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Regional Test 1 > lower extremity blocks > Flashcards

lower extremity blocks Flashcards

1
Q

how many cervical nerves are there

A

8 cervical nerves

7 vertebrae

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2
Q 
Cervical nerves
thoracic nerves
lumbar nerves
sacral nerves
coccygeal nerves
total
A 
8-C
12-T
5-L
5-S
1-C
total 31 pairs of spinal nerves
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3
Q

each spinal nerves has what two root

A

anterior and posterior root

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4
Q

the anterior nerve roots join to form

A

plexuses

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5
Q

name the 4 plexuses

A

Cervical plexus
Brachial plexus
Lumbar plexus
Sacral plexus

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6
Q

what does the posterior root form

A

ganglia

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7
Q

Cervical plexus

A

formed by anterior divisions of the upper 4 cervical nerves

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8
Q

Brachial plexus

A

formed by the anterior divisions of C5,6,7,C8, and T1 nerves.

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9
Q

Lumbar plexus

A

formed by the anterior division of L1-4

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10
Q

Sacral plexus

A

formed by the roots of lumbar 4 - 5 and sacral 1-3 nerves.

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11
Q

Brachial Plexus- “Break Down”

A 
5 Roots 
3 Trunks
6 Divisions
3 Cords
Terminal branches (nerves)
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12
Q

what are the 3 distinct trunks-

what muscle are they between??

A

superior (C5-6), Middle (C7) , and inferior (C8-T1) Between ant & middle scalene muscle

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13
Q

where do the trunks lie?

A

Trunks pass over lateral border of 1st rib under clavicle and divides into anterior and posterior divisions

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14
Q

where do the Divisions lie?

how many are there?

A

6 divisions: At lateral edge of the 1st rib, behind the clavicle, the trunks divide into
3 anterior divisions
3 posterior divisions

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15
Q

what are the cords named after?

how many cords are there

A

named after their relationship to the axillary artery

3

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16
Q

name the 3 cords

A

lateral cord
posterior cord
medial cord

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17
Q

lateral cord is formed from

A

union of anterior divisions of upper and middle trunks

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18
Q

Posterior cord

A

all 3 posterior divisions

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19
Q

Medial cord

A

continuation of the anterior division of the inferior trunk.

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20
Q

lateral cord-what nerves does it supply

A

gives off lateral branch of the median nerve and terminates as musculocutaneous

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21
Q

Medial cord -what nerves does it supply

A

gives off medial branch of the median nerve and terminates as the ulnar nerve

22
Q

Posterior cord what nerves does it supply

A

gives off the axillary nerve and terminates as the radial nerve

23
Q

slide 16

A

slide 16

24
Q

indications for inter scalene approach

A

procedures on the shoulder, proximal upper arm

25
Q

indications for supraclavicular

A

entire arm including hand

26
Q

indications for infraclavicular

A

procedures of the hand, forearm, elbow, and not good for upper arm.

27
Q

axillary approach indications

A

procedures up to elbow

28
Q

advantages for interscalene

A

most appropriate for shoulder surgery
reduced risk (small risk) of pneumothorax
clear landmarks even in obese patients.

29
Q

disadvantages for interscalene

A

essential to elicit paresthesias

30
Q

for interscalene block what block may need to be supplementary

A

Supplementary ulnar block may be required

31
Q

interscalene not recommended for?

A

Not recommended for hand surgery or any surgery below the level of the elbow

32
Q

interscalene block-

A

Unless large volumes are used, lower trunk anesthesia may be missed

33
Q

what block is used for reduction of the sublimated shoulder joint

A

interscalene block

34
Q

what roots are most densely blocked in interscalene blocks

A

roots c5-c7

35
Q

indications for interscalene

A

Surgical procedures on the clavicle, shoulder, elbow and upper arm with the exception of the medial aspect of the arm

For complete surgical anesthesia of shoulder, superficial cervical plexus block may need to be supplemented

36
Q

interscalene - used when other approaches are made difficult or undