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Fa: Anatomy 2 > 1. Overview of Brachial Plexus Blocks > Flashcards

1. Overview of Brachial Plexus Blocks Flashcards

1
Q

brachial plexus nerve roots

A

C5-T1

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2
Q

proximal to distal breakdown of brachial plexus

A

proximal
Roots
Trunks
Divisions
Cords
Branches
distal

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3
Q

trunks

A

superior
middle
inferior

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4
Q

divisions

A

anterior
posterior

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5
Q

cords

A

lateral
posterior
medial

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6
Q

how are the cords named?

A

according to relationship to axillary artery

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7
Q

how many branches of the brachial plexus

A

5

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8
Q

branches of brachial plexus

A

axillary
radial
ulnar
median
musculocutaneous

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9
Q

does the brachial plexus cover T2?

A

no

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10
Q

T2 dermatome

A

upper medial arm

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11
Q

medial forearm nerve

A

medial cutaneous

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12
Q

lateral forearm nerve

A

musculocutaneous nerve

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13
Q

shoulder
lateral arm innervation

A

C5-C7

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14
Q

deltoid innervation

A

axillary nerve

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15
Q

what nerve roots innervate the medial arm
and medial hand?

A

C8-T1

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16
Q

posterior medial forearm
posterior elbow innervation

A

radial nerve (C5-C6)

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17
Q

lateral forearm
lateral anterior elbow innervation

A

muscolocutaneous nerve
(C5-C7)

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18
Q

medial forearm
medial anterior elbow innervation

A

medial cutaneous nerve
(C8-T1)

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19
Q

medial hand
(anterior/posterior) innervation

A

ulnar nerve
(C8-T1)

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20
Q

posterior lateral hand innervation

A

radial nerve
(C5-C6)

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21
Q

anterior lateral hand
fingertips of first 3.5 digits
innervation

A

median nerve
(C6-C8)

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22
Q

what does the brachial plexus not block

A

upper medial arm

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23
Q

can a singular brachial plexus block cover the entire arm/shoulder?

A

no

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24
Q

4 main brachial plexus blocks

A
  1. interscalene
  2. supracalvicular
  3. infraclavicular
  4. axillary
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25
Q

brachial plexus blocks
proximal to distal

A

proximal
interscalene
supraclavicular
infraclavicular
axillary
distal

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26
Q

interscalene block level

A

roots

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27
Q

what does the interscalene block

A

C5-C7
shoulder
lateral arm

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28
Q

what does the interscalene not block

A

C8-T1
medial elbow
forearm
ulnar sparing

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29
Q

interscalene anesthetizes

A

shoulder
2/3 of lateral clavicle
most of arm (not med forearm/hand)

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30
Q

what is interscalene great for

A

shoulder
upper arm

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31
Q

what is interscalene bad for

A

forearm
elbow
hand

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32
Q

interscalene complications

A

ipsilateral hemidiaphragmaic paresis
hoarseness
horner’s syndrome

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33
Q

horner’s syndrome

A

miosis (pupil constriction)
ptosis (droopy eyelid)
anhidrosis (no sweat)

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34
Q

supraclavicular block level

A

trunks
and
divisions

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35
Q

supraclavicular reliably blocks

A

C5-C7
C8-T1
entire arm

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36
Q

infraclavicular block level

A

cords

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37
Q

infraclavicular reliably blocks

A

C5-C7
C8-T1
entire arm

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38
Q

infraclavicular is not considered for what surgery

A

shoulder
(more distal insertion sitea)

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39
Q

supraclavicular/infraclavicular disadvantage

A

poor block of shoulder

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40
Q

supraclavicular pro

A

avoids complications of interscalene block

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41
Q

is supraclavicular as effective as interscalene?

A

no - interscalene is more effective

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42
Q

supraclavicular has _______ spread

A

supraclavicular has less efficient spread to suprascapular and axillary nerves

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43
Q

axillary block level

A

branches

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44
Q

which branches does the axillary block

A

median
radial
ulnar

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45
Q

which branches does the axillary not block

A

musculocutaneous nerve

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46
Q

what does the axillary block well?

