Femoral and Popliteal Block Why?

[Maverikk]

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Started regional and have 2 questions
1) I did a femoral and tibial block for a TKA today. Why do both blocks? For tourniquet pain I can see the femoral + saphenous but why the tibial (it's a branch of the femoral).
Another regional question: What's the deal with spinal vs. regional, which one allows for extended pain vs recovery vs. fall risk. I don't know too much about this and all the textbooks focus on u/s technique, drugs and complications. I'm looking for some practical info into why certain surgeons choose different blocks (and we do spinal vs. regional depending on our orthopods preference)

 

[risnwb]

Started regional and have 2 questions
1) I did a femoral and tibial block for a TKA today. Why do both blocks? For tourniquet pain I can see the femoral + saphenous but why the tibial (it's a branch of the femoral).
Another regional question: What's the deal with spinal vs. regional, which one allows for extended pain vs recovery vs. fall risk. I don't know too much about this and all the textbooks focus on u/s technique, drugs and complications. I'm looking for some practical info into why certain surgeons choose different blocks (and we do spinal vs. regional depending on our orthopods preference)

Get out your anatomy book brah



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[sevoflurane]

Get out your anatomy book brah



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Yes... this. Look at femoral and sciatic veeeeery carefully.

 

[BobBarker]

 

[sleepallday]

Started regional and have 2 questions
1) I did a femoral and tibial block for a TKA today. Why do both blocks? For tourniquet pain I can see the femoral + saphenous but why the tibial (it's a branch of the femoral).
Another regional question: What's the deal with spinal vs. regional, which one allows for extended pain vs recovery vs. fall risk. I don't know too much about this and all the textbooks focus on u/s technique, drugs and complications. I'm looking for some practical info into why certain surgeons choose different blocks (and we do spinal vs. regional depending on our orthopods preference)

Wow. No excuse for this.

Also, thats pretty sad if you work at an institution where the surgeons dictate your anesthetic.

 

[WholeLottaGame7]

They say there are no such things as stupid questions...but some questions are better looked up in private before posting for the world to see...

 

[DreamLover]

Started regional and have 2 questions
1) I did a femoral and tibial block for a TKA today. Why do both blocks? For tourniquet pain I can see the femoral + saphenous but why the tibial (it's a branch of the femoral).
Another regional question: What's the deal with spinal vs. regional, which one allows for extended pain vs recovery vs. fall risk. I don't know too much about this and all the textbooks focus on u/s technique, drugs and complications. I'm looking for some practical info into why certain surgeons choose different blocks (and we do spinal vs. regional depending on our orthopods preference)

I'd review the branches of the femoral nerve as well as the branches of the sciatic nerve. I'm sure you'll figure out the answer.

If on the off chance you MEANT to say that you did a Femoral and a saphenous nerve block, I could see your redundancy...I don't know who would instruct you to do such silly things BUT if you meant femoral and popliteal blocks and question why, I'm sure you can tell by the responses that you are not correct in your anatomy, why did you not ask your attending what you are asking us? (Sorry for that atrocious run on sentence)

 

[racerx]

Wow. . .just. . .wow.

 

[epidural man]

Started regional and have 2 questions
1) I did a femoral and tibial block for a TKA today. Why do both blocks? For tourniquet pain I can see the femoral + saphenous but why the tibial (it's a branch of the femoral).
Another regional question: What's the deal with spinal vs. regional, which one allows for extended pain vs recovery vs. fall risk. I don't know too much about this and all the textbooks focus on u/s technique, drugs and complications. I'm looking for some practical info into why certain surgeons choose different blocks (and we do spinal vs. regional depending on our orthopods preference)

Just a clarification: Don't say spinal vs regional. Spinal IS a regional anesthetic technique (but often not spoken as such). A better classification would be neuraxial regional anesthesia vs peripheral regional.

No fall risk with spinal. No pain relief with spinal.

 

[Oggg]

In PP, surgeons dictate the postop pain mgmt, usually based on their experiences with RA during training (+1 to lots of RA in academia). It's up to the anesthesia group to convince them of the right choice.

 

[cognitus]

Just a clarification: Don't say spinal vs regional. Spinal IS a regional anesthetic technique (but often not spoken as such). A better classification would be neuraxial regional anesthesia vs peripheral regional.

No fall risk with spinal. No pain relief with spinal.

Why no pain relief with spinal? I know I've seen spinal anesthesia used for TKAs before

 

[Libertas]

duration of action, unless you put intrathecal opioids or use some other additional techniques. A bupivicaine spinal is only going to last a few hours, probably not much longer than surgery itself.

 

[pgg]

Why no pain relief with spinal? I know I've seen spinal anesthesia used for TKAs before

Even though most places will put patients who got intrathecal morphine on precautions for 24 hours, meaningful TKA pain relief from intrathecal morphine doesn't last nearly that long. Lots of surgeons hate it because it tends to wear off at 2 AM the night of surgery, and although the on-call anesthesiologist is on the hook for managing that breakthrough pain, the surgeons still hear about it from their patients.

Peripheral blocks are the gold standard for TKAs, though certainly not standard of care.

 

[Noyac]

Wow, I guess nobody here has ever made a mistake like Maverikk before. I agree it should have been looked up rather than posted on an Internet forum. But that seems to be how more and more people learn things these days.

Mav, don't worry. I made a stupid mistake just yesterday and I've been at this for 13 yrs.
Keep posting but please do yourself a favor and read as well.