Locoregional Techniques for SA

Question 1

What is another name for the topical anesthetic that has lidocaine and prilocaine in it?

Answer 1

EMLA cream-requires occlusive dressing and 60 minutes before it takes affect

Question 2

What medication can be used to dress along side an incision line?

Answer 2

Lidoderm-analgesic effect-not full block

Question 3

Which drugs are used during IOP measurement?

Answer 3

Tetracaine/proparacaine

Question 4

What topical anesthetic is commonly used in cats to reduce laryngeospasms?

Answer 4

Lidocaine (.1 mL 2%)-apply to arytenoids

Question 5

What locoregional anesthetic technique would you use for total ear canal ablation, amputation, oncologic surgery and large wound closure surgeries?

Answer 5

Wound soaker catheter-allows consistent/prolonged analgesia

Question 6

What is another name for intravenous regional anesthesia?

Answer 6

Bier block

Question 7

When would you use a bier block?

Answer 7

Distal extremities for ~60 minute procedures

Question 8

What type of anesthetic is injected during a bier block?

Answer 8

Lidocaine IV

Question 9

How long can the tourniquet be placed for a bier block before potential nerve/tissue damage occurs?

Answer 9

60-90 minutes

Question 10

What are the 5 peripheral nerve blocks of the head?

Answer 10

1. Retrobulbar n. block
2. Maxillary n. block
3. Infraorbital n. block
4. Inferior alveolar n. block
5. Mental n. block

Question 11

What type of nerve block is indicated for enucleation, evisceration and intraocular surgery?

Answer 11

Retrobulbar block

Question 12

What nerves are affected during a retrobulbar block?

Answer 12

CN III. IV, V, VI and ciliary ganglion

Question 13

What is the preferred technique of a retrobulbar n. block?

Answer 13

Inferior-temporal palpebral

Question 14

What nerve does the maxillary nerve block act on?

Answer 14

The sensory branch of CN V

Question 15

During a maxillary nerve block, where is the anesthesia acting on?

Answer 15

Ipsilateral maxilla, teeth, soft tissues and lateral nasal mucosa

Question 16

What are the three techniques for the maxillary nerve block?

Answer 16

Subzygomatic, maxillary tuberosity and infraorbital

Question 17

What nerve block provides anesthesia for the 3rd premolar and rostral teeth, rostral maxilla and soft tissues?

Answer 17

Infraorbital nerve block

Question 18

Where is the infraorbital nerve block administered?

Answer 18

Dorsal to the distal root of 3rd premolar

Question 19

Which route is preferred in cats for the infraorbital nerve block?

Answer 19

Extraoral

Question 20

Which nerve block acts on a branch of the mandibular nerve?

Answer 20

Inferior alveolar n. block

Question 21

What nerve may also be affected during the inferior alveolar block?

Answer 21

Lingual n. –> sensory to rostral 2/3 of tongue

Question 22

T/F: the mental n. block provides anesthesia for the rostral lower lip only.

Answer 22

TRUE-no teeth are blocked

Question 23

What are the four peripheral nerve blocks for the thoracic limb?

Answer 23

Cervical paravertebral block, brachial plexus block, RUMM block and “declaw” block

Question 24

What nerve block provides anesthesia for the entire thoracic limb including scapula and shoulder joint?

Answer 24

Cervical paravertebral block-good for forelimb amputations-but difficult to do

Question 25

Which nerve block provides anesthesia for thoracic limb distal to elbow?

Answer 25

Brachial plexus

Question 26

How should the needle be advanced for the brachial plexus block?

Answer 26

Parallel to chest wall to avoid thoracic puncture

Question 27

Where does the RUMM block provide anesthesia?

Answer 27

Distal thoracic limb including carpus (radial, ulnar, median and musculocutaneous nerves)

Question 28

Where does peripheral nerve blocks for the pelvic limb provide anesthesia for?

Answer 28

Distal to mid-femur

Question 29

Where does the intercostal nerve block provide anesthesia for?

Answer 29

Thoracotamy, rib fractures

Question 30

Where do nerves run in relation to the ribs?

Answer 30

CAUDAL aspect- block at the site, 2 forward and 2 back as well (5 total areas)

Question 31

Which nerve block is injected into thoracic cavity?

Answer 31

Intrapleural regional

Question 32

How should the patient lay post intrapleural regional block?

Answer 32

Lay the patient affected side down-gravity will pull to affected area

Question 33

Where are epidurals commonly performed?

Answer 33

L-S space in SA

Question 34

What position should your patient be in for epidural?

Answer 34

Sternal recumbency with legs pulled forward (hanging drop technique)

Question 35

How do you know that you are in the L-S space during an epidural procedure?

Answer 35

Loss of resistance- you initially go through supraspinous, interspinous ligaments and the ligamentum flavum–> once through it all you will feel a pop and release of pressre

Question 36

What is the main concern with high volume injections in epidurals?

Answer 36

The anesthetic will spread more cranially causing concern for sympathetic blockade and hypotension

Question 37

Which opioid administered L-S can provide analgesia to thoracic wall and thoracic limbs?

Answer 37

Morphine-not an anesthetic so we don’t worry about sympathetic block
Morphine is less lipid soluble- more cranial spread

Question 38

What is a major complication of lumbosacral epidurals?

Answer 38

Hypotension