Dr. Nilesh ParikhMD,PDCC

(Card.Anaes)

Consultant Anaesthesiologist

NADIAD

Anaesthesia for laparoscopy in a CARDIAC patient

LOWER EXTREMITY

BLOCKS

ANATOMY

• The nerve supply to the lower extremity is derived from the lumbar and sacral plexus.

• The lumbar plexus is formed by anterior rami of L1-L4 + T12 & L5.

• The Ant. Divi. Of L2-4 forms the obturator nerve, Post. Divi. Forms the femoral nerve and lat.femoral cutaneous nerve.

Anatomy cont.

• Post.cutaneous nerve of the Thigh is derived from S1-3, Sciatic nerve is formed by S1-3 + Ant.rami of L4-5

• The Sciatic nerve is actually a combination of two major nerve trunks, the Tibial and the common peroneal nerve.

• The sciatic nerve is largest of the four peri.nerves with a width of 2cm.

Sciatic nerve supplies the cutaneous innervation to the post.thigh and all of the leg and foot below the knee except a thin medial strip supplied by the saphenous nerve.Femoral nerve supplies the Ant. Compartment muscles of the thigh and the skin of the Ant.thigh from the inguinal ligament to the knee. Its terminal branch is the saphenous nerve, which supplies an area of skin along the medial side of the leg from the knee to the big toe.

Blockade of the sciatic nerve combined with femoral block can be used for surgical procedures below theknee without production of sympathectomy.

Femoral block is useful for # Mid femoral shaft femur and knee arthroscopy.Femoral + sciatic block is useful for below knee procedures.Lumbar plexus block is useful for hip and Anterolateral thigh surgery.Lumbar+Sciatic block is useful for whole lower limb.