Highlighted stuff for exam 2 (make sure you know)

Question 1

What is unique about the posterior Lumbar Plexus (Psoas compartment) block?

Answer 1

this block has one of the highest complication rates of any peripheral nerve blocks, d/t depth of block (longer needle needed).

Question 2

Psoas compartment block also known as posterior lumbar plexus block, you want to elicit what twitch?

Answer 2

quadriceps twitch

Question 3

What nerves are included in a 3-in-1-block?

and where does the single injection go?

Answer 3

femoral nerve
lateral femoral cutaneous nerve
obturator nerve
w/ single injection below inguinal ligament

Question 4

What twitch do you want to elicit with a femoral nerve block (3-in-1-block)

Answer 4

quadriceps twitch

Question 5

What nerve block can cause meralgia paresthetica (pain syndrome)?

Answer 5

Lateral Femoral Cutaneous nerve block

Question 6

What is identified by a “release” or a “pop” as the needle passes through it (also tell me what block this is)

Answer 6

when you pass through the FASCIA LATA you will hear a pop.

Lateral Femoral Cutaneous nerve block.

Question 7

What twitch do you want to elicit with obturator nerve block?

Answer 7

thigh adduction

Question 8

Obturator nerve block is performed in combination with what other nerve blocks to provide anesthesia of the knee/leg? (3)

Answer 8

femoral nerve block

lateral femoral cutaneous nerve block

sciatic nerve block

Question 9

Sciatic nerve divides into?

Answer 9

tibial and common peroneal

Question 10

What twitch do you want to elicit with a Sciatic nerve block?

Answer 10

plantar or dorsiflection

Question 11

What block do you have the risk of mild hypotension d/t sympathetic fiber blockade?

Answer 11

Sciatic nerve block

Question 12

Which block is also known as the popliteal approach to the sciatic?

Answer 12

popliteal nerve block

Question 13

Where do you place US probe for popliteal block?

Answer 13

place probe above crease of fossa to view popliteal artery/vein & 2 nerves: common peroneal & tibial (sciatic nerve branches)

Question 14

What nerve is the most medial branch of the femoral nerve?

Answer 14

Saphenous nerve

Question 15

What block is commonly used with sciatic popliteal block to provide anesthesia/analgesia below the knee?

Answer 15

Saphenous nerve block

Question 16

With a cervical plexus block, tell me the first thing you are going to mark?

Answer 16

mark lateral edge of SCM muscle!

Question 17

What block provides a dense block of the supraglottic region?

Answer 17

Superior laryngeal nerve block (airway block)

Question 18

What membrane are you wanting to PASS THROUGH with a superior laryngeal nerve block? (while you are performing the block)

Answer 18

thyrohyoid membrane

Question 19

If you aspirate air with a superior laryngeal nerve block what does this indicate?

Answer 19

too deep

Question 20

Which block do you WANT to aspirate air with?

Answer 20

Translaryngeal (trans-tracheal) block

Question 21

Interscalene block will need to be supplemented with what other block?

Answer 21

ulnar nerve block

Question 22

Supraclavicular block occurs at the level of what?

Answer 22

level of the three trunks

Question 23

The most important advantage of a supraclavicular block?

Answer 23

no danger of missing peripheral/proximal nerve branches because of failure of LA spread

Question 24

Infraclavicular block will block at what level?

Answer 24

The level of the cords of the brachial plexus

Question 25

What nerves does the infraclavicular block actually block that an axillary block will “miss”?

Answer 25

it will block the musculocutaneous nerve, compared to the axillary block that misses the MC nerve bc it has already exited the sheath before the level of an axillary block.

Question 26

What major structure/landmark do you want to identify for an infraclavicular block?

Answer 26

ID the coracoid process

with US Position transducer 2 cm medial and 2 cm caudad to the coracoid process

Question 27

What twitch response do you want to elicit with an infraclavicular block?

Answer 27

finger response is elicited at 0.5mA

you DO NOT want elbow response

Question 28

Interscalene block what is it indicated for and what is it NOT for?

Answer 28

indicated mostly for surgical anesthesia of the SHOULDER, upper arm, and forearm but is often insufficient for the hand.
NOT for below the elbow procedures.

Question 29

S/E with an interscalene block?

Answer 29

Horner syndrome
Phrenic nerve block
RLN block
carotid compression

Question 30

What does a supraclavicular block NOT block?

Answer 30

DOES NOT block the shoulder and typically not the ulnar nerve.

Question 31

interscalene block compared to supraclavicular block in relation to pneumothorax?

Answer 31

supraclavicular block has an increased risk of pneumothorax and interscalene has a small risk of pneumo.

Question 32

infraclavicular block is good for what kind of procedure?

Answer 32

procedures DISTAL to the elbow

Question 33

What two patients should you avoid an infraclavicular block with?

Answer 33

Avoid in patients with vascular catheters in the SCL region

Avoid in patients with ipsilateral pacemaker

Question 34

Axillary block occurs at what level?

Answer 34

Terminal branches

Question 35

Axillary advantages? (3)

Answer 35

Less risk of major complications

Suitable for ER and outpatient use

***Not imperative to seek paresthesias

Question 36

How MUST the arm be positioned for an axillary block?

Answer 36

abducted

Question 37

**Axillary block is not good for what kind of surgery?

Answer 37

***Extent of anesthesia is insufficient for shoulder or upper arm surgery without using large volumes of solution

Question 38

**What nerves are typically missed with an axillary block?

Answer 38

**the axillary, musculocutaneous, & medial cutaneous nerves are usually missed because they exited the sheath proximal to the point of injection (outside the neurovascular sheath)

Question 39

Tell me the full technique for Bier block?

Answer 39

Check tourniquet device (both cuffs)
Supine position
Standard monitors including blood pressure monitor, ECG and pulse oximeter are routinely applied.
A small IV intravenous catheter (22-gauge) is introduced in the dorsum of the patient’s hand of the arm to be anesthetized (or thigh)
The catheter should be firmly taped in place to prevent its dislodgment during application of the Esmarch bandage

The arm is then elevated to passively promote venous drainage while the extremity is wrapped in Esmarch elastic bandage from distal to proximal

At this point the distal cuff is inflated first to squeeze blood further from the arm ( and its functionality should be checked for occlusion of the radial artery pulse

Then, the proximal cuff is also inflated to maintain cuff pressure at 150 mmHg above systolic blood pressure (usually 250 mmHG for upper and 350-400 mmHG for the lower)

functionality should be checked for occlusion of the radial artery pulse (check both cuffs)

At this point (if both cuffs work well), the distal tourniquet is deflated

Esmarch bandage is removed. The patient’s arm is returned to the horizontal position

A syringe with local anesthetic (0.5 % lidocaine) is attached to the previously inserted IV catheter and slowly injected( 25mL for forearm, 50cc for arm, 100cc for a thigh) is injected over 2-3 minutes. Anesthesia is usually well established after 5-10 minutes… (popular dose is 40 cc)

The proximal Tourniquet is left inflated until the patient complains of tourniquet pain (may develop after 20-30 minutes)

At this point the distal tourniquet can be inflated and the proximal deflated. The distal cuff should be over an anesthetized area

***test tourniquet at all times in between cuff changes

Question 40

If you are using an axillary block what other nerve must you block to achieve adequate block of the arm?

Answer 40

MC nerve block

Question 41

Digital nerve blocks, do you use epi or not?

Answer 41

NEVER use epi

Question 42

Should you use a tourniquet for digital nerve blocks?

Answer 42

Use is cautioned (especially do not use rubber band tourniquet)

Question 43

If you did use a normal tourniquet (not rubber band) what is the time limit for use on digits?

Answer 43

15 min limit

Question 44

What is the max dose of LA on each side of a digit block?

Answer 44

2ml max dose on each side. (4ml total)

Question 45

How long must a beir block proximal cuff stay inflated to prevent systemic absorption of LA?

Answer 45

20 minute minimum after injection.

Question 46

What block has the highest rate of toxicity/ highest blood levels of LA based on volume of ANY block?

Answer 46

Intercostal block

Question 47

Does a lumbar plexus block provide complete anesthesia of the lower extremity?

Answer 47

Does not supply complete anesthesia of lower extremity because it cannot achieve blockade of the sacral roots that supply the sciatic nerve.