4. Overview of Chest Wall Blocks

Question 1

true ribs

Answer 1

1-7
cartilages attach to sternum

Question 2

false ribs

Answer 2

8-12
cartilages DO NOT attach to sternum

Question 3

floating ribs

Answer 3

11-12

Question 4

floating ribs only attach to

Answer 4

vertebrae

Question 5

scapula extends to

Answer 5

inferior border of 7th rib

Question 6

how many pairs of intercostal nerves

Answer 6

12 pairs

Question 7

how many pairs of thoracic nerve roots

Answer 7

12 pairs

Question 8

intercostal muscle layers

Answer 8

external
internal
innermost

Question 9

where does the vein, artery , and nerve lie?

Answer 9

between internal and innermost muscles
behind the rib

Question 10

position of vein artery and nerve

Answer 10

Superior
Vein
Artery
Nerve
Inferior

(VAN)

Question 11

what is deep to intercostal muscles

Answer 11

lung

Question 12

what levels do you inject for intercostal block

Answer 12

2 levels above and below incision site

Question 13

inferior border of scapula dermatome

Answer 13

T6

Question 14

injection site for intercostal block

Answer 14

angle of rib

Question 15

what dermatome levels can you use intercostal blocks

Answer 15

T6 dermatome and below

Question 16

intercostal block complication

Answer 16

1. pneumothorax
2. pt discomfort
3. LAST

Question 17

which block has the highest blood level of local anesthetic per volume?

Answer 17

intercostal block

Question 18

do you sedate during intercostal block?

Answer 18

yes

Question 19

which injection site have higher risk of LAST?

Answer 19

IV
tracheal

Question 20

Highest to lowest local anesthetic absorption

Answer 20

HIGHEST
IV > Tracheal > intercostal
Caudal
Epidural
Brachial Plexus
Axillary
Lower extremity (Femoral)
Sub Q
LOWEST

Question 21

can you use ultrasound for intercostal block?

Answer 21

yes - but its not common because you cant visualize the nerve

Question 22

paraverterbal block indications

Answer 22

alternative approach to intercostal block by blocking intercostal nerves in paravertebral space

Question 23

what levels do you block with paravertebral

Answer 23

2 levels above and below

Question 24

paravertebral space

Answer 24

wedge shaped located to side of vertebral commons

Question 25

TPVS contacts ________ medially and ______ laterally

Answer 25

TPVS contacts epidural space medially and intercostal space laterally

Question 26

main landmark for paravertebral blcok

Answer 26

transverse process of spine (2-3 cm lateral to spinous process)

Question 27

where should needle contact on insertion for paravertebral block without ultrasound?

Answer 27

transverse process

Question 28

which block has higher compliocations: intercostal or paravertebral

Answer 28

intercostal

Question 29

which block has higher risk of LAST: intercostal or paraverterbal

Answer 29

intercostal

Question 30

which block is easier with ultrasound: intercostal or paravertebral

Answer 30

paravertebral

Question 31

which block must use multiple injections: intercostal or paravertebral

Answer 31

intercostalw

Question 32

which block for dermatomes above T7?

Answer 32

paravertebral

Question 33

paravertebral block complications

Answer 33

pneumothorax epidural injection hypotension (sympa blockade)

Question 34

PECS 1 block coverage

Answer 34

T1

Question 35

PECS 2 block coverage

Answer 35

T2-T4 (spreads to axilla)

Question 36

do PECS blocks cover midline?

Answer 36

no

Question 37

SAPB compared to PECS

Answer 37

SAPB is wider coverage

Question 38

SAPB coverage

Answer 38

lateral T2-T9 thoracodorsal nerve long thoracic nerve lateral intercostal nerve

Question 39

does SAPB cover midline?

Answer 39

no

Question 40

which block is longer and better than intercostal: PECS or SAPB

Answer 40

both PECS and SAPB are longer duration than intercostal

Question 41

which is more superficial: SAPB or PECS

Answer 41

SAPB

Question 42

which block has lower risk of pneumothorax: SAPB or PECS

Answer 42

SAPB

Question 43

which block has more coverage: SAPB or ESPB

Answer 43

ESPB

Question 44

TTP block targets

Answer 44

anterior branches of intercostal nerves T2-T6

Question 45

TTP indication

Answer 45

minimize sternotomy pain after cardiac

Question 46

TTP coverage

Answer 46

median chest