Regional Anaesthesia

Transcription

1 Regional Anaesthesia

2 Lower limb anatomy and blocks

3 Hip and Knee Joint

4 Hip Joint: Nerve supply Lumbar plexus Femoral nerve through the nerve to the Rectus Femoris Ant division of the Obturator nerve The Accessory Obturator nerve Sacral plexus The nerve to the quadratus femoris The Sup Gluteal nerve

5 Knee Joint Femoral nerve, through its branches to the VasD esp VasD Medialis Obturator through its post division Scia=c nerve through genicular branches of the Tibial and Common Peroneal

6 Ankle Joint Scia=c nerve Tibial n Superficial Peroneal n Deep Peroneal n

7 Lumbo- Sacral Plexus FormaDon and Branches

8 Lumbo- sacral plexus Lumbar plexus Ant rami L 1-4, Frq include branches from T 12 and occ from L 5 Sacral plexus S 1,2,&3 Sacral nerves Plus branches from the ant rami of L 4,5

9 Dorsal division Upper and lower divisions L 1 Ventral division Iliohypogastric nerve Lat cut n. of thigh L 2 L 3 Genitofemoral nerve Ilioinguinal nerve L 4 Femoral nerve Branch to lumbosacral trunk Obturator nerve

10 L 4 L 5 Sup gluteal nerve S 1 Inf gluteal nerve S 2 Sciatic nerve S 3 Post cut n. of thigh S 4 Pudendal nerve

11 Motor responses if using PNS + US Ant Femoral Sartorius Post Femoral Quads ( Dancing of Patella) Common Peroneal n sdmuladon Dorsiflexion Eversion of the foot Tibial nerve sdmuladon Plantar flexion Inversion of the foot

12 Genito-femoral nerve Lateral cutaneous nerve of thigh Obturator nerve Femoral nerve Sciatic nerve

13 Obturator nerve Lateral cutaneous nerve of thigh Femoral nerve Sciatic nerve

14 Femoral Nerve

15 PELVIS ILIACUS L 2 L 3 L 4 Femoral nerve RECTUS FEMORIS HIP JOINT Lat circumflex femoral artery PECTINEUS SARTORIUS VASTUS LATERALIS INTERMEDIUS MEDIALIS MED FEMORAL CUT NERVE INTERMEDIATE FEMORAL CUT NERVE KNEE JOINT FEMORAL ARTERY INFRAPATELLAR BRANCH DEEP FASCIA BELOW KNEE SAPHENOUS NERVE

16 Femoral Nerve above the Inguinal Ligament Femoral Nerve below the Inguinal Ligament Iliac Vessels Femoral vessels Sartorius

17 Fascia Lata Fatty tissue between the two fascia often mistaken for the nerve Femoral Nerve Facia Iliaca

18 Fascia Lata Fatty tissue between the two fascia often mistaken for the nerve Femoral Nerve Femoral Artery Facia Iliaca

19 Ultrasound Guided

20 Probe Gel Iliopsoas

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22 Saphenous nerve

23 Sub- sartorial

24 Not a single nerve but Nerve to Vastus Medialis and Saphenous nerve lie together and a muscular response can be elicited by using PNS Femoral artery

25 Nerve to Vastus Medialis Saphenous Nerve

26 LCFN

27 Lat cut nerve of the thigh

28 Internal oblique muscle Iliacus Fascia External oblique Aponeurosis ASIS Single pop through fascia lata, deposit LA above and below the fascia to catch the main and the cut branches 1 cm Iliacus Muscle Inguinal ligament Fascia Lata

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31 Fascia Lata Fascia Iliaca ASIS

32 Obturator Nerve

33 AL OBTURATOR NERVE

34 OBTURATOR NERVE L 2 L 3 PELVIS OBTURATOR EXTERNUS L 4 OBTURATOR FORAMEN ADDUCTOR BREVIS THIGH ADDUCTOR PORTION OF ADDUCTOR MAGNUS HIP JOINT ADDUCTOR BREVIS ADDUCTOR LONGUS Ant Div Post Div KNEE JOINT TWIG TO PECTINIUS GRACILIS MEDIAL THIGH SKIN OVER ADDUCTORS

35 FEMORAL VESSELS OBTURATOR NERVE FEMORAL NERVE PT 2Cms 2Cms

36 AL Adductor Longus AB Adductor Brevis AM Adductor Magnus

37 3 in 1 Block!!!

38 Lat Cut Nerve of Thigh Psoas Major Single injection large volume misses out Obturator as it lies on the medial side ( sometimes within the substance) of the Psoas muscle Iliacus Femoral Nerve Iliopsoas Inguinal ligament Obturator Nerve

39 SciaDc Nerve

40 Sciatic nerve Popliteal fossa Tibial nerve Common peroneal Med & lat plantar nerves Sural nerve Superficial Peroneal Deep Peroneal

41 SciaDc nerve

42 Approaches to SciaDc Nerve in the Gluteal Region

43 GT IT PSIS Sacral Hiatus

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45 Gluteus Maximus Sciatic Nerve

46 Popliteal Fossa

47 Artery Vein Nerve Medial Lateral Tibial Sural Common Peroneal

48 Tibial n Semimembranous Biceps Femoris Common Peroneal n Sural communicating branch Medial and lateral heads of Gastronemius Sural n

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52 LA around the nerve

53 Distal spread of LA around the main baranches

54 ANKLE

55 Superficial Peroneal nerves Great Saphenous Vein and Saphenous Nerve Medial Malleolus Dorsal Paedis Artery Deep Peroneal Nerve Lateral Malleolus Post Tibial Artery Tibial Nerve Achilles Tendon Sural Nerve Small Saphenous Vein

56 Saphenous Sural Superficial Peroneal Deep Peroneal Medial plantar Lateral plantar

57 Post Tibial

58 Sural nerve at level of Lat Malleolus Short Saphenous vein

59 Deep Peroneal at the ankle level Ant Tibial Artery

60 Cases Anaesthesia and Blocks

61 82 yrs old padent listed for Dynamic Hip Screw ( DHS)

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63 78 yrs old padent for hemi- arthroplasty

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65 28yr old padent for ORIF of Tibia and Fibula

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67 55 yrs old diabedc padent for amputadon of the big toe of Rt foot

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