated
Transducer location Transverse
In-Plane approach
Needle size 50 mm
LA volume 10 ml
Saphenous Nerve Block Anatomy
Saphenous Nerve Block*
Blocks of the Trunk
TAP
Para vertebral
Intercostal
Rectus sheath block
Transversus Abdominus Plane Block (TAP)
Transversus Abdominus Plane Block (TAP) Indications
Lower abdominal procedures
Hysterectomy
C- section under GA
Abdominoplasty
Transversus Abdominus Plane Block (TAP)
Landmarks Triangle of Petit
Anteriorly External Oblique
Posteriorly Latissimus Dorsi
Inferiorly Illiac Crest
http://www.usra.ca/sb_tap
Transversus Abdominus 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
Transversus Abdominus Plane Block
http://www.usra.ca/sb_tap
Transversus Abdominus Plane Block
http://www.usra.ca/sb_tap
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
Successful U/S Regional Anesthesia
Needle selection
Small movements of the needle
Evaluate frequently and touch-up early
Identification of difficult landmarks
Successful U/S Regional Anesthesia
Use rabbits feet, rubbing stones, beads, and other totally ridiculous luck charms.
