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Anesthesia Principles II > Additonal Blocks > Flashcards

Additonal Blocks Flashcards

1
Q

Key points about paravertebral blocks

A

profound analgesia
can do single shot or continuous catheter
okay in anticoagulated patients
preserve bladder sensation
intact motor/sensory distal to block

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2
Q

absolute contraindication for PVB?

A

empyema

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3
Q

what makes up each side of paravertebral space?

A

parietal pleura
posterlateral aspect of vertebral body
sup. costotransverse ligament (SCT) / internal intercostal membrane (IIM)

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4
Q

what is the sup costotransverse ligament continuous with?

A

internal intercostal membrane

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5
Q

sup costotransverse ligament runs from what to what?

A

inf aspect of transverse process to rib below it

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6
Q

volumes for single shot and continous catheter in PVB?

A

single shot: 5-7cc per segment
continuous: 6-10cc/hr

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7
Q

where do you inject if using landmark approach to PVB?

A

2.5cm lateral from midline and 2-6cm deep

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8
Q

name this block

A

transverse in plane PVB

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9
Q

Name the block and structures

A

transverse in plane PVB
pleural line
internal intercostal muscle
transverse process

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10
Q

name this block and structures

A

parasaggital in plane approach to PVB

transverse process
costotransverse ligament
paravertebral space
pleura

goal is depression of the pleura, shimmer may be seen

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11
Q

volume for intercostal block?

A

3-5cc of LA at each level blocked

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12
Q

tell me about the intercostal block

A

insertion site is at the angle of the rib, 6-8cm to spinous process

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13
Q

how many methods to cervical plexus block? and do they block motor or sensory?

A

2:
superficial: only sensory
deep: sensory and motor

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14
Q

how do you do a deep cervical plexus block with landmark technique?

A

at post border of SCM

C2 2cm below mastoid
C3 4cm below mastoid
C4 6cm below mastoid

insert needle at desired level, hit TP, withdraw slightly and inject

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15
Q

volume for deep cervical plexus block with landmark technique?

A

5cc

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16
Q

what is chassaignacs tubercle

A

TP of C6

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17
Q

what is this? how do you do it?

A

superficial cervical plexus
halfway between mastoid process and C6 TP subq injection at post border of SCM, perpendicular, caudal, cephalad

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18
Q

what is this block?

A

superficial cervical plexus block

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19
Q

What block and what structures?

A

superficial cervical plexus block
SCM
middle scalene muscle
cervical plexus
ant scalene
carotid artery

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20
Q

nerves of the nose?

A

greater and lesser platine
ant ethmoid

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21
Q

gen sensation to upper and middle larynx?

A

internal branch of sup laryngeal nerve

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22
Q

gen sensation below lower larynx

A

recurrent laryngeal nerve

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23
Q

motor innervation of all larynx intrinsic muscles except the cricothyroid?

A

recurrent laryngeal

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24
Q

innervation of the cricothyroid muscle

A

external branch of super laryngeal nerve

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25
Q

sensory to post 1/3 of tounge?

A

glossopharyngeal

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26
Q

gen sensation of ant 2/3 of tounge?

A

trigeminal, not part of gag reflex

27
Q

what else does glossopharyneal innervate?

A

post 1/3 of tounge
vallecula
ant surface of epiglottis
walls of pharynx
tonsils

28
Q

dose and time for nebulized lidocaine?

A

2-4% for 15-30min

29
Q

volume for glossopharyngeal block?

A

5ml

30
Q

name this block. How do you do it?

A

sup laryngeal block

hit hyoid cornu, walk off inf edge and peirce thyrohyoid membrane, inject 2ml, contact cornu, withdraw 1-2mm, inject 2ml

need to get on both sides of the membrane

31
Q

name this block. How do you do it?

A

recurrent laryngeal block (transtracheal block)
use 20g angiocath, pierce while aspirating, have them take a deep breath, rapidly inject so they will cough and atomize it all over

32
Q

what approaches to TAP block?

A

2 quadrant and 4 quadrant

33
Q

volumes for TAP blocks?

A
34
Q

where is tap plane?

A

between internal oblique and transversus abdominus m.

35
Q

name the two approaches to TAP block and their use?

A
36
Q

What are we looking at?

A

TAP block

37
Q

what are we looking at?

A

TAP block after injection

38
Q

extra risk with rectus sheath block?

A

bowel perforation

39
Q

how do you do rectus sheath block?

A

try to inject in muscle near where the nerve runs, if you go too deep you might perforate bowel

40
Q

What block?

A

rectus sheath block

41
Q

what block?

A

rectus sheath block

42
Q

What block and what do we see?

A

rectus sheath block

43
Q

what block? used for what? what risk?

A

ilioinguinal/iliohypogastric

inguinal hernias

peroneal pierced

44
Q

what are we looking at?

A

ilioinguinal/iliohypogastric block

45
Q

what two blocks for shoulder if you dont want to risk phrenic nerve involvement?

A

suprascapular and axillary nerve block

46
Q

what is suprascapular block used for?

A

post shoulder pain, can be used in pacu as rescue block for failed interscalene block

47
Q

name the block and structures

A

suprascapular

48
Q

what block would you use for ant shoulder pain?

A

axillary block

49
Q

where is axillary nerve?

A

in quadrangular space

50
Q

what makes up quadrangular space?

A

teres minor, medial and lateral heads of triceps muscle

51
Q

name this block

A

axillary nerve block

52
Q

what are we looking at?

A

axillary block

53
Q

lateral pec nerve supplies?

A

sensory to pec major

54
Q

medial pec nerve supplis?

A

sensory to pec major and pec minor

55
Q

what does long thoracic nerve innervate?

A

ant serratus muscle

56
Q

what does thoracodorsal nerve innervate?

A

latissimus dorsi

57
Q

what does Pec 1 block?

A

medial and lateral pec nerves

58
Q

what does pec2 block?

A

medial and lateral pec nerves
T2-T4
long thoracic nerve

59
Q

is pec 1 or pec 2 better for more extensive surgeries?

A

pec 2

60
Q

name the block

A

pec 1 block

61
Q

name this block

A

pec 2

62
Q

where do you inject for pec 1 block? and what volume?

A

between pec major and pec minor and 10cc

63
Q

where do you inject for pec 2 block? and what volume?

A

between pec minor and serratus ant 20ml

(maybe also do pec 1 block too on the way out?) 10ml

64
Q

what volume for serratus plane block?

A

40ml LA

Anesthesia Principles II (14 decks)

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