A

hand

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47
Q

how can the axillary block the entire forearm/elbow?

A

only if performed alongside separate musculocutaneous block

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48
Q

the axillary does not block ________ well

A

the axiallary does not block the upper arm well

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49
Q

what does the musculocutaneous nerve innervate?

A

lateral foreaarm

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50
Q

axillary block for forearm surgery

A

requires separate injection for musculocutaneous nerve

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51
Q

axillary block for hand surgery

A

no additional block for musculocutaneous nerve

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52
Q

does the axillary block target the axillary nerve?

A

nope :)

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53
Q

what surgeries are axillary blocks food for?

A

forearm
hand

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54
Q

what block is good for tourniquet pain during hand surgery?

A

musculocutaneous nerve block

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55
Q

what block covers T2

A

intercostobrachial block

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56
Q

intercostaobrachial block is used for

A

elbow surgery
(medial elbow)
axillary surgery

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57
Q

does the intercostobrachial block help tourniquet pain?

A

nope

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58
Q

how is the intercostobrachial block performed?

A

10mL injected subQ in the axillary region
upper border of bicep
lower border of tricep

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59
Q

what block covers C8-T1

A

medial cutaneous nerve block

60
Q

when is the medial cutaneous block used?

A

with a interscalene block

61
Q

when is the musculocutaneous block used?

A

for coverage to lateral forearm when axillary block is used

62
Q

most likely block for shoulder surgery

A

interscalene

63
Q

alternative block for shoulder surgery

A

supraclavicular
- to avoid complications

64
Q

forearm surgery block

A
  1. supraclavicular
  2. infraclavicular
  3. axillary + musculocutaneous
65
Q

hand surgery block

A
  1. supraclavicular
  2. infraclavicular
  3. axillary block
66
Q

block with lowest complications for hand surgery

A

axillary

67
Q

ipsilateral phrenic nerve palsy: interscalene

A

yes

68
Q

ipsilateral phrenic nerve palsy: supraclavicular

A

yes - less common

69
Q

ipsilateral phrenic nerve palsy: infraclavicular

A

not really

70
Q

ipsilateral phrenic nerve palsy: axillary

A

no

71
Q

recurrent laryngeal nerve palsy: interscalene

A

yes

72
Q

recurrent laryngeal nerve palsy: suprclavicular

A

yes - less common

73
Q

recurrent laryngeal nerve palsy: infraclavicular

A

no

74
Q

recurrent laryngeal nerve palsy: axillary

A

no

75
Q

horner’s syndrome: interscalene

A

yes

76
Q

horner’s syndrome: supraclavicular

A

yes - less common

77
Q

horner’s syndrome: infraclavicular

A

yes - less common

78
Q

horner’s syndrome: axillary

A

no

79
Q

epidural/subarachnoid injection (total spinal): interscalene

A

yes

80
Q

epidural/subarachnoid injection (total spinal): supraclavicular

A

no

81
Q

epidural/subarachnoid injection (total spinal): infraclavicular

A

no

82
Q

epidural/subarachnoid injection (total spinal): axillary

A

no

83
Q

pneumothorax: interscalene

A

possible (rare)

84
Q

pneumothorax: supraclavicular

A

yes

85
Q

pneumothorax: infraclavicular

A

yes - less likley

86
Q

pneumothorax: axillary

A

no

87
Q

subclavian artery puncture: interscalene

A

no

88
Q

subclavian artery puncture: supraclavicular

A

yes

89
Q

subclavian artery puncture: infraclavicular

A

no

90
Q

subclavian artery puncture: axillary

A

no

91
Q

vertebral artery puncture: interscalene

A

yes

92
Q

vertebral artery puncture: supraclavicular

A

no

93
Q

vertebral artery puncture: infraclavicular

A

no

94
Q

vertebral artery puncture: axillary

A

no

95
Q

axillary artery puncture: interscalene

A

no

96
Q

axillary artery puncture: supraclavicular

A

no

97
Q

axillary artery puncture: infraclavicular

A

yes

98
Q

axillary artery puncture: axillary

A

yes

99
Q

musculocutaneous sparing: interscalene

A

no

100
Q

musculocutaneous sparing: supraclavicular

A

no

101
Q

musculocutaneous sparing: infraclavicular

A

no

102
Q

musculocutaneous sparing: axillary

A

yes

103
Q

ulnar sparing: interscalene

A

yes

104
Q

ulnar sparing: supraclavicular

A

yes - less likely

105
Q

ulnar sparing: infraclavicular

A

yes - less likely

106
Q

ulnar sparing: axillary

A

no

107
Q

upper arm tourniquet pain: interscalene

A

yes (from T1/T2)

108
Q

upper arm tourniquet pain: supraclavicular

A

yes (from T2)

109
Q

upper arm tourniquet pain: infraclavicular

A

Yes (from T2)

110
Q

upper arm tourniquet pain: axillary

A

yes (T2)

111
Q

which brachial plexus block is best for COPD patients?

A

infraclavicular
- lower risk of ipsilateral phrenic nerve palsy

112
Q

which brachial plexus block has highes risk of pneuemothorax?

A

supraclavicular

113
Q

which brachial plexus block is ulnar sparing?

A

interscalene
supra/infra possibly

114
Q

which brachial plexus block is musculocutaneous sparing?

A

axillary

115
Q

interscalene SE (8)

A
  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
Q

supraclavicular complications (7)

A
  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
Q

infraclavicular complications (5)

A
  1. horner’s syndrome
  2. pneumothorax
  3. axillary artery puncture
  4. ulnar sparing possible
  5. upper arm tourniquet pain (T2)
118
Q

axillary complications (3)

A
  1. axillary artery puncture
  2. musculocutaneous sparine
  3. upper arm tourniquet pain (T2)
119
Q

interscalene block CI (2)

A
  1. resp dz/COPD
  2. contralateral phrenic dysfunction
120
Q

supraclavicular block CI (2)

A
  1. resp dz/COPD
  2. contralateral phrenic dysfunction
121
Q

infraclavicular block CI (1)

A
  1. ipsilateral central line or pacemaker
122
Q

axillary block CI

A

none

123
Q

which block is CI in pts with ipsilateral central line or pacemaker?

A

infraclavicular block

124
Q

which block is CI in pts with contralateral phrenic nerve dysfunction?

A

interscalene
supraclavicular

125
Q

which block is CI in pts with respiratory disease or COPD?

A

interscalene
supraclavicular

126
Q

which block for shoulder/proximal humerus?

A

interscalene

127
Q

which block for mid humerus?

A

interscalene
supraclavicular

128
Q

which block for elbow?

A

supraclavicular
infraclavicular
axillary + musculocutaneous

129
Q

which block for medial elbow?

A

intercostobrachial (T2) block

130
Q

how many pts have T2 extending to elbow joint?

A

1/3 of pts

131
Q

which block for forearm?

A

supraclavicular
infraclavicular
axillary + musculocutaneous

132
Q

which block for wrist?

A

supraclavicular
infraclavicular
axillary

133
Q

which block for hand?

A

supraclavicular
infraclavicular
axillary
wrist block

134
Q

which block for fingers?

A

supraclavicular
infraclavicular
axillary
wrist block
digital block

135
Q

interscalene needle location

A

ROOTs

136
Q

supraclavicular needle location

A

trunks
divisions

137
Q

infraclavicular needle location

A

Cords

138
Q

axillary needle location

A

branches

139
Q

does the axillary block the axillary nerve

A

nope

140
Q

interscalene coverage

A

shoulder
lateral 2/3 clavicle
lateral arm/hand

141
Q

what does the interscalene not block?

A

medial arm/hand/elbow

142
Q

supraclavicular coverage

A

entire arm/hand except upper medial portion

143
Q

infraclavicular coverage

A

same as supraclavicular
not used in shoulder

144
Q

axillary coverage

A

hand
medial arm
most of elbow

145
Q

what does the axillary not cover?

A

upper arm
lateral forearm

Fa: Anatomy 2 (16 decks)

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