Anatomy Flashcards
A patient is undergoing a brachiobasilic AV fistula placement. He states that he feels pain at the surgical site of his medial upper arm despite a successful supraclavicular block. Which nerve block could have prevented this pain?
Intercostobrachial nerve block
The intercostobrachial nerve is usually missed when performing a brachial plexus block (usually arises from the dorsal rami of T2 and thus is spared by all brachial plexus blocks)
Subcutaneous infiltration of the entire width of the axillary crease will block which nerve?
Intercostobrachial nerve
Which nerve is usually missed when performing a brachial plexus block?
The intercostobrachial nerve is usually missed when performing a brachial plexus block (usually arises from the 2nd thoracic nerve root T2)
Brachial Plexus
Interscalene blocks target what level of the brachial plexus?
Roots & Trunk
Supraclavicular blocks target what level of the brachial plexus?
Trunk & Divisions
Infraclavicular blocks target what level of the brachial plexus?
Cords
Axillary blocks target what level of the brachial plexus?
Branches
Supraclavicular blocks are ideal for what kind of surgery?
Supraclavicular blocks are ideal for elbow surgery.
Infraclavicular blocks cover what part of the upper extremity?
Infraclavicular blocks cover the upper arm and elbow.
Axillary blocks are ideal for what kind of surgery?
Wrist and hand
The femoral nerve arises from what lumbar nerves?
L2-L4
The sciatic nerve arises from what lumbar nerves?
L4-L5
S1-S3
NOTE:
Sciatic nerve divides into the tibial nerve and common peroneal nerve (fibular).
The saphenous nerve is a branch of what nerve?
The saphenous nerve is a branch of the femoral nerve.
The saphenous nerve is covered in what block?
Adductor canal block
Adductor Canal Block
The sciatic nerve branches into the tibial and common peroneal nerve which control what motor movements?
Tibial- inversion, plantar flexion
Peroneal- eversion, dorsiflexion
TIP, PED
The common peroneal nerve gives off what two branches?
Superficial Peroneal: innervates dorsal side of foot
Deep Peroneal: innervates webspace between 1st and 2nd toe
_ is a branch of the tibial nerve which provides sensation to the lateral aspect of the foot.
The sural nerve is a branch of the tibial nerve which provides sensation to the lateral aspect of the foot.
What are the five nerves targeted in an ankle block?
Saphenous nerve
Posterior tibial nerve
Sural nerve
Superficial peroneal nerve
Deep peroneal nerve
NOTE:
“5 notes = 5 nerves”
Sensation of thigh from lateral to medial.
Lateral femoral cutaneous
Femoral nerve
Obturator nerve
Sensation of lower leg/foot from medial to lateral.
Saphenous nerve
Peroneal nerve (common, superficial, deep)
Sural nerve
In adults, the spinal cord ends at what level?
L1-L2
In infants, the spinal cord ends at what level?
L3
What is the purpose of an epidural test dose?
To ensure catheter isn’t intravascular or intrathecal.
Lidocaine 1.5% + 1:200,000 epinephrine, 3cc
Positive Intravascular:
Epinephrine: HR increases within 60 seconds (>10bpm); BP increases (> 20 mmHg)
(Beta-blockers, opioids, other sedatives can blunt this response)
Lidocaine: “LA toxicity” symptoms like tinnitus, perioral numbness, metallic taste, dizziness
Positive Intrathecal: Sensory loss within 1-2 min, motor loss within 3-4 minutes (different from epidural administration of local anesthetics); hypotension; dizziness; general feeling of malaise (until you treat the hypotension)
Risk factors for Post-Dural Puncture Headache (PDPH)?
Younger (patient age 18-50 highest risk)
Female sex
Pregnancy
Low body mass index
Use of cutting (beveled) spinal needles (as opposed to pencil point)
Use of larger needles (22G / Touhy)
Prior history of headaches (questionable ??)
Definitive treatment for PDPH?
Blood patch