Additonal Blocks Flashcards
Key points about paravertebral blocks
profound analgesia
can do single shot or continuous catheter
okay in anticoagulated patients
preserve bladder sensation
intact motor/sensory distal to block
absolute contraindication for PVB?
empyema
what makes up each side of paravertebral space?
parietal pleura
posterlateral aspect of vertebral body
sup. costotransverse ligament (SCT) / internal intercostal membrane (IIM)
what is the sup costotransverse ligament continuous with?
internal intercostal membrane
sup costotransverse ligament runs from what to what?
inf aspect of transverse process to rib below it
volumes for single shot and continous catheter in PVB?
single shot: 5-7cc per segment
continuous: 6-10cc/hr
where do you inject if using landmark approach to PVB?
2.5cm lateral from midline and 2-6cm deep
name this block
transverse in plane PVB
Name the block and structures
transverse in plane PVB
pleural line
internal intercostal muscle
transverse process
name this block and structures
parasaggital in plane approach to PVB
transverse process
costotransverse ligament
paravertebral space
pleura
goal is depression of the pleura, shimmer may be seen
volume for intercostal block?
3-5cc of LA at each level blocked
tell me about the intercostal block
insertion site is at the angle of the rib, 6-8cm to spinous process
how many methods to cervical plexus block? and do they block motor or sensory?
2:
superficial: only sensory
deep: sensory and motor
how do you do a deep cervical plexus block with landmark technique?
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
volume for deep cervical plexus block with landmark technique?
5cc
what is chassaignacs tubercle
TP of C6
what is this? how do you do it?
superficial cervical plexus
halfway between mastoid process and C6 TP subq injection at post border of SCM, perpendicular, caudal, cephalad
what is this block?
superficial cervical plexus block
What block and what structures?
superficial cervical plexus block
SCM
middle scalene muscle
cervical plexus
ant scalene
carotid artery
nerves of the nose?
greater and lesser platine
ant ethmoid
gen sensation to upper and middle larynx?
internal branch of sup laryngeal nerve
gen sensation below lower larynx
recurrent laryngeal nerve
motor innervation of all larynx intrinsic muscles except the cricothyroid?
recurrent laryngeal
innervation of the cricothyroid muscle
external branch of super laryngeal nerve
sensory to post 1/3 of tounge?
glossopharyngeal
gen sensation of ant 2/3 of tounge?
trigeminal, not part of gag reflex
what else does glossopharyneal innervate?
post 1/3 of tounge
vallecula
ant surface of epiglottis
walls of pharynx
tonsils
dose and time for nebulized lidocaine?
2-4% for 15-30min
volume for glossopharyngeal block?
5ml
name this block. How do you do it?
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
name this block. How do you do it?
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
what approaches to TAP block?
2 quadrant and 4 quadrant
volumes for TAP blocks?
where is tap plane?
between internal oblique and transversus abdominus m.
name the two approaches to TAP block and their use?
What are we looking at?
TAP block
what are we looking at?
TAP block after injection
extra risk with rectus sheath block?
bowel perforation
how do you do rectus sheath block?
try to inject in muscle near where the nerve runs, if you go too deep you might perforate bowel
What block?
rectus sheath block
what block?
rectus sheath block
What block and what do we see?
rectus sheath block
what block? used for what? what risk?
ilioinguinal/iliohypogastric
inguinal hernias
peroneal pierced
what are we looking at?
ilioinguinal/iliohypogastric block
what two blocks for shoulder if you dont want to risk phrenic nerve involvement?
suprascapular and axillary nerve block
what is suprascapular block used for?
post shoulder pain, can be used in pacu as rescue block for failed interscalene block
name the block and structures
suprascapular
what block would you use for ant shoulder pain?
axillary block
where is axillary nerve?
in quadrangular space
what makes up quadrangular space?
teres minor, medial and lateral heads of triceps muscle
name this block
axillary nerve block
what are we looking at?
axillary block
lateral pec nerve supplies?
sensory to pec major
medial pec nerve supplis?
sensory to pec major and pec minor
what does long thoracic nerve innervate?
ant serratus muscle
what does thoracodorsal nerve innervate?
latissimus dorsi
what does Pec 1 block?
medial and lateral pec nerves
what does pec2 block?
medial and lateral pec nerves
T2-T4
long thoracic nerve
is pec 1 or pec 2 better for more extensive surgeries?
pec 2
name the block
pec 1 block
name this block
pec 2
where do you inject for pec 1 block? and what volume?
between pec major and pec minor and 10cc
where do you inject for pec 2 block? and what volume?
between pec minor and serratus ant 20ml
(maybe also do pec 1 block too on the way out?) 10ml
what volume for serratus plane block?
40ml LA
