Lower Extremity Blocks
Contents
Lower Extremity Blocks#
Popliteal Sciatic#
covers 80% circumferential around ankle (anterior, lateral, posterior)
covers most of foot
motor block to foot & calf
no motor block to hamstrings (extends leg)
thigh tourniquet usually above coverage
positioning: elevate leg or lateral
Note: Sciatic Nerve block can also be done at subgluteal level (more proximal) if no access to popliteal fossa
more challenging as sciatic nerve is much deeper (~7+ cm)
may require curvilinear probe
also will block hamstrings
Saphenous (Adductor Canal)#
covers 20% medial side of ankle
covers medial side of foot to toe
covers part of knee
saphenous nerve is pure sensory, no motor block
Femoral#
covers medial thigh & knee
blocks quadricep muscles (extends knee)
obese patients - tape pannus away from groin
Fascia Iliaca#
Fascial plane block
can be difficult to identify fascial plane
Coverage:
femoral nerve - 100% of cases
lateral femoral cutaneus (LFCN) - 80-100% of cases
obturator nerve - sometimes
useful for skin graft harvest site & hip surgeries
2 approaches:
Infrainguinal - similar view as femoral
Suprainguinal - better for getting wider spread (e.g. LFCN, obturator)
Suprainguinal Fascia Iliaca Block:
Sources#
Most of resources/images taken from NYSORA which is a good site for learning/review. https://www.nysora.com/techniques/lower-extremity/