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Pain Exam 3 > 9: Truncal Nerve Blocks and POCUS (Part 1) > Flashcards

9: Truncal Nerve Blocks and POCUS (Part 1) Flashcards

1
Q

what forms the cervical plexus?

A

anterior rami of C1-C4
(first four cervical vertebrae)

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2
Q

cutaneous branches of the cervical plexus block

A
  • Lesser occipital nerve
  • greater auricular nerve
  • transverse cervical nerve
  • supraclavicular nerves
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3
Q

motor branches of the cervical plexus block

A
  • Phrenic nerve
  • ansa cervicalis
  • unnamed branch to the posterior neck muscles
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4
Q

clinical indications of cervical plexus block (2)

A

Unilateral Neck Surgery: Effective for procedures such as carotid endarterectomy

Supplemental Block: with interscalene block for clavicle or shoulder anesthesia

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5
Q

Superficial Cervical Plexus Block targers

A

cutaneous branches of the cervical plexus

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6
Q

superficial cervical plexus block purpose

A

Provides analgesia to the skin over the jaw, neck, occiput, and medial shoulder

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7
Q

a deep cervical plexus block targets

A

Nerve roots of the cervical plexus as they emerge from the vertebral foramina

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8
Q

the purpose of a deep cervical plexus block is

A

denser block to deeper neck structures

no significant difference in anesthesia quality has been found compared to the superficial block

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9
Q

comparison of the cervical plexus blocks

A

Both techniques can lead to hemidiaphragmatic paralysis

No clear advantage of deep block over superficial in terms of surgical anesthesia quality

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10
Q

patient positioning for superficial cervical plexus block

A

Supine with the head turned away from the side to be blocked

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11
Q

landmark identification for superficial cervical plexus block

A

The external jugular vein should be identified and avoided

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12
Q

procedure for superficial cervical plexus block (3)

A

Identify Sternocleidomastoid Muscle: turn head against resistance to locate

Needle: Insert a short block needle halfway between the mastoid process and the clavicle

Anesthetic: 5–10 mL LA subQ

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13
Q

ultrasound probe placement for superficial cervical plexus block

A

high-frequency linear probe
place transversely over the sternocleidomastoid muscle at the midpoint between the mastoid process and clavicle

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14
Q

ultrasound technique identification for superficial cervical plexus block

A

Visualize the cutaneous nerves of the cervical plexus as round, hypoechoic structures within the fascial plane deep to the sternocleidomastoid

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15
Q

needle insertion for ultrasound guided superficial cervical plexus block

A

Insert a short block needle posterior to the transducer and direct it towards the identified plane

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16
Q

anesthetic injection for US guided superficial cervical plexus block

A

Inject 5–10 mL of local anesthetic to hydrodissect the plane and ensure coverage of the cutaneous nerves

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17
Q

deep cervical plexus block target

A

Anesthetizes the nerve roots of the cervical plexus as they exit the vertebral foramina

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18
Q

advantage of deep cervical plexus block

A

Aims for denser anesthesia of deeper neck structures, though clinical trials have not proven superior effectiveness for procedures like carotid endarterectomy

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19
Q

risk considerations of deep cervical plexus block

A

Epidural/Intraspinal: needle can pass thru foramen

Vertebral Artery Injection: Proximity to the vertebral artery; small amount of LA can cause seizure

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20
Q

deep cervical plexus block ultrasound probe positioning

A

Place a small curvilinear probe on the lateral neck in a transverse orientation

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21
Q

deep cervical plexus block landmark identification

A
  • transverse process of C6
  • identify via its anterior tubercle
  • scan cephalad to identify the transverse processes from C5 to C2
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22
Q

needle insertion for deep cervical plexus block

A

At each level from C2 to C4, insert a small gauge needle posterior to the probe, advance to the nerve root, aspirate for blood, and inject 5 mL of local anesthetic while visualizing spread around the nerve root

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23
Q

deep cervical plexus block effectiveness

A

No significant difference between superficial and deep cervical plexus blocks in terms of surgical anesthesia quality for carotid endarterectomy

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24
Q

potential complications of deep cervical plexus block (2)

A

Hemidiaphragmatic Paralysis

Risk of epidural/intrathecal spread and vertebral artery injection

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25
Q

peripheral nerve blocks of the trunk are the gold standard for

A

surgeries of the thorax, abdomen, pelvis

26
Q

limitations of peripheral nerve blocks of the trunk (2)

A

Not suitable for anticoagulated patients

Ineffective for outpatient surgeries

27
Q

risks of peripheral nerve blocks of the trunk (4)

