6. Performing Chest Wall Blocks

Question 1

intercostal block landmarks

Answer 1

inferior border of scapula (T6)
angle of rib
inferior border of each rib

Question 2

intercostal block pt positioning

Answer 2

prone
or
sitting

Question 3

where can you find the angle of the rib

Answer 3

6-8 cm from spinous process where costal groove is the widest

Question 4

needle incertion intercostal block

Answer 4

20 deg cephalad until contacts rib

Question 5

“pop” intercostal block

Answer 5

fascia of internal intercostal muscle

Question 6

volume of injection intercostal block

Answer 6

3-5 mL

Question 7

can you use u/s for intercostal block

Answer 7

yes - uncommon because you cannot visualize the nerve

Question 8

landmarks paravertebral block

Answer 8

hit tranverse process with needle

Question 9

paravertebral block needle insertion

Answer 9

cephalad

Question 10

how deep can you advance need intercostal block

Answer 10

4 cm MAX to avoid puncturing the pleura

Question 11

“pop” paravertebral block

Answer 11

costotransverse ligament

Question 12

paravertebral mutiple injection volume

Answer 12

3-4 mL

Question 13

paravertebral single injection volume

Answer 13

20 mL

Question 14

paravertebral u/s technique

Answer 14

insert needle through paraspinal muscles
past costotranvsers ligament

Question 15

PECS 1 LA placement

Answer 15

between pectoralis major and minor muscles

Question 16

PECS 2 LA placement

Answer 16

between pectoralis minor and serratus anterior muscles

Question 17

PECS 1 pt positioning

Answer 17

arm 90 degrees

Question 18

PECS 1 probe placement

Answer 18

medial to coracoi process
perpendicular to clavicle

Question 19

PECS 1 probe angle

Answer 19

angled slight medial

Question 20

what do you see when PECS 1 probe is angled medially?

Answer 20

second rib seen under axillary vein

Question 21

what do you see when PECS1 probe is angled inferiorly and laterally?

Answer 21

third rib

Question 22

which level does the PECS1 injection take place at?

Answer 22

3rd rib

Question 23

what do you see when probe is move inferiorly and laterally again?

Answer 23

4th rib
serratus anterior

Question 24

PECS 2 level of injection

Answer 24

4th rib
serratus anterio

Question 25

which PECS should you do first

Answer 25

PECS 2 because it is deeper

Question 26

if you cant see the ribs, how should you redirect the probe?

Answer 26

move probe more medially

Question 27

where is LA deposite in SAPB

Answer 27

between lats and serattus anterior muscles

Question 28

pt positioning SAPB

Answer 28

arm abducted 90 deg

Question 29

probe placement SAPB

Answer 29

mid-axillary line
at level of nipple

Question 30

needle placement SAPB

Answer 30

superior to 5th rib
(near level of nipple)

Question 31

ESPB LA placement

Answer 31

between erector spinae muscle and lamina of throacic vertebrae on level T4 or T5

Question 32

level of ESPB placment

Answer 32

T4 or T5

Question 33

which block is safe in anticoagulated pts

Answer 33

ESPB

Question 34

probe placement ESPB

Answer 34

vertically
T5 level

Question 35

needle insertion ESPB

Answer 35

in-plane
cranial to caudad direction

Question 36

the needle passes through what layers (3) for ESPB

Answer 36

trapezius
rhomboid
erector spinae muscle

Question 37

where does the needle tip stope for ESPB?

Answer 37

transverse process

Question 38

LA is injected where for ESPB

Answer 38

between transverse process and erector spinae muscle

Question 39

TTP block volume

Answer 39

15 mL on each side

Question 40

TTP block LA location

Answer 40

between transversus thoracic muscle and internal intercostal muscle
between the 4th and 5th costal cartilages connecting at the sternum