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Regional > Brachial Plexus > Flashcards

Brachial Plexus Flashcards

0
Q

intensity of nerve stimulation

A

low intensity, up to 5 mA

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1
Q

blocks of the brachial plexus

A

interscalene, supraclavicular, infraclavicular, axillary

roots-trunks-divisions-cords-terminal branches

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2
Q

duration of nerve stimulation

A

0.05-0.1 ms

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3
Q

nerve stimulation helps avoid…

A

intraneural intrafascicular injection and subsequent nerve injury

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4
Q

C5, C6

A

axillary, upper and lower subscapular, suprascapular

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5
Q

C5, C6, C7

A

musculocutaneous, long thoracic, lateral pectoral

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6
Q

C5

A

dorsal scapular, to subclavious muscle

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7
Q

C5, C6, C7, C8

A

to longus colli and scalene muscles

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8
Q

C5, C6, C7, C8, T1

A

radial, median

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9
Q

C8, T1

A

ulnar, medial pectoral, medial cutaneous nerve of forearm

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10
Q

T1

A

medial cutaneous nerve of arm

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11
Q

C6, C7, C8

A

thoracodorsal (middle subscapular)

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12
Q

acceptable twitches

A

pectoralis major, deltoid, biceps, triceps, forearm , hand

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13
Q

advantages of ISB

A

landmarks easy to find in obese patients, shoulder surgery, small risk of pneumothorax

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14
Q

ISB disadvantages

A

paresthesias usually elicited
ulnar nerve frequently spared
not appropriate for the pulmonarily compromised
phrenic nerve blockade typically ensues (only 10%)

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15
Q

ISB complications

A

unintentional spinal/epidural anesthesia
vertebral artery puncture
phrenic nerve block
LAST

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16
Q

ISB technique

A

head contralateral, HOB slightly elevated
sternocleidomastoid palpated
roll fingers off posteriorly
intersection at C6

17
Q

ISB insertion

A

22/23g needle almost perpendicular to the floor
45 degrees caudad, posterior, and medial
watch out for EJ
paresthesias are elicited and injection performed (30 ml)

18
Q

drugs and dosages for ISB

A

lidocaine 20-30ml
mepivacaine 20-30ml
bupivacaine 20-30ml
ropivacaine 20-30ml

19
Q

advantages SCB

A

3 trunks of the brachial plexus (most compact here)
arm can be in any position
most homogenous block of brachial plexus (ulnar nerve not spared)

20
Q

disadvantages of SCB

A

difficult to teach
considerable experience required
major risk of pneumo

21
Q

SCB complications

A

puncture of subclavian artery
pneumo
phrenic nerve block
LAST

22
Q

SCB dosages

A

Lidocaine 30ml
Bupivacaine 30ml
Ropivacaine 30ml
Mepivacaine 30ml

23
Q

ICB advantages

A

nerves frequently missed with axillary approach are blocked
musculocutaneous nerve blocked
does not require positioning of the arm like axillary approach
phrenic nerve blockade not a possibility

24
Q

ICB disadvantages

A

no pulse to assist in blocking bundle
if injection too far proximal to clavicle, musculocutaneous and axillary nerves will be missed
needle insertion too medial can result in pneumothorax

25
Q

ICB dosages

A

Lidocaine 30 ml
Bupivacaine 30 ml
Mepivacaine 30 ml
Ropivacaine 30 ml

26
Q

Median nerve in quadrants…

A

1 & 8 in 56% of subjects

27
Q

ulnar nerve in quadrants…

A

2 in 59% of subjects

28
Q

radial nerve in quadrant…

A

3 in 38% of subjects

29
Q

advantages of AxB

A

surgery on forearm and wrist
fewer complications than SCB
safest and most reliable for the patient

30
Q

AxB disadvantages

A

arm abducted for surgery
not for shoulder or upper arm surgery
musculocutaneous nerve lies outside of perivascular sheath, need separate block

31
Q

AxB technique

A

supine head contralateral
arm abducted 90 degrees
forearm flexed 90 degrees
palpate brachial artery as far proximal

32
Q

Dosages AxB

A

Lidocaine 20-30ml
Bupivacaine 20-30ml
Ropivacaine 20-30ml
Mepivacaine 20-30ml

33
Q

elbow blocks technique

A

flex elbow 90 degrees
ID medial condyle of humerus
insertion point is between medial condyle of humerus and olecranon process of ulna
Inject 4 ml LA (3-5 ml)

34
Q

median nerve block

A

draw a line from the medial to lateral condyles of the humerus on anterior surface
insert B bevel needle slightly medial to the brachial artery
inject 4 ml (3-5 ml)

35
Q

radial nerve block

A

elbow extended
locate brachioradialis muscle and biceps brachii insertion (tendon)
radial nerve is in the groove between the muscles mentioned above
inject 4 ml (3-5 ml)

36
Q

movements in response to radial nerve stimulation

A

extension at elbow
supination of forearm
extension of wrist and fingers

37
Q

movement in response to ulnar nerve stimulation

A

flexion of wrist
adduction of all fingers
flexion and opposition of medial two fingers towards thumb

38
Q

movement in response to median nerve stimulation

A

pronation of forearm
flexion of wrist
opposition of middle, forefinger, and thumb
flexion of the lateral three fingers

39
Q

movement in response to musculocutaneous stimulation

A

flexion at elbow

Regional (4 decks)

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