A

Spinal cord/nerve root injury, hematoma, hypotension, infection

28
Q

paravertebral block advantages

A

Similar to epidural analgesia

29
Q

paravertebral block risks (2)

A

Hypotension, pneumothorax

30
Q

intercostal block advantages

A

Dense block to single thoracic dermatome

31
Q

intercostal block risks

A

Pneumothorax, multiple blocks needed for extensive coverage

32
Q

fascial plane blocks advantages

A

Single injection, long duration, minimal risks

33
Q

fascial plane block purpose

A

Adapt to less invasive surgeries, same-day discharge

34
Q

Refer to Figure 46-70 for Truncal Blocks for Various Indications

A
35
Q

intercostal blocks provide analgesia for… (4)

A
  • Thoracic and Upper Abdominal Surgery: Effective in providing pain relief post-surgery
  • Rib Fractures: Relieves pain and discomfort from rib injuries
  • Herpes Zoster: Provides analgesia for pain associated with shingles
  • Cancer-Related Pain: Alleviates pain from cancer affecting the thoracic region
36
Q

intercostal block injection sites

A

Requires precise injections at each intercostal nerve to achieve desired analgesia

37
Q

challenges of intercostal blocks

A

High Blood Levels of Local Anesthetic: Intercostal blocks result in the highest blood levels of local anesthetic relative to the dose injected

38
Q

complications of intercostal blocks (2)

A

Intravascular Injection: Risk due to the proximity of the intercostal artery and vein
Pneumothorax: Risk due to the proximity to the pleura

39
Q

duration of effect of intercostal blocks

A

Short Duration: Due to high vascular flow and rapid uptake/removal of the local anesthetic from tissues

40
Q

intercostal nerves origin

A

Dorsal and Ventral Rami: Emanate from the thoracic spinal nerves

41
Q

pathway of intercostal nerves

A

Exit: From the spine at the intervertebral foramen

Groove: Enter a groove on the underside of the corresponding rib

Neurovascular Bundle: Run alongside the intercostal artery and vein

42
Q

intercostal nerve location/anatomical position

A

The intercostal nerve is the most inferior structure within the neurovascular bundle, situated between the internal and innermost intercostal muscles

43
Q

Each intercostal nerve provides sensory innervation to

A

its corresponding dermatome

44
Q

branches of intercostal nerves

A

Extend along the length of the nerve to cover its designated skin area

45
Q

positioning options for intercostal block (3)

A

Lateral Decubitus: Patient lies on the side
Supine: Patient lies on their back
Prone: Patient lies on their stomach

46
Q

landmark identification in intercostal block

A

Locate and mark the level of each rib in the mid and posterior axillary line

47
Q

needle insertion technique for intercostal block

A

Insert a small-gauge needle at the inferior edge of the selected rib

Bone Contact: Needle contacts the rib, then is walked off inferiorly by approximately 0.25 cm

Aspirate: Check for blood or air before injection

Injection: Inject 3–5 mL of local anesthetic at each target level

48
Q

ultrasound guidance advantages for intercostal block (2)

A

Single Entry Point: Allows for multiple levels to be reached through one skin entry point

Needle Placement: Use of a long block needle redirected to cover several intercostal nerves

49
Q

paravertebral block indications

A
  • Surgical Anesthesia/Analgesia:
  • thoracic or abdominal wall procedures
  • mastectomy
  • inguinal or abdominal hernia repair
  • invasive unilateral abdominal procedures
50
Q

paravertebral block coverage

A

Dermatomes: Typically covers one to two dermatomes above and below the injection level

51
Q

mastectomy coverage

A

Coverage from T2 to T6, block at T3 and T5

52
Q

axillary node dissection coverage

A

Additional T2 injection for C7 through T2 dermatomes

53
Q

inguinal hernia repair coverage

A

Coverage from T10 through L2

54
Q

ventral hernia repair coverage

A

: Bilateral injections at the surgical site level

55
Q

local anesthetic duration in paravertebral block

A

nearly 24 hours

56
Q

perineural catheter

A

possible with paravertebral block but variable spread across levels

57
Q

spinal nerves emerge from

A

intervertebral foramina

58
Q

spinal nerves divide into

A

anterior and posterior ramus

59
Q

anterior ramus innervates

A

anterolateral body wall and limbs

60
Q

posterior ramus innervates

A

the back and neck

61
Q

thoracic paravertebral space boundaries (posterior, anterolateral, medial, inferior/superior)

A

Posterior: Superior costotransverse ligament

Anterolateral: Parietal pleura

Medial: Vertebrae and intervertebral foramina

Inferior/Superior: Heads of the ribs

62
Q
A

Pain Exam 3 (16 decks)

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