Name:
ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Popliteal and Saphenous Nerve Blocks
Description:
ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Popliteal and Saphenous Nerve Blocks
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/7fc01149-bae2-4e22-9829-1a0c7c38215c/thumbnails/7fc01149-bae2-4e22-9829-1a0c7c38215c.jpg?sv=2019-02-02&sr=c&sig=%2F58jKqIZ4OwhMTTSSNlCCqEuK3Ki%2FeiHUCjuMPn2aJ0%3D&st=2023-06-07T09%3A46%3A12Z&se=2023-06-07T13%3A51%3A12Z&sp=r
Duration:
T00H03M36S
Embed URL:
https://stream.cadmore.media/player/7fc01149-bae2-4e22-9829-1a0c7c38215c
Content URL:
https://asa1cadmoremedia.blob.core.windows.net/asset-bf206482-2bfa-4302-b543-30ab58c01bbe/ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Po.mov
Upload Date:
2022-02-23T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DIGITAL INTRO TUNE:
DR. HADZIC: Okay, let's do a quick review on how to do popliteal and saphenous blocks in a patient having an ankle fracture. Here we can see the patient is in the lateral or oblique position, and the probe is placed just above the popliteal fossa crease. Here we can see a typical image of the sciatic nerve and the popliteal fossa. There's the sciatic nerve sheath, with the tibial and the common peroneal nerve enveloped in the same sheath.
DR. HADZIC: If we start scanning a bit more distally, we're going to see the tibial nerve and common peroneal separate, and more proximally they come together in the same sheath. Color Doppler is useful to detect the tibial artery and the vein. In here we're going to insert the needle out-of-plane because it's the shortest path to the nerve and the nerve is rather superficial.
DR. HADZIC: Look, you see the needle being inserted through the sheath at the popliteal nerve? In the absence of a twitch, 0.5 milliamps and a low injection pressure, an injection has first been made, but it doesn't seem to make it into the sheath. For that reason, we're going to advance the needle a little deeper assuming that there's no motor response.
DR. HADZIC: A motor response would indicate that the needle touches the nerve. So here's a little deeper needle insertion, and now we can see how the local anesthetic in the sheath displaces the tibial and the common peroneal nerve.
SOOTHING BACKGROUND MUSIC:
SOOTHING BACKGROUND MUSIC: Now we're going to switch to the saphenous nerve. The patient is now in a supine position and the probe is over the quadriceps muscle or sartorius muscle, if you will. The Doppler reveals the femoral vein and the artery and the finger just pointed to where the remnants of the femoral nerve are. The needle is inserted out-of-plane,
SOOTHING BACKGROUND MUSIC: through the sartorius muscle and bypasses the femoral artery in the femoral canal. Here we can see the needle tip and the needle passing through the posterior fascia of the sartorius, and with a little bit of a pop it enters into the femoral triangle. And now is the distribution of the local anesthetic in the triangle.
SOOTHING BACKGROUND MUSIC: And again, we will have to make sure that there's no motor response, which would at 0.5 milliamp indicate needle-nerve contact. Here we are 15 minutes later in the operating room. Here's one of our fellows charting the medical record. And the patient is under light sedation, as usual. Preparation for the surgery continues. [medical staff's indistinct background conversation] These are our stellar foot and ankle surgeons who could do 10 to 15 cases a day.
SOOTHING BACKGROUND MUSIC: And here we see infusion of 0.8 micrograms per kilogram per minute.
DIGITAL OUTRO TUNE:
