3. Overview of Abdominal Blocks Flashcards
A
Right hypochondrium
B
epigastric
C
Left hypochondrium
D
Right lumbar
E
umbilical region
F
left lumbar
H
right iliac
I
hypogastrium
J
L iliac
4 main abdominal muscles: Superficial to DEEP
SUPERFICIAL
external oblique
internal oblique
rectus abdominis
transversus abdominis
DEEP
external oblique
outermost muscles on each side of rectus abdominis
external oblique muscles extend from
lower ribs to pelvis
internal oblique direction
opposite external oblique
rectus abdominis
6 pack
linea alba
connective tissue separating the muscles on each side of rectus abdominis
transversus abdominis
wraps around spine for protection and stability
what encircles the rectus muscle
rectus sheath
where does the rectus sheath extend
to the external oblique, internal oblieuq, and transversus abdominis
psoas major origin
T12-L4
psoas major insertion
lesser trochanter of femur
which muscle is missing? in how many people?
psoas minor
40-70%
iliacus origin
iliac fossa
iliacus insertion
lesser trochanter of femur (w/psoas major)
iliopsoas
the unification of the psoas major and iliacus muscle
where does the iliopsoas form
in the inguinal region
where does the iliopsoas descend?
below the inguinal ligament with the femoral nerve
what nerves are targetd by abdominal blocks
intercostal nerves
subcostal nerves
iliohypogastric and ilioingiunal nerves
intercostal nerves
T7-T11
subcostal nerves
T12
iliohypogastric and ilioinguinal nerves
L1-L2
Transversus abdominus plane (TAP)
space between transversus abdominis and internal oblique muscles
1
transverse abdominis muscle
2
internal oblique muscle
3
external oblique muscle
the TAP plane is superficial to ________ and deep to ______
the TAP plane is superficial to the transversus abdominis and deep to internal oblique
TAP requires how many injections
2 total: 1 injection per side
TAP: first “pop”
fascia between external and internal obliques
TAP: second “pop”
internal oblique and transverse abdominus
where do abdominal nerves travel
to the midline of the abdomen
rectus sheath block
inject between the rectus muscle and posterior rectus sheath
lower abdominal nerves
ilioinguiinal
iliohypogastric
genitofemoral
(L1-L2/3)
lower abdominal nerves innervate
the lower abdominal region in the groin area
TAP coverage
T10-L1
(lower abdominal area)
is the TAP a bilateral or unilateral block
TAP only covers 1 side
need to block bilaterally for full coverage
TAP volume
10-20mL
TAP risk from volume of block
higher risk of LAST
QL block coverage
T7-L1
(entire abdominal area)
is the QL a unilateral or bilateral block
bilateral - must anesthetize both sides
QL volume
high volume = higher change of LAST
QL block injection site
around the QL muscle
TAP block anesthesia
somatic only
QL block anesthesia
somatic and visceral
which block has a longer duration of analgesia: QL or TAP?
QL
QL block duration
24-48 hrs
TAP duration
8-12 hrs
which block is good for midline coverage?
rectus sheath block
ilioinguinal/iliohypogastric block coverage
L1-L3
(lower abdominal)
ilioinguinal/iliohypogastric anesthetizes
hypogstric region
inguinal crease
upper medial thigh
varicocele
enlargement of veins that cary blood away from testicle
varicocele treatment
varicocelectomy to reduce testicle pain and increase fertility
hydrocele
swelling in the scrotoum due to fluid accumulation in the thin sac surrouding the testicle
hydrocele treatment
hydrocelectomy
which muscle is technically the deepest abdominal muscle but is commonly referred to as a back muscle?
QL
posterior view: Superficial to Deep back muscles
Superficial
latissimus dorsi
erector spinae
quadratus lumborum
Deep
yellow
latissimus dorsi
purple
erector spinae
blue
quadratus lumborum
what is anterior to the QL muscle
psoas major
what is posterior to the QL muscle
erector spinae
the QL lies anterior to _____ and posterior to ______
the QL lies anterior to erector spinae and posterior to the psoas major
QL superficial to deep
SUPERFICIAL
lats
erector
QL
psoas major
DEEP
the QL muscle is ______ to transverse process
lateral
psoas major is ________ to QL
anterior
erector spinae is ____ to QL
posteriro
from a lateral view, the external oblique contacts
the external oblique contacts the latissimus dorsi