5. Performing Brachial Plexus Blocks Flashcards
interscalene block needle insertion no u/s
interscalene groove at level of cricoid (C6)
interscalene block head positioning
30 degree to contralateral side
interscalene block probe placement
parallel to clavicle
over the lateral head of the sternocleidomastoid
at level of cricoid/thyroid cartilage
where does the brachial plexus lie in the interscalene block
in the interscalene groove
what direction is the needle inserted for interscalene block?
lateral to medial
in-plane approach
landmark for supraclavicular block
subclavian artery
probe placement for supraclavicular block
in the supraclavicular fossa
parallel to the superior border of the clavicle
angle toward thorax
what is pulsatile in supraclavicular block
subclavian rtery
where is the brachial plexus in relation to the subclavian artery for supraclavicular approach
lateral
what moves when the pt is breathing in supraclav block
pleura
what should you avoid in supraclav block
subclavian artery injection
going below rib
where should you inject in supraclav block
lateral to subclavian artery
superior to first rib
how much do you inject supraclav
20-30 mL
probe placement infraclav block
perpendicular to clavicle
medial to coracoid process
landmarks infraclav
axillary artery
axillary vein
needle insertion point infraclav
inferior to clavicle
in plane from cephalad aspect
what is the needle inserted through for infraclav?
pectoralis major
pectoralis minor
which block requires a more steep needle angle
infraclav
where do you inject LA in infraclav
U-shape around the axillary artery because its difficult to identify all 3 cords
which block has highest risk of pneumothorax
supraclav
which block has highest incidence of phrenic nerve palsy
supraclav
which block is best with indwelling catheter
infraclav due to pectoralis stabilization
why is supraclav difficult in obese pts?
supraclavicular fat pads
why is infraclav difficult in obese pts?
deeper nerves
which block is best for COPD?
infraclav
which block has fastest onset?
infraclav
which block has best visualization
supraclav
(more superficial)
which block has worse visualization
infraclav
(deeper)
which block has higher risk of hematoma with accidental vascular puncture?
infraclav
(difficult to apply pressure)
landmark for axillary block
axillary pulse
axillary pulse location
between biceps/coracobrachialis and triceps muscle
axillary block pt positioning
supine with arm abducted 90 degrees
head turned toward contralateral side
median nerve location
median n is superior to pulse
ulnar nerve location
inferior above the pulse
radial nerve location
inferior-posterior
just behind pulse
neurovascular bundle
median, radial, ulnar arteries that lie around the axillary artery
which nerve lies outside the neurovascular bundle
musculocutaneous
musculocutaneous location
between biceps and coracobrachialis
which nerve do you need u/s for in axillary block
musculocutaneous nerve
transarterial axillary needle ga
22 ga
transarterial volume
30-40 mL
trasarterial axillary injection location
posteriorly
or
anteriorly
why is an u/s good for axillary blcok
decr volume of LA
musculocutaneous can be done
probe placement axillary block
immediately distal to point where pectoralis major inserts onto humerus
landmarks axillary
radial, ulnar, median nerves around axillary artery
musculocutaneous nerve between biceps and coracobrachialis
where do you inject for axillary
injection around each nerve
axillary volume
5-7mL per injection
== 20 mL total
which nerve do you inject first
radial nerve
why do you inject that nerve first?
to avoid displacing structures deepeer, inject posterior to the artery first
which nerve is posterior to axillary artery?
radial nerve
axillary block advantage
lower complication rate
axillary block disadvantag
higher LAST risk
does not block axillary nerve
reqs extra injection for musculocutaneous nerve
