6. Performing Chest Wall Blocks Flashcards
intercostal block landmarks
inferior border of scapula (T6)
angle of rib
inferior border of each rib
intercostal block pt positioning
prone
or
sitting
where can you find the angle of the rib
6-8 cm from spinous process where costal groove is the widest
needle incertion intercostal block
20 deg cephalad until contacts rib
“pop” intercostal block
fascia of internal intercostal muscle
volume of injection intercostal block
3-5 mL
can you use u/s for intercostal block
yes - uncommon because you cannot visualize the nerve
landmarks paravertebral block
hit tranverse process with needle
paravertebral block needle insertion
cephalad
how deep can you advance need intercostal block
4 cm MAX to avoid puncturing the pleura
“pop” paravertebral block
costotransverse ligament
paravertebral mutiple injection volume
3-4 mL
paravertebral single injection volume
20 mL
paravertebral u/s technique
insert needle through paraspinal muscles
past costotranvsers ligament
PECS 1 LA placement
between pectoralis major and minor muscles
PECS 2 LA placement
between pectoralis minor and serratus anterior muscles
PECS 1 pt positioning
arm 90 degrees
PECS 1 probe placement
medial to coracoi process
perpendicular to clavicle
PECS 1 probe angle
angled slight medial
what do you see when PECS 1 probe is angled medially?
second rib seen under axillary vein
what do you see when PECS1 probe is angled inferiorly and laterally?
third rib
which level does the PECS1 injection take place at?
3rd rib
what do you see when probe is move inferiorly and laterally again?
4th rib
serratus anterior
PECS 2 level of injection
4th rib
serratus anterio
which PECS should you do first
PECS 2 because it is deeper
if you cant see the ribs, how should you redirect the probe?
move probe more medially
where is LA deposite in SAPB
between lats and serattus anterior muscles
pt positioning SAPB
arm abducted 90 deg
probe placement SAPB
mid-axillary line
at level of nipple
needle placement SAPB
superior to 5th rib
(near level of nipple)
ESPB LA placement
between erector spinae muscle and lamina of throacic vertebrae on level T4 or T5
level of ESPB placment
T4 or T5
which block is safe in anticoagulated pts
ESPB
probe placement ESPB
vertically
T5 level
needle insertion ESPB
in-plane
cranial to caudad direction
the needle passes through what layers (3) for ESPB
trapezius
rhomboid
erector spinae muscle
where does the needle tip stope for ESPB?
transverse process
LA is injected where for ESPB
between transverse process and erector spinae muscle
TTP block volume
15 mL on each side
TTP block LA location
between transversus thoracic muscle and internal intercostal muscle
between the 4th and 5th costal cartilages connecting at the sternum
