1. Overview of Brachial Plexus Blocks Flashcards
1
Q
brachial plexus nerve roots
A
C5-T1
2
Q
proximal to distal breakdown of brachial plexus
A
proximal
Roots
Trunks
Divisions
Cords
Branches
distal
3
Q
trunks
A
superior
middle
inferior
4
Q
divisions
A
anterior
posterior
5
Q
cords
A
lateral
posterior
medial
6
Q
how are the cords named?
A
according to relationship to axillary artery
7
Q
how many branches of the brachial plexus
A
5
8
Q
branches of brachial plexus
A
axillary
radial
ulnar
median
musculocutaneous
9
Q
does the brachial plexus cover T2?
A
no
10
Q
T2 dermatome
A
upper medial arm
11
Q
medial forearm nerve
A
medial cutaneous
12
Q
lateral forearm nerve
A
musculocutaneous nerve
13
Q
shoulder
lateral arm innervation
A
C5-C7
14
Q
deltoid innervation
A
axillary nerve
15
Q
what nerve roots innervate the medial arm
and medial hand?
A
C8-T1
16
Q
posterior medial forearm
posterior elbow innervation
A
radial nerve (C5-C6)
17
Q
lateral forearm
lateral anterior elbow innervation
A
muscolocutaneous nerve
(C5-C7)
18
Q
medial forearm
medial anterior elbow innervation
A
medial cutaneous nerve
(C8-T1)
19
Q
medial hand
(anterior/posterior) innervation
A
ulnar nerve
(C8-T1)
20
Q
posterior lateral hand innervation
A
radial nerve
(C5-C6)
21
Q
anterior lateral hand
fingertips of first 3.5 digits
innervation
A
median nerve
(C6-C8)
22
Q
what does the brachial plexus not block
A
upper medial arm
23
Q
can a singular brachial plexus block cover the entire arm/shoulder?
A
no
24
Q
4 main brachial plexus blocks
A
- interscalene
- supracalvicular
- infraclavicular
- axillary
25
brachial plexus blocks
proximal to distal
proximal
interscalene
supraclavicular
infraclavicular
axillary
distal
26
interscalene block level
roots
27
what does the interscalene block
C5-C7
shoulder
lateral arm
28
what does the interscalene not block
C8-T1
medial elbow
forearm
***ulnar sparing***
29
interscalene anesthetizes
shoulder
2/3 of lateral clavicle
most of arm (not med forearm/hand)
30
what is interscalene great for
shoulder
upper arm
31
what is interscalene bad for
forearm
elbow
hand
32
interscalene complications
ipsilateral hemidiaphragmaic paresis
hoarseness
horner's syndrome
33
horner's syndrome
miosis (pupil constriction)
ptosis (droopy eyelid)
anhidrosis (no sweat)
34
supraclavicular block level
trunks
and
divisions
35
supraclavicular reliably blocks
C5-C7
C8-T1
entire arm
36
infraclavicular block level
cords
37
infraclavicular reliably blocks
C5-C7
C8-T1
entire arm
38
infraclavicular is not considered for what surgery
shoulder
(more distal insertion sitea)
39
supraclavicular/infraclavicular disadvantage
poor block of shoulder
40
supraclavicular pro
avoids complications of interscalene block
41
is supraclavicular as effective as interscalene?
no - interscalene is more effective
42
supraclavicular has _______ spread
supraclavicular has less efficient spread to suprascapular and axillary nerves
43
axillary block level
branches
44
which branches does the axillary block
median
radial
ulnar
45
which branches does the axillary not block
musculocutaneous nerve
46
what does the axillary block well?
hand
47
how can the axillary block the entire forearm/elbow?
only if performed alongside separate musculocutaneous block
48
the axillary does not block ________ well
the axiallary does not block the upper arm well
49
what does the musculocutaneous nerve innervate?
lateral foreaarm
50
axillary block for forearm surgery
requires separate injection for musculocutaneous nerve
51
axillary block for hand surgery
no additional block for musculocutaneous nerve
52
does the axillary block target the axillary nerve?
nope :)
53
what surgeries are axillary blocks food for?
forearm
hand
54
what block is good for tourniquet pain during hand surgery?
musculocutaneous nerve block
55
what block covers T2
intercostobrachial block
56
intercostaobrachial block is used for
elbow surgery
(medial elbow)
axillary surgery
57
does the intercostobrachial block help tourniquet pain?
nope
58
how is the intercostobrachial block performed?
10mL injected subQ in the axillary region
upper border of bicep
lower border of tricep
59
what block covers C8-T1
medial cutaneous nerve block
60
when is the medial cutaneous block used?
with a interscalene block
61
when is the musculocutaneous block used?
