Exam 3 Flashcards
Label this picture.
What is the mnemonic for the brachial plexus? How many of each are there?
RTDCB = remember to drink cold beer = roots (5), trunk (3), divisions (6), cord (3), and branches (5)
What nerves does the lateral, medial and posterior cord divide into?
- musculocutaneous nerve, the lateral part of the median nerve, lateral pectoral nerve
- ulnar nerve, the medial part of the median nerve, medial cutaneous nerves of the arm/forearm, medial pectoral nerve
- radial nerve, axillary nerve, and subscapular nerve
Where does the brachial plexus originate? What does it pass between?
- C5 - T1
- pass between the anterior and scalene muscles
Describe the advantages and drawbacks of each block of the brachial plexus.
Interscalene block: describe the levels blocked; portion of body blocked; parts of body not covered; location of block; complications; expected side effects
- Levels: roots/proximal trunks
- blocks: shoulder and arm (C3-5)
- not covered: C8, T1, and respective innervation -medial cord (ulnar, medial antebrachial cutaneous, medial brachial cutaneous nerves), top of shoulder, parts of the radial nerve
- location: locate prominent EJ or sweep up from clavicle until SCM, ASM, and MSM appear with C567 in “stoplight” fashion (usually at C6 level (cricoid cartilage line))
- Complications: pneumothorax, neural injury, local anesthetic toxicity, intrathecal/epidural injection, block failure
- Expected side effects: loss of flexion, phrenic nerve block (numbness w/deep breath; occurs with C345 block), Horner’s syndrome (sympathetic block), voice change (possible recurrent laryngeal nerve block), partial cervical plexus block
List sx of Horner’s syndrome.
- ptosis
- miosis
- anhydrosis
- enophthalmos
- redness of conjunctiva
ISB: How much LA used, needle type, needle for skin infiltrate, type of US used, pt position, nerve stimulation (describe)
- 20-30 mL LA
- 50-80 mm echogenic needle
- 25 g needle w/3mL LA for skin inflitration
- US machine w/high to mid frequency linear probe
- pt semi recumbent w/head turned away and facing toward US machine (placed on contralateral side)
- biceps contraction/flexion @0.4 mA
Supraclavicular block: describe the levels blocked; portion of body blocked; parts of body not covered; location of block; complications; expected side effects
- Level: trunks and divisions
- blocks: arm, elbow, forearm
- not covered: the dorsal scapular, long thoracic, and sometimes the suprascapular (shoulder joint) nerves are missed; at times complete block of the inferior trunk or T1 root might be difficult to obtain
- location: posterior, lateral, and cephalad to subclavian artery
- complications: pneumothorax (up to 6% before US-guidance), vascular puncture, chylothorax on left-sided blocks, neural injury, LAST
- expected s/e: phrenic nerve block (25-60%), Horner’s sx (sympathetic block)
Infraclavicular block: describe the levels blocked; portion of body blocked; parts of body not covered; location of block; complications; expected side effects
- levels: cords
- blocks: elbow, forearm, hand
- not covered (usually): proximal plexus branches
What type of block would be attempted with this view on US?
Interscalene Block
What type of block provides coverage to these areas
SCB: Supraclavicular Block
What type of block provides coverage to these areas?
ISB: interscalene block
What type of block provides coverage to these areas?
ICB: infraclavicular block
What type of block provides this type of coverage?
AxB: Axillary Block
What block is likely being performed in this image?
Infraclavicular block (ICB)
What block is likely being performed in this image?
SCB: supraclavicular block
