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Anaesthesia for laparoscopy in a CARDIAC patient



                            Dr. Nilesh Parikh
                                MD,PDCC
                             (Card.Anaes)

                              Consultant
                           Anaesthesiologist
                               NADIAD
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.
Lower limb mpuh
Lower limb mpuh
Lower limb mpuh
Lower limb mpuh
Lower limb mpuh
Lower limb mpuh
Lower limb mpuh
Lower limb mpuh

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Lower limb mpuh

  • 1. Anaesthesia for laparoscopy in a CARDIAC patient Dr. Nilesh Parikh MD,PDCC (Card.Anaes) Consultant Anaesthesiologist NADIAD
  • 3. 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.
  • 4. 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.
  • 5. 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.
  • 6. 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.