Highlighted stuff for exam 2 (make sure you know) Flashcards
What is unique about the posterior Lumbar Plexus (Psoas compartment) block?
this block has one of the highest complication rates of any peripheral nerve blocks, d/t depth of block (longer needle needed).
Psoas compartment block also known as posterior lumbar plexus block, you want to elicit what twitch?
quadriceps twitch
What nerves are included in a 3-in-1-block?
and where does the single injection go?
femoral nerve
lateral femoral cutaneous nerve
obturator nerve
w/ single injection below inguinal ligament
What twitch do you want to elicit with a femoral nerve block (3-in-1-block)
quadriceps twitch
What nerve block can cause meralgia paresthetica (pain syndrome)?
Lateral Femoral Cutaneous nerve block
What is identified by a “release” or a “pop” as the needle passes through it (also tell me what block this is)
when you pass through the FASCIA LATA you will hear a pop.
Lateral Femoral Cutaneous nerve block.
What twitch do you want to elicit with obturator nerve block?
thigh adduction
Obturator nerve block is performed in combination with what other nerve blocks to provide anesthesia of the knee/leg? (3)
femoral nerve block
lateral femoral cutaneous nerve block
sciatic nerve block
Sciatic nerve divides into?
tibial and common peroneal
What twitch do you want to elicit with a Sciatic nerve block?
plantar or dorsiflection
What block do you have the risk of mild hypotension d/t sympathetic fiber blockade?
Sciatic nerve block
Which block is also known as the popliteal approach to the sciatic?
popliteal nerve block
Where do you place US probe for popliteal block?
place probe above crease of fossa to view popliteal artery/vein & 2 nerves: common peroneal & tibial (sciatic nerve branches)
What nerve is the most medial branch of the femoral nerve?
Saphenous nerve
What block is commonly used with sciatic popliteal block to provide anesthesia/analgesia below the knee?
Saphenous nerve block
With a cervical plexus block, tell me the first thing you are going to mark?
mark lateral edge of SCM muscle!
What block provides a dense block of the supraglottic region?
Superior laryngeal nerve block (airway block)
What membrane are you wanting to PASS THROUGH with a superior laryngeal nerve block? (while you are performing the block)
thyrohyoid membrane
If you aspirate air with a superior laryngeal nerve block what does this indicate?
too deep
Which block do you WANT to aspirate air with?
Translaryngeal (trans-tracheal) block
Interscalene block will need to be supplemented with what other block?
ulnar nerve block
Supraclavicular block occurs at the level of what?
level of the three trunks
The most important advantage of a supraclavicular block?
no danger of missing peripheral/proximal nerve branches because of failure of LA spread
Infraclavicular block will block at what level?
The level of the cords of the brachial plexus
What nerves does the infraclavicular block actually block that an axillary block will “miss”?
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.
What major structure/landmark do you want to identify for an infraclavicular block?
ID the coracoid process
with US Position transducer 2 cm medial and 2 cm caudad to the coracoid process
What twitch response do you want to elicit with an infraclavicular block?
finger response is elicited at 0.5mA
you DO NOT want elbow response
Interscalene block what is it indicated for and what is it NOT for?
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.
S/E with an interscalene block?
Horner syndrome
Phrenic nerve block
RLN block
carotid compression
What does a supraclavicular block NOT block?
DOES NOT block the shoulder and typically not the ulnar nerve.
interscalene block compared to supraclavicular block in relation to pneumothorax?
supraclavicular block has an increased risk of pneumothorax and interscalene has a small risk of pneumo.
infraclavicular block is good for what kind of procedure?
procedures DISTAL to the elbow
What two patients should you avoid an infraclavicular block with?
Avoid in patients with vascular catheters in the SCL region
Avoid in patients with ipsilateral pacemaker
Axillary block occurs at what level?
Terminal branches
Axillary advantages? (3)
Less risk of major complications
Suitable for ER and outpatient use
***Not imperative to seek paresthesias
How MUST the arm be positioned for an axillary block?
abducted
**Axillary block is not good for what kind of surgery?
***Extent of anesthesia is insufficient for shoulder or upper arm surgery without using large volumes of solution
**What nerves are typically missed with an axillary block?
**the axillary, musculocutaneous, & medial cutaneous nerves are usually missed because they exited the sheath proximal to the point of injection (outside the neurovascular sheath)
Tell me the full technique for Bier block?
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
If you are using an axillary block what other nerve must you block to achieve adequate block of the arm?
MC nerve block
Digital nerve blocks, do you use epi or not?
NEVER use epi
Should you use a tourniquet for digital nerve blocks?
Use is cautioned (especially do not use rubber band tourniquet)
If you did use a normal tourniquet (not rubber band) what is the time limit for use on digits?
15 min limit
What is the max dose of LA on each side of a digit block?
2ml max dose on each side. (4ml total)
How long must a beir block proximal cuff stay inflated to prevent systemic absorption of LA?
20 minute minimum after injection.
What block has the highest rate of toxicity/ highest blood levels of LA based on volume of ANY block?
Intercostal block
Does a lumbar plexus block provide complete anesthesia of the lower extremity?
Does not supply complete anesthesia of lower extremity because it cannot achieve blockade of the sacral roots that supply the sciatic nerve.