for coverage to lateral forearm when axillary block is used
62
most likely block for shoulder surgery
interscalene
63
alternative block for shoulder surgery
supraclavicular
- to avoid complications
64
forearm surgery block
1. supraclavicular
2. infraclavicular
3. axillary + musculocutaneous
65
hand surgery block
1. supraclavicular
2. infraclavicular
3. axillary block
66
block with lowest complications for hand surgery
axillary
67
ipsilateral phrenic nerve palsy: interscalene
yes
68
ipsilateral phrenic nerve palsy: supraclavicular
yes - less common
69
ipsilateral phrenic nerve palsy: infraclavicular
not really
70
ipsilateral phrenic nerve palsy: axillary
no
71
recurrent laryngeal nerve palsy: interscalene
yes
72
recurrent laryngeal nerve palsy: suprclavicular
yes - less common
73
recurrent laryngeal nerve palsy: infraclavicular
no
74
recurrent laryngeal nerve palsy: axillary
no
75
horner's syndrome: interscalene
yes
76
horner's syndrome: supraclavicular
yes - less common
77
horner's syndrome: infraclavicular
yes - less common
78
horner's syndrome: axillary
no
79
epidural/subarachnoid injection (total spinal): interscalene
yes
80
epidural/subarachnoid injection (total spinal): supraclavicular
no
81
epidural/subarachnoid injection (total spinal): infraclavicular
no
82
epidural/subarachnoid injection (total spinal): axillary
no
83
pneumothorax: interscalene
possible (rare)
84
pneumothorax: supraclavicular
yes
85
pneumothorax: infraclavicular
yes - less likley
86
pneumothorax: axillary
no
87
subclavian artery puncture: interscalene
no
88
subclavian artery puncture: supraclavicular
yes
89
subclavian artery puncture: infraclavicular
no
90
subclavian artery puncture: axillary
no
91
vertebral artery puncture: interscalene
yes
92
vertebral artery puncture: supraclavicular
no
93
vertebral artery puncture: infraclavicular
no
94
vertebral artery puncture: axillary
no
95
axillary artery puncture: interscalene
no
96
axillary artery puncture: supraclavicular
no
97
axillary artery puncture: infraclavicular
yes
98
axillary artery puncture: axillary
yes
99
musculocutaneous sparing: interscalene
no
100
musculocutaneous sparing: supraclavicular
no
101
musculocutaneous sparing: infraclavicular
no
102
musculocutaneous sparing: axillary
yes
103
ulnar sparing: interscalene
yes
104
ulnar sparing: supraclavicular
yes - less likely
105
ulnar sparing: infraclavicular
yes - less likely
106
ulnar sparing: axillary
no
107
upper arm tourniquet pain: interscalene
yes (from T1/T2)
108
upper arm tourniquet pain: supraclavicular
yes (from T2)
109
upper arm tourniquet pain: infraclavicular
Yes (from T2)
110
upper arm tourniquet pain: axillary
yes (T2)
111
which brachial plexus block is best for COPD patients?
infraclavicular
- lower risk of ipsilateral phrenic nerve palsy
112
which brachial plexus block has highes risk of pneuemothorax?
supraclavicular
113
which brachial plexus block is ulnar sparing?
interscalene
supra/infra possibly
114
which brachial plexus block is musculocutaneous sparing?
axillary
115
interscalene SE (8)
1. ipsilateral phrenic palsy
2. recurrent laryngeal palsy
3. horner's syndrome
4. total spinal
5. pneumothorax (rare)
6. vertebral artery puncture
7. ulnar sparing
8. upper arm tourniquet pain (T1/2)
116
supraclavicular complications (7)
1. ipsilateral phrenic palsy
2. recurrent laryngeal palsy
3. horner's syndrome
4. pneumothorax
5. subclavian artery puncture
6. ulnar sparing (less likely)
7. upper arm tourniquet pain (T2)
117
infraclavicular complications (5)
1. horner's syndrome
2. pneumothorax
3. axillary artery puncture
4. ulnar sparing possible
5. upper arm tourniquet pain (T2)
118
axillary complications (3)
1. axillary artery puncture
2. musculocutaneous sparine
3. upper arm tourniquet pain (T2)
119
interscalene block CI (2)
1. resp dz/COPD
2. contralateral phrenic dysfunction
120
supraclavicular block CI (2)
1. resp dz/COPD
2. contralateral phrenic dysfunction
121
infraclavicular block CI (1)
1. ipsilateral central line or pacemaker
122
axillary block CI
none
123
which block is CI in pts with ipsilateral central line or pacemaker?
infraclavicular block
124
which block is CI in pts with contralateral phrenic nerve dysfunction?
interscalene
supraclavicular
125
which block is CI in pts with respiratory disease or COPD?
interscalene
supraclavicular
126
which block for shoulder/proximal humerus?
interscalene
127
which block for mid humerus?
interscalene
supraclavicular
128
which block for elbow?
supraclavicular
infraclavicular
axillary + musculocutaneous
129
which block for medial elbow?
intercostobrachial (T2) block
130
how many pts have T2 extending to elbow joint?
1/3 of pts
131
which block for forearm?
supraclavicular
infraclavicular
axillary + musculocutaneous
132
which block for wrist?
supraclavicular
infraclavicular
axillary
133
which block for hand?
supraclavicular
infraclavicular
axillary
wrist block
134
which block for fingers?
supraclavicular
infraclavicular
axillary
wrist block
digital block
135
interscalene needle location
ROOTs
136
supraclavicular needle location
trunks
divisions
137
infraclavicular needle location
Cords
138
axillary needle location
branches
139
does the axillary block the axillary nerve
nope
140
interscalene coverage
shoulder
lateral 2/3 clavicle
lateral arm/hand
141
what does the interscalene not block?
medial arm/hand/elbow
142
supraclavicular coverage
entire arm/hand except upper medial portion
143
infraclavicular coverage
same as supraclavicular
not used in shoulder
144
axillary coverage
hand
medial arm
most of elbow
145
what does the axillary not cover?
upper arm
lateral forearm
