Class 10 Upper Extremity Blocks

Question 1

Where does the positive (red) and negative (black) ends of the nerve stimulator go?

Answer 1

• Positive = patient

- Negatie = needle

Question 2

What procedures can a Superficial Cervical Block be used for?

Answer 2

• Superficial neck, shoulder, thyroid

- Carotids

Question 3

Where should a Superficial Cervical Block be placed?

Answer 3

• midpoint between C6 and mastoid

- Fan block on Posterior border of SCM

Question 4

What complications can be found with any regional block?

Answer 4

• Infection
• Hematoma
• LA toxicity
• Nerve injury
• Pneumo

Question 5

What complications are related to just Superficial Cervical Block?

Answer 5

• Phrenic nerve block
• Subararchoid or epidural
• TIA
• RLN block

Question 6

What are the indications for the Interscalene Block?

Answer 6

• Shoulder and Shoulder joint
• Lateral 2/3 of clavical
• proximal humerous

Question 7

With an Interscalene Block the arm and forearm will likely not be covered, this is due to which nerve not having and adequate block?

Answer 7

-Ulnar

Question 8

Where should the needle be inserted for an Interscalene Block?

Answer 8

-Just behind the SCM in the scalene groove at C6 level.

Question 9

When using a stimulator for an interscalene block, how far should you advance the needle?

Answer 9

-Until parasthesia is felt below the shoulder

Question 10

During an Interscalene Block, parasthesia at the shoulder could indicate the needle is where?

Answer 10

-Suprascapular nerve

Question 11

The mAmp goal of a stimulator is what? What does stimulation at 0.2 indicate?

Answer 11

• 0.4

- Intraneural

Question 12

What are some Interscalene Block specific complications?

Answer 12

• Spinal or epidural
• Intervertebral injection
• Phrenic nerve block
• Horner’s syndrome

Question 13

What are indications for a Supraclavicular Block?

Answer 13

• Any surgery of the UE not involving the shoulder

- Excellent for hand and elbow

Question 14

Why are bilateral Supraclavicular Block not a good idea?

Answer 14

-Possible respiratory emergency from bilateral phrenic nerve blocks

Question 15

When stimulating the Supraclavicular Block, what are you looking for?

Answer 15

-Finger flex or extend.

Question 16

What runs with the brachial plexus lower in the interscalene triangle?

Answer 16

-Subclavian artery

Question 17

Where is the needle place for a Supraclavicular Block?

Answer 17

-One inch lateral to the SCM insertion to the clavicle

Question 18

How is the needle inserted on a Supraclavicular Block?

Answer 18

• Angled caudally

- No deeper than and inch

Question 19

What is the preferred technique for a Supraclavicular Block?

Answer 19

-ultrasound to avoid pneumo and subclavian

Question 20

Which brachial plexus block has highest risk of pneumo?

Answer 20

-Supraclavicular Block

Question 21

What are the indications for an Infraclavicular Block?

Answer 21

-Any arm surgery up to but not including the shoulder

Question 22

What is the main contraindication for a Infraclavicular Block? Why?

Answer 22

• Coagulation

- difficult to place pressure on vascular bundle

Question 23

At what level of the brachial plexus does the Infraclavicular Block work?

Answer 23

Cord

Question 24

Where is the needle inserted for a Infraclavicular Block?

Answer 24

• 2cm medial and 2cm inferior of the coracoid process
• 90 degree angle
• 4-4.5 cm deep

Question 25

What are the indications for an axillary block?

Answer 25

-Surgery of the forearm, wrist, or hand

Question 26

When considering an axillary block what 3 nerves run with the axillary artery? and which exits high in the axilla?

Answer 26

- Radial, medial, Ulnar | - Musculocutaneous (may not get coverage)

Question 27

Where should the needle be inserted for an axillary block?

Answer 27

-After axillary artery is palpated high in axilla, needle is inserted just above or below the pulse.

Question 28

What block can be used if as a supplement to an axillary block or if axillary block failed to anesthestize the ulnar nerve?

Answer 28

-High/mid humeral

Question 29

At the high/mid humeral block level where are the median and ulnar nerves? Musculocutaneous? Radial?

Answer 29

- Median and Ulnar = with axillary artery - Musculocutaneous = under bicep - Radial = posterior to humerous

Question 30

At the wrist level where would you find the median nerve?

Answer 30

-Between palmaris longus tendon and fexorcarpi radialis trndon

Question 31

At the wrist level where would you find the radial nerve?

Answer 31

Medial aspect of brachioradialis muscle

Question 32

At the wrist level where would you find the ulnar nerve?

Answer 32

Between ulnar artery and tendon of lexor carpi ulnaris

Question 33

How would you block the radial nerve at the wrist?

Answer 33

- 5ml proximal to the radial styloid | - 5ml superior to the radial bone

Question 34

Where would you place a block of the ulnar nerve at the wrist?

Answer 34

- Needle under the tendon of flexor carpi just above ulnar styloid - At ulnar styloid inject dorsally toward radioulnar joint

Question 35

Where would you place a block of the median nerve at the wrist?

Answer 35

-between tendons of palmaris longus and flexor carpi radialis

Question 36

What must you cautious of with wrist blocks?

Answer 36

-intraneural injections (not much room for nerve movement)

Question 37

Where do finger nerves run?

Answer 37

-ventrolateral aspect of the finger

Question 38

What are some rare complications of a digit block?

Answer 38

- Vascular insufficiency | - Gangrene

Question 39

What should not e used with digit block and why?

Answer 39

- Epi | - constrict blood supply to finger

Question 40

What three nerves should be blocked to help with tourniquet pain?

Answer 40

- Intercostobrachial - Medial Brachial Cutaneous - Medial Antebrachial cutaneous