Interscalene Block

Question 1

For interscalene block, the local anesthetic solution is injected into the interscalene groove adjacent to the

Answer 1

Transverse process of C6

Question 2

The interscalene block provide blockage at the level of the

Answer 2

Superior and middle trunks

Question 3

The brachial plexus nerve roots emerge between which muscles

Answer 3

Anterior and the middle scalene muscles

Question 4

Nerve stimulation acceptable for interscalene block?

Answer 4

0.2-0.5mA of the pectoralis, deltoid, triceps, hand and forearm with the goal to stimulate trunks and divisions

Question 5

To view brachial plexus easier to start at

Answer 5

obtain a view of the subclavian artery and brachial plexus at the level of the clavicle and following the brachial plexus upward

Question 6

What is a plexus?

Answer 6

afferent and efferent fibers that arise from the merging of the anterior rami of spinal nerves and blood vessels.

Question 7

Risks associated with Interscalene block

Answer 7

Diaphragmatic hemiparesis 2nd to blockade of the ipsilateral phrenic nerve as the phrenic nerve lies on the anterior scalene muscles.

Question 8

Branches of the phrenic nerve

Answer 8

C3,C4, C5

Question 9

Patient may develop

Answer 9

Hoarse voice with the blockade of the recurrent laryngeal nerve

Question 10

Signs and symptoms of horner’s syndrome

Answer 10

Ptosis
Miosis
Nasal congestion
Anhidrosis (inability to sweat normaly)
enophthalmous (posterior displacement of the eyeball within the orbit)
Flushing

Question 11

The blockade of the inferior trunk is often

Answer 11

incomplete and must be supplemented at the ULNAR NERVE for adequate analgesia

Question 12

Landmark of the Interscalene Block

Answer 12

Clavicular head of the Sternocleidomastoid
Clavicle
Cricoid Cartilage

Question 13

At what level can the Chassaignac’s tubercle be felt?

Answer 13

C6

Question 14

What kind of transducer is needed for the Ultrasound for Interscalene Block

Answer 14

> 7MHz

Question 15

A 22-gauge, 2- or 4-cm, short-bevel needle is advanced near the plexus in a short axis view with needle advanced in an out-of-plane or in-plane approach to a depth of approximately

Answer 15

1 to 3 cm in most patients

Question 16

Techinique for landmark

Answer 16

A line is extended laterally from the cricoid cartilage to intersect the vertical line of the interscalene groove. this represents the level of the C6 transverse process. The external jugular vein often crosses at this level but is not a reliable anatomic landmark

Question 17

Dose for Interscalene groove

Answer 17

After a test dose of local anesthetic agent is given, 10 to 30 mL of the agent is injected incrementally, with frequent aspiration.