4. Overview of Chest Wall Blocks Flashcards
true ribs
1-7
cartilages attach to sternum
false ribs
8-12
cartilages DO NOT attach to sternum
floating ribs
11-12
floating ribs only attach to
vertebrae
scapula extends to
inferior border of 7th rib
how many pairs of intercostal nerves
12 pairs
how many pairs of thoracic nerve roots
12 pairs
intercostal muscle layers
external
internal
innermost
where does the vein, artery , and nerve lie?
between internal and innermost muscles
behind the rib
position of vein artery and nerve
Superior
Vein
Artery
Nerve
Inferior
(VAN)
what is deep to intercostal muscles
lung
what levels do you inject for intercostal block
2 levels above and below incision site
inferior border of scapula dermatome
T6
injection site for intercostal block
angle of rib
what dermatome levels can you use intercostal blocks
T6 dermatome and below
intercostal block complication
- pneumothorax
- pt discomfort
- LAST
which block has the highest blood level of local anesthetic per volume?
intercostal block
do you sedate during intercostal block?
yes
which injection site have higher risk of LAST?
IV
tracheal
Highest to lowest local anesthetic absorption
HIGHEST
IV > Tracheal > intercostal
Caudal
Epidural
Brachial Plexus
Axillary
Lower extremity (Femoral)
Sub Q
LOWEST
can you use ultrasound for intercostal block?
yes - but its not common because you cant visualize the nerve
paraverterbal block indications
alternative approach to intercostal block by blocking intercostal nerves in paravertebral space
what levels do you block with paravertebral
2 levels above and below
paravertebral space
wedge shaped located to side of vertebral commons
TPVS contacts ________ medially and ______ laterally
TPVS contacts epidural space medially and intercostal space laterally
main landmark for paravertebral blcok
transverse process of spine
(2-3 cm lateral to spinous process)
where should needle contact on insertion for paravertebral block without ultrasound?
transverse process
which block has higher compliocations: intercostal or paravertebral
intercostal
which block has higher risk of LAST: intercostal or paraverterbal
intercostal
which block is easier with ultrasound: intercostal or paravertebral
paravertebral
which block must use multiple injections: intercostal or paravertebral
intercostalw
which block for dermatomes above T7?
paravertebral
paravertebral block complications
pneumothorax
epidural injection
hypotension (sympa blockade)
PECS 1 block coverage
T1
PECS 2 block coverage
T2-T4
(spreads to axilla)
do PECS blocks cover midline?
no
SAPB compared to PECS
SAPB is wider coverage
SAPB coverage
lateral T2-T9
thoracodorsal nerve
long thoracic nerve
lateral intercostal nerve
does SAPB cover midline?
no
which block is longer and better than intercostal: PECS or SAPB
both PECS and SAPB are longer duration than intercostal
which is more superficial: SAPB or PECS
SAPB
which block has lower risk of pneumothorax: SAPB or PECS
SAPB
which block has more coverage: SAPB or ESPB
ESPB
TTP block targets
anterior branches of intercostal nerves
T2-T6
TTP indication
minimize sternotomy pain after cardiac
TTP coverage
median chest
