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Regional 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

3 categories of anterior abdominal wall blocks

A
  • TAP block
    Posterior and subcostal
  • Rectus Sheath Block
  • Inguinal Block
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2
Q

2 anterior abdominal blocks not located in TAP plane

A

Rectus Sheath Block

Transversalis Fascial Plane

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3
Q

External ribs attachment points and direction

A

Ribs and ASIS

Rung longitudinally (lateral to midline)

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4
Q

Internal oblique attachment points and direction

A

Iliac crest and lower part of rib margin

Run midline lateral (opposite of externals)

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5
Q

Transversus abdominus direction

A

Horizontally

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6
Q

TAP blocks are placed between

A

Internal Oblique (IOM)

And

Transversus Abdominis (TAM)

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7
Q

TAP blocks block which type of pain

A

Somatic pain

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8
Q

Anterior cutaneous branches of intercostal nerve origin

A

T7-T11

Deep

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9
Q

Anterior cutaneous branch of subcostal nerve origin

A

T12

Deep

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10
Q

Ilioinguinal nerve origin

A

L1

Deep

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11
Q

Anterior branch of iliohypogastric nerve origin

A

L1

Deep

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12
Q

Lateral cutaneous branches of intercostal nerve origin

A

T7-T11

Superficial

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13
Q

Anterior cutaneous branch of subcostal nerve origin

A

T12

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14
Q

Which nerve provides sensory portion of center of abdominal at very superficial level

A

Anterior cutaneous branch of subcostal

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15
Q

2 branches of genitofemoral nerve

A

Femoral branch

Genital branch

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16
Q

Subcostal TAP block blocks which dermatomes

A

T7-T11

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17
Q

TAP block blocks which dermatomes

A

T10-L1

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18
Q

Ilioinguinal-hypogastric blocks which dermatomes

A

L1

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19
Q

Subcostal TAP block targets

A

Upper abdomen

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20
Q

Midaxillary/posterior TAP block covers

A

Lower abdomen

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21
Q

Ilioinguinal-iliohypogastric block targets

A

Deep groin area

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22
Q

Components of Petit’s Triangle

A

Rib Cage
Latissimus Dorsi
External Oblique
Pelvis

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23
Q

For posterior TAP block you are targeting

A

Intercostal nerves running between transversus abdominis and internal oblique muscles

24
Q

Posterior TAP block you block at __________ targeting

A

Posterior location and blocks lateral and anterior cutaneous branch

25
Q

TAP block blocks which dermatomes

26
Q

TAP blocks are unilateral/bilateral?

A

Unilateral

Does not cross midline

27
Q

Volume for TAP block

A

30-40ml per side

28
Q

Dosage approach for TAP blocks

A

0.3-0.6ml/kh

29
Q

Concentration for TAP blocks

A

Dilute so get volume needed

  1. 25% Bupivacaine
  2. 3% Ropivacaine
30
Q

Indications for Subcostal TAP block

A

surgery below the umbilicus

31
Q

Unexpected injection into transversalis fascia results in

Why?

A

Femoral Nerve block

Bc transversalis fascia is continuous with lumbar plexus

32
Q

Midaxillary TAP block landmarks

A

Costal margin

Superior Iliac Crest

33
Q

With midaxillary TAP you want ______ spread

Why?

A

Posterior spread

Nerves exit/branch earlier

34
Q

Inadvertent muscle injection of LA can result in

A

Myotoxicity- nerve necrosis

Most common with Bupivacaine

35
Q

Method of improving needle isonization

A

Heel-to-toe (rocking) to get ultrasound beam parallel to needle

36
Q

To get longer block location with TAP block

A

Add epi 1:400,000

Add Decadron 4 mg/side

Exparel

Place catheters when possible

37
Q

2 tips to improve success of blocks

A

Large volumes (30-40ml)

Be posterior as possible

38
Q

Subcostal approach TAP block provides analgesia of

A

T7-T12

Upper abdomen

39
Q

Indications for subcostal TAP block

A

Upper abdominal surgeries

Ventral or incisional hernias

40
Q

Volume of LA for subcostal TAP

A

20-30ml per side

Reduced volume because smaller plane

41
Q

If upper abdominal procedure close to midline

A

Combine subcostal and rectus sheath block

42
Q

US view of subcostal

A

Rectus muscle seen medial

43
Q

Easiest area of TAP block to visualize fascial planes

Why?

A

Subcostal approach

Skin thinnest here (even in obese)

44
Q

Indications for ilioinguinal/iliohypogastric block

A

Inguinal hernia repair

Testicular or scrotal surgery

45
Q

Iliohypogastric nerve and ilioinguinal nerve origin

46
Q

Genitofemoral nerve origin

A

L1 and L2 root

47
Q

Why with ilioinguinal/iliohypogastric block do you want to be as posterior as possible

A

Because lateral branches branch off early and more posterior more likely to hit these

48
Q

Block that targets L1 the best

A

Transversalis fascial plane block

49
Q

LA amount for ilioinguinal/iliohypogastric block

A

10 ml each injection

2 injections total

50
Q

Landmark identification for ilioinguinal/iliohypogastric block

A

ASIS

2cm medial then 2 cm cephalad

51
Q

ilioinguinal/iliohypogastric block provides analgesia to

A

L1 segment

52
Q

ilioinguinal/iliohypogastric block covers

A

Very low abdomen groin area

53
Q

US for ilioinguinal/iliohypogastric block

A

EOM
IOM
TAM

ASIS

Use doppler because deep circumflex iliac artery adjacent to ilioinguinal/iliohypogastric nerves

54
Q

Which block TAP should you use Doppler of US before injection?

Why

A

ilioinguinal/iliohypogastric block

Deep circumflex iliac artery adjacent to nerves

55
Q

LA concentration and volume location for ilioinguinal/iliohypogastric block

A

20 ml total

  • 10 ml EOM and IOM
  • 10 ml IOM and TAM
  1. 25%-0.5% Bupivacaine
  2. 375%-0.5% Ropivacaine

Regional 1 (8 decks)

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