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Regional Anesthesia > Apex- Truncal Blocks > Flashcards

Apex- Truncal Blocks Flashcards

1
Q

see pic

& what kind of approach is this to a TAP block?

A

C & D; lateral approach

  • TAP block targets: T6-L1
  • Travel between internal oblique (C) & transverse abdominis muscles (D)
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2
Q

a TAP block provides analgesia to what 2 areas?

A

-the abdominal wall (muscle and skin)

& the parietal peritoneum

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3
Q

What approaches to a tap block should be taken for:

Procedures above the umbilicius (1)

Procedures below the umbilicus (2)

A

above > subcostal approach

below > lateral or posterior approach

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4
Q

Which thoracolumbar nerves does a TAP block anesthetisize and where?

A

T6-L1

as they travel in the fascial plane between the internal oblique in the transverse abdominis muscles

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5
Q

How much local anesthetic to inject with a tap block?

A

20mls at each injection site

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6
Q

2 complications of a TAP block

A
  1. LAST
  2. Peritoneal injury
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7
Q

What landmark should be identified if doing a TAP block by the landmark technique?

A

The interior lumbar triangle (triangle of Petit)

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8
Q

T/F- the internal oblique is deep to the transverse abdominis

A

false- the transverse abdominis is deep to the internal oblique

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9
Q

Which nerves innervate the internal oblique and transverse abdominis muscles?

A

T6-L1

-think TAP block

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10
Q

What position should pts be in with each approach to a tap block (subcostal, lateral, posterior)

A

-all the same - supine

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11
Q

Where should the transducer be placed for a subcostal approach to a TAP block?

A

lateral to the xiphroid process and parallel with teh lower margin of the rib cage

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12
Q

Label - which approach is this showing for what block?

A

Lateral

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13
Q

Which TAP block approach involves placing the transducer at the mid-axillary line, superior and parallel to the iliac crests?

A

Lateral Approach

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14
Q

Label

What approach gives this view?

A

Skin/transducer

Sub-q tissue

External oblique

Internal oblique

Transverse abdominis

Peritoneal cavity

Lateral Approach

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15
Q

When you do a posterior approach to a TAP block, you place the tranducer in the same positon as the lateral approach, then slide it past the midaxillary line until you see what?

A

The aponeurosis of the tensor fascia late (TFL)

yikes

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16
Q

Label the posterior approach to a TAP block ultrasound

A

Posterior

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17
Q

What landmark technique involves advancing the needle over the iliac crest until you feel a “pop” and where is your needle at this point?

A

TAP block

between the internal oblique and transverse abdominus (inside the triangle of petit)

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18
Q

What block anesthetizes the intercosta, iliohypogastric, and ilioinguinal nerves?

A

TAP block

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19
Q

What are the 4 paired muscles of the anterolateral abdominal wall?

A
  1. Rectus abdominis
  2. Transversus abdominis
  3. External oblique
  4. Internal oblique
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20
Q

What are the anatomic boundaries of the inferior lumbar triange? (Triangle of petit)

  • Inferior border =
  • Posterior border =
  • Anterior border =
  • Inside the triangle (floor) =
A
  • Inferior border = iliac crest
  • Posterior border = Latissismus dorsi
  • Anterior border = external oblique
    • Inside the triangle (floor) = ​internal oblique
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21
Q

a PEC II block targets the facial plane between the: (select 2)

A. Pec major and minor muscles

B. Medial Pec and lateral pec nerves

C. Pec minor and serratus anterior muscles

D. Serratius anterior and latissiumus dorsi muscles

A

A. Pec major and minor muscles

C. Pec minor and serratus anterior muscles

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22
Q

PECS blocks provide anesthesia to the (anterior/posterior/lateral) chest wall

A

anterior

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23
Q

PECS 1 block targets which nerves by injecting local where?

A

medial and lateral pectoralis nerves

inject LA into the fascial plane between the pec major and minor mujscles

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24
Q

What does the PECS II block provide addtional coverage to? (2)

A

the thoracic intercostal nerves and the long thoracic nerve

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25
unlike PECS 1 & 2 blocks, the _______ block specifically targets the axillary region and not the chest.
Serratus anterior plane (SAP) block
26
What kind of block would be indicated for breast reconstruction with a latissimus dorsi flap?
SAP block (Serratus Anterior Plane) block
27
volume of LA for a PEC 1 vs PEC 2 vs SAP block
PEC 1 & 2 = 10-15mls SAP = 20mls
28
What artery is at risk for inadvertant puncture/injury/hematoma/LAST with PECS and SAP blocks?
Thoraco-Acromial artery
29
Label
30
What type of block would be best for breast implantantion?
PECS 1
31
What kind of block would be best for implantable cardiac device?
PECS 2
32
What kind of block would be good for a mastectomy, sentinal node biopsy, or tumor resection?
PECS 2
33
Label
34
T/F- you can do an isolated PECS 2 block
False- it is done in combo with PECS I block
35
What kind of block?
PECS 1
36
What kind of block?
PECS II \*Pec minor - serrates anterior muscles
37
What kind of block?
SAP block Serratus Anterior Plane block
38
Label imaging for a SAP block
39
What kind of block?
SAP block - Serratus Anterior Plane block \*Lateral Dorsi & Serratus anterior
40
Max local anesthetic doses for PECS block vs SAP block
PECS block - 0.2mg/kg SAP block 0.4mg/kg
41
Benifits of an intercostal nerve block include: (Select 2): A. Multi-level coverage after a single injection B. Decreased risk of opioid induced respiratory depression C. Hemodynamic stability D. Low risk of LAST
B. Decreased risk of opioid induced respiratory depression C. Hemodynamic stability
42
T/F: an intercostal nerve block provides anesthesia along a *single* dermatome
True -this necessitates multiple injections for procedures that require coverage of multiple dermatome levels
43
T/F: intercostal nerve blocks inhibit sympatheteic nerves and can lead to signfiicant hemodynamic instability
False -They do block sympathetic nerves, but they don't cause significant hemodynamic instability
44
An intercostal nerve block provides (sensory/motor) anesthesia of the trunk from where to where?
xiphoid to pubis (single dermatome level)
45
What kind of nerve block would be good for herpes zoster pain?
Intercostal block
46
T/F- an intercostal block would be appropriate for a cholecystectomy
True
47
what kind of block would be approrpiate for a chest tube or rib fractures?
intercostal block
48
How many ml's of LA would you inject per dermatome level for an intercostal block?
3-5mls
49
2 complications of an intercostal block
PTX, LAST
50
What are the intercostal nerves of the chest that innervate the skin covering the chest wall, intercostal muscles, and parietal pleura?
T2-T6
51
What are the intervostal nerves of the abdomen that innervate the skin over the anterior abdomen, abdominal muscles, and parietal peritoneum?
T7-T11 7-11 fucks with your abdomen
52
Label
53
What position should the pt be in for an intercostal block?
sitting or prone
54
For an intercostal block, the transducer should be in the sagittal orientation, approximately \_\_\_cm lateral to the midline at the desired block level
7cm
55
What kind of block?
Intercostal
56
Label for an intercostal block
57
What kind of block?
Intercostal
58
Who might it not be good to do an intercostal block on and why?
a severe COPD pt who depend on their intercostal muscles for ventilation
59
Advantages of a thoracic paravertebral block include the ability to (select 2): A. Produce unilateral epidural anesthesia B. Achieve segmental blockade C. Produce spinal anesthesia D. Elminate the risk of lask
A. Produce unilateral epidural anesthesia B. Achieve segmental blockade
60
What block targets the spinal nerves exiting the vertebral foramen?
Paravertebral block
61
What kind of block can be thought of as a unilateral epidural?
Paravertebral block
62
Unlike intercostal blocks, what block anesthetizes muldtiple dermatomal levels, reducing the number of injections required?
Paravertebral block
63
How many mls of LA should be injected for a paravertebral block?
5-10mls
64
when doing a paravertebral block, how can you achieve b/l blockade?
by using a larger volume of local anesthetic
65
t/f - intrathecal injection is normal with a paravertebral block
fasle- it's a complication
66
What kind of block can result in a post-dural puncture headache?
Paravertebral block
67
What kind of block would be best for pain management for herpes zoster where coverage of more than 1 dermatome is needed
Paravertebral block
68
Pt position for a paravertebral block
Lateral decub , block side up
69
T/F: when doing a paravertebral block, the transducer should be placed laterally to the spinous process at the level you want to block
true
70
What block?
Paravertebral block
71
What block?
Paravertebal block
72
Label for paravertebal block
73
What anatomical structures make up the borders of the paravertebral space? * Anterior border: * Medial border: * Posterior border:
* Anterior border: **Parietal pleura** * Medial border: **Vertebral body and intravertebral foramen**​Posterior border: **​Transverse process and superior costotransverse ligament**
74
_Select the BEST regional anesthesia techniques that provide analgesia to a patient with rib fractures (select 3):_ - Intercostal - Transverse abdominus plane - IPACK - Erector spinae - Paravertebral - Fascia iliaca What’s wrong w the other 2 options?
- intercostal - Erector spinae - Paravertebral (or a thoracic epidural) - IPACK block targets the knee - fascia iliaca block targets the hip
75
What block targets the **dorsal and ventral rami** of the **thoracolumbar nerves** at the level of injection?
Erector spinae block
76
77
Whats the group of spinal muscles that help the vertebral column stay upright?
Erector spinae muscles
78
label these muscles what are they known as collectively?
Green - Spinalis Orange- Iliocostalis Blue- Longissimus **Erector Spinae**
79
The erector spinae consists of what 3 paired muscles that extend from the sacrum to the skill base?
"I Like Standing" - Iliocostalis - Longissimus (the longest one and most lateral ones) - Spinalis (closest to the spine)
80
Injecting LA deep to hte erector spinae muscle group and superficial to the transverse process causes significant _________ spread.
craniocaudal (up and down)
81
What block? What approach?
**Erector Spinae block** Transvere process + Erector spinae muscle group **Thoracic Approach**
82
erector spinae block - how much mls of LA
20mls in 5ml increments
83
84
What block, what approach?
Erector spinae block lumbar approach
85
Approximately how many dermatome levels are covered by a thoracic erector spinae block vs lumbar erector spinae block?
Thoracic ESB = 8-10 dermatome levels Lumbar ESB = 3-4 dermatome levels
86
_When performing a rectus sheath block, the needle is inserted into the fascial plane between the (select 2):_ - external oblique muscle - anterior rectus sheath - rectus abdominis muscle - posterior rectus sheath
- rectus abdominis muscle - posterior rectus sheath
87
What block is used as part of a multimodal pain management plan for midline surgical incisions of the abdomen (ie. umbillical hernia repar)
Rectus sheath block
88
What arteries travel within the rectus sheath and are at risk for intravascular injection?
the inferior epigastric arteries
89
What block?
**Rectus Sheath Block** \* Rectus abdominus muscle + Posterior rectus sheath
90
Label U/S for rectus sheath block
91
Match each quadratus lumborum block with its target area for depositing local anesthetic: - Quadratus lumborum 3: - Quadratus lumborum 2: - Quadratus lumborum 1: Options; Antior/Lateral/Posterior to the quadrataus lumborum muscle
- Quadratus lumborum 3: **Anterior** - Quadratus lumborum 2: **Posterior** (2 buttcheeks) - Quadratus lumborum 1: **Lateral**
92
What is the target area for the quadratus lumborum block?
the thoracolumbar fascia
93
What block is indicated for providing analgesia for procedures of the *anteriolateral abdominal wall?*
*Quadratus Lumborum Block*
94
What frequency transducers should be used for a QL 1, 2, and 3 blocks?
QL1 & 2 = high-frequency linear array (\>7MHz) QL3 = low frequency curvilinear array (2-5MHz)
95
Where does the quadratus lumborum muscle reside?
**deep in the posterior abdominal wall** -originates in the iliac crest & iliolumbar ligament & extends to the 12th rib and the transverse processes of _L1-L4_
96
What is referred to as a indirect paravertebral block?
the quadratus lumborum block
97
The quadratus lumborum muscle resides between which two layers of the thoracolumbar fascia?
anterior and middle
98
Label Quadratus Lumborum Block anatomy
99
A QL1 block is for surgeries where? What bout QL 2 & 3 blocks?
QL 1 - abdominal surgery below the umbilicus QL 2 &3: Abdominal surgery below or above the umbilicus (up to T6)
100
What kind of block?
QL 1 block anteriolateral border of the QL muscle
101
Which block is associated with a shamrock sign on the ultrasound?
QL3 block stem = L4 transverse process 3 leaves = erector spinae, QL muscle, psoas muscle (moving posterior to anterior)
102
Label - what block
Q3 block
103
Will all fascial plane blocks, (large/small) volumes of (high/lower) concentration anesthetic are needed to achieve a consistent, reliable block.
large volumes of low concentrations
104
Which nerve block produces aensthesia by injecting local anesthetic into the thoracolumbar fascia? A. PECS 2 B. Intercostal C. TAP D. QL1
D. QL 1
105
What dat? A. Tendinous intersection B. Semilunaris C. Arcuate line D. Linea alba
D. Linea alba
106
What is the BEST regional anesthetic technique to provide analgesia to a patient with herpese zoster? A. Intercostal nerve block B. QL 3 block C. Erector spinae block D. Rectus sheath block
A. Intercostal nerve block
107

Regional Anesthesia (6 decks)

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