Transcript Ultrasound Upper Extremity Regional Anesthesia

Lower Extremity and
Trunk Ultrasound
Guided Blocks
Andrew Biegner
CRNA, FAAPM
Anesthesia Staffing Consultants
Hillsdale Community Health Center
Hillsdale, MI
Lower Extremity Regional
Anesthesia Blocks
Lumbar Plexus
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Psoas Compartment
Nerve Block
Sciatic Nerve Block
*Femoral Nerve Block
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Fascia Iliaca Block
*Popliteal Fossa
Block
Obturator Nerve
Block
*Saphenous nerve
Lateral Femoral
Cutaneous Nerve
Block
Ankle Block
Lumbar Plexus Anatomy
Genitofemoral
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Lower branch L1 and branch of L2
Obturator
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Anterior divisions of L2, L3 and L4
Femoral
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Large branches of the posterior divisions L2 and L3
Posterior division of L4
Lateral Femoral Cutaneous
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Small branches of the posterior division of L2 and L3
Femoral Nerve Block
Femoral Nerve Block
Produces anesthesia to the anterior portion
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Upper leg
Medial calf
Results in inability
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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:
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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 Block
Patient position
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Supine or recumbent with groin exposed
Transducer location
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Placed axially between the inguinal crease to the
inguinal ligament
In-Plane approach
Needle size
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100mm
LA volume
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20 ml
Femoral Nerve Block
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Landmarks
Femoral Nerve Block*
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Landmarks
Femoral Nerve Block Complications
Intravascular injection
Hematoma
Direct nerve injury
Popliteal Fossa Nerve Block
Popliteal Fossa
Diamond-shaped area bounded
Provides innervation to distal lower extremity
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Except medial aspect of the leg
Saphenous nerve
Contains
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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
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Femoral nerve block or
Saphenous nerve block
Popliteal Fossa U/S Nerve Block
Patient position
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Supine, prone or lateral decubitus
Transducer location
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Popliteal fossa crease
In-Plane approach
Needle size
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50 mm
LA volume
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20 ml
Popliteal Nerve Block: Anatomy
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External & Internal Landmarks
Popliteal Nerve Block: Anatomy
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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 Block
Patient position
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Supine with thigh and leg externally rotated
Transducer location
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Transverse
In-Plane approach
Needle size
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50 mm
LA volume
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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
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Triangle of Petit
Anteriorly
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External Oblique
Posteriorly
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Latissimus Dorsi
Inferiorly
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Illiac Crest
http://www.usra.ca/sb_tap
Transversus Abdominus
Plane Block
Patient position
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Supine
Transducer location
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Transverse between the margin of the 12th rib and superior iliac
spine
In-Plane approach
Needle size
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100 mm
LA volume
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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.
Questions / Comments
[email protected]
C: 517-607-5969