What is the response of the brachial plexus to stimulation during placement of an interscalene block?
- twitching of any of the following muscles
- Pectoralis muscle
- Deltoid muscle
- Triceps muscle
- Biceps muscle
- Any twitch of the hand or forearm
The axillary nerve provides motor innervation to what muscles?
Deltoid and terres minor
What is the cutaneous innervation of the axillay nerve?
Skin of the shoulder
What muscles does the radial nerve provide motor stimulus to?
- Exstensor muscles arm and the forearm
- Digital extensors
- Abductor pollicis longus
What is the cutaneous innervation of the radial nerve?
posterior later surface of the arm, forearm, and hand
What is the motor innervation of the musculocutaneous nerve?
Biceps, brachialis, coracobrachialis
What is the cutaneous innervation of the musculocutaneous nerve?
Lateral surface of the forearm
What is the muscular innervation of the median nerve?
- Flexors of the forearm
- Pronator quadratus
- pronator terres
- digital flexors
What is the cutaneous innervation of the median nerve?
Skin over the aneteriolateral hand
What is the muscular innervation of the ulnar nerve?
- Flexor carpi ulanris
- adductor pollicis
- small digital muscles
What is the cutaneous innervation of the ulnar nerve?
medal surface of the hand
What nerve roots are associated with the radial nerve?
What nerve roots are associated with the ulnar nerve?
What nerve roots are associated with the median nerve?
What nerve roots are associated with the musculocutaneous nerve?
What nerve roots are associated with the axillary nerve?
c5 and c6
What are the landmarks for a median nerve block?
- Flexor carpi radialis
- Flexor palmaris longus
What are the landmarks of a radial nerve blocks?
Describe the process of blocking the radial nerve?
Insert needle just proximal to the radial styloid in a medial fashion
Describe the process of blocking the median nerve.
Insert 25 g needle between the tendons of flexor carpi radialis and flexor palmaris longus until bone is contacted and then withdraw 2-3 cm. 3-5 ml la infilrated.
Describe the process of blocking the ulnar nerve.
Insert 25 g needle just under the flexor carpi unlaris just above the styloid of the ulna. Infiltrate 3-5 mls of LA
Describe the process of blocking the deep peroneal nerve during and ankle block?
Insert 25 g 1.5 in needle just lateral to the extensor hallicus longus. When contact with the bone is met withdraw 2-3 mm and infiltrate 2-3 ml LA.
Describe the process of blocking the posterior tibial nerve?
Insert 25 g 1.5 in needle just behind the medial malleolus until contact with bone is felt. With draw 1-2 mm and infiltrate 2-3 ml LA.
Describe blocking the saphenous nerve during an ankle block.
To block the saphenous nerve, a 1.5 in, 25-gauge needle is inserted at the level of the medial malleolus and a "ring" of local anesthetic is raised from the point of needle entry to the Achilles tendon and anteriorly to the tibial ridge. 5 ML of LA is usually enough.
Describe blocking the superficial peroneal nerve during an ankle block.
o block the superficial peroneal nerve, the needle is inserted at the tibial ridge and extended laterally toward the lateral malleolus. 5 ML of LA usually suffices.
Describe blocking the sural nerve during an ankle block.
the needle is inserted at the level of the lateral malleolus and the local anesthetic is infiltrated toward the Achilles tendon (Figure 12). Five milliliters of local anesthetic is deposited in a circular fashion.
What is the largest nerve of the lumbar plexus?
What two fascial planes need to be crossed to ensure block of the femoral nerve?
From what nerves doe the femoral nerve arise?
What muscle response is sought when stimulating the femoral nerve prior to block.
Twitching of the quadriceps
Describe the muscular and cutaneous distribution of the femoral nerve.
Skin and muscles of the anterior thigh and most of the femur and knee joint. The block also confers anesthesia of the skin on the medial aspect of the leg below the knee joint.
What twitch will be seen when stimulating the sciatic nerve?
twitch of the hamstring, calf, foot, or toes
for what procedures would it be appropriate to block the sciatic nerve?
knee, calf, Achilles tendon, ankle, and foot
What nerve roots make up the sciatic nerve?
What is the distribution of a sciatic block?
anesthesia of the skin of the posterior aspect of the thigh, hamstring, and biceps femoris muscles; part of the hip and knee joint; and the entire leg below the knee with the exception of the skin of the medial aspect of the lower leg.
What are the landmarks for the performance of a posterior approach to the sciatic nerve?
- greater trochanter
- posterior inferior iliac spine
Where is the needle insertion point for a posterior approach to the sciatic nerve?
Line drawn between the greater trochanter and PSIS. This line is divided in half and a perpendicular line drawn that is 4 cm long. This is the needle placement.