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Pain Management > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Local anesthetics are ______ blockers

A

Calcium channl

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2
Q

How do local anesthetics work?

A

Prevent depolarization, blocks conduction of nerve impulses to inhibit pain

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3
Q

What nerve fibers are affected by local anesthesia, and what effect does that have?

A

A-delta & C fibers first > Provides analgesia

A-beta & A-alpha second > paralysis

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4
Q

Order of sensation disappearance with local anesthesia

A

Pain > Cold > Warmth > Touch > Joint pain > deep pressure > motor blockade (paralysis)

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5
Q

What are the 3 basic units of local anesthetics?

A
  1. Aromatic group (benzene ring) > Lipophilic
  2. Intermediate chain - Ester-linked or Amide-linked
  3. Tertiary Amine (amino tail) > Hydrophillic
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6
Q

How does lipid solubility affect local anesthetic efficacy?

A
  1. Higher solubility = Higher potency

2. Smaller lipophilic modules = faster onset of action

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7
Q

Ester-linked local aesthetics

A

Procaine, tetracaine, proparacane

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8
Q

Amine-linked local anesthetics

A

Lidocaine, bupivacaine, ropivacaine, mepivacaine

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9
Q

How does pKa influence local anesthetics?

A

More basic&raquo_space; More rapid onset, greater potency

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10
Q

How does addition of vasoconstrictors (epinephrine, etc.) influence local anesthetics?

A
  1. Delays absorption & onset
  2. Prolongs duration
  3. May increase intensity of blockade
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11
Q

How does addition of bicarbonate influence local anesthetics?

A

Increases pKa (more basic)&raquo_space; more rapid onset

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12
Q

List common adjuvants to local anesthesia

A

Opioids
Vasoconstrictors
Alpha-2 Agonists

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13
Q

How are opioids commonly used with local anesthetics?

A
  1. Enhance epidural anesthesia
  2. Improve analgesia without affecting motor blockade
  3. With lidocaine +/- ketamine for CRIs
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14
Q

How do alpha-2 agonists affect local anesthetics?

A
  1. Enhance epidural analgesia
  2. Enhance peripheral nerve blocks
  3. Increase duration
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15
Q

How does bupivacaine compare to lidocaine?

A
  1. Slower onset
  2. Longer duration
  3. May be more cardiotoxic
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16
Q

Tuohy needle

A

Curved, blunt tip needle used for epidurals.
Less likely to penetrate perineurium
Better tactile sensation

17
Q

Spinal needle

A

Very sharp with short stylet. Used for spinal injections & CSF colection

18
Q

Insulated nerve block needle

A
  1. Used with peripheral nerve stimulator
  2. Directs current to tip
  3. Helps identify target nerves before injection
19
Q

How is ultrasound used for regional anesthesia?

A
  1. Used alone or with peripheral nerve stimulator

2. Allows for visualization of nerve for more precise placement

20
Q

Peripheral Nerve Stimulator

A
  1. Used with nerve block needles
  2. As needle approaches target, less current is needed to stimulate response
  3. When response is elicit at 0.2 - 0.6 mA, okay to inject
21
Q

When is the best time to use an incision block?

A

Pre-op; but sometimesat closure

22
Q

Mepivacaine & Ropivacaine for IA block

A

Less chondrotoxic

23
Q

What opioid can be used for IA block?

A

Preservative-free morphine; preservatives may play a role in chondrotoxicity

24
Q

Why should steroids be used with caution for IA injection?

A

Can be chondrotoxic depending on dose & duration

25
Q

What are the 2 types of testicular blocks?

A
  1. Direct injection

2. Spermatic cord

26
Q

What local anesthetics are used for testicular or line blocks?

A

Lidocaine or bupivacaine

27
Q

How will eye react if retrobulbar block is successful?

A
  1. Pupil dilated

2. Central eye position

28
Q

What area is blocked by brachial plexus block?

A

Distal humerus to digits.

29
Q

Can blind approach be used for brachial plexus block?

A

Not recommended. Use nerve stimulator and/or ultrasound.

30
Q

Rostral maxillary (infraorbital) block

A
  1. Needle inserted into infraorbital foramen

2. Blocks from 3rd premolar rostrally to midline (soft tissue, teeth, bone, upper lip, lateral nasal mucosa)

31
Q

Caudal maxillary block

A
  1. Insert needle perpendicularly behind 2nd maxillary molar

2. blocks caudal maxilla (hard& soft palate, teeth & bone) rostrally to midline.

32
Q

Rostral mandibular (middle mental) block

A
  1. Insert needle into middle mental foramen

2. Blocks rostral soft tissue but not teeth

33
Q

Caudal mandibular (inferior alveolar) block

A
  1. Needle inserted medial to mandibular notch in line with lateral canthus
  2. Blocks ipsilateral mandible to midline

Pain Management (1 decks)

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