الفهرس 
Applied anatomy of the Lumbar PlexusOnly 14 pages are availabe for public view
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Abstract
The lumber and sacral plexi are the major nerve distributions in lower extremities. The lumbar plexus is derived from the anterior primary rami of the 1st, 2nd, 3rd and part of the 4th lumbar nerve roots. It gives ilio-inguinal, ilio-hypogastric, femoral, obturator, genitofemoral, lateral cutaneous nerve of the thigh and accessory obturator nerves. The sacral plexus is formed from a contribution of the 4th, from the entire 5th lumbar, 1st, 2nd and 3rd sacral anterior primary rami and from a part of 4th sacral. The branches of the sacral plexus are Posterior cutaneous nerve of thigh, Perforating cutaneous nerve, Parasympathetic to the pelvic plexus, Muscular and two terminal branches sciatic and Pudendal nerve. The sciatic nerve gives Common peroneal, Tibial, Articular to the hip joint and muscular branches
Local anesthetics are drugs which prevent conduction of electrical impulses by the nerve membrane.They are two types, ester local anesthetics such as cocaine, procaine, chloroprocaine and tetracaine and amide local anesthetics such as lidocaine, bupivacaine, mepivacaine, Ropivacaine and prilocaine. We can add Vasoconstrictor drugs, Steroids, Ketamine, Hyaluronidase, opioids, Clonidine and dexmedetomidine to potentiate its effect. Local anesthetic systemic toxicity ranges from mild systemic symptoms (auditory changes, circumoral numbness, metallic taste and agitation), to central nervous system findings (seizures, coma and respiratory arrest) and cardiovascular events (hypertension, hypotension, tachycardia, bradycardia, ventricular arrhythmias and cardiac arrest) Lumbosacral nerve blockades can be used for vascular Surgeries, hip surgery, Surgery of the Knee, below the knee and foot surgery. The assessment of the patient requires choice of the suitable patient, premedication, informed consent, vital signs monitoring and all equipment that may be required for the process as well as resuscitation equipment must be checked and available. Nerve block can be done by eliciting paraesthesia, field block, anatomical, use of nerve stimulators and ultrasound guided. Psoas compartment blockadecan be done by evoked motor responses, Loss of resistance technique and ultrasound guided. Femoral nerve block can be done by eliciting paraesthesia, ultrasound guided and perivascular 3-in-1 block.
Sciatic nerve block can be done by many Techniques such as Posterior approach of Labatt, Anterior approach, Supine approach (of raj), Subgluteal approach and Parasacral approach. There are low incidence of complications such as local anesthetic systemic toxicity, epidural spread, accidental vascular puncture, local infection, abscess formation, catheter kinking, knotting and peripheral nerve damage. Peripheral nerve damage may be due to direct local anesthetic toxicity, needle injury, compression, stretch, ischemia and complete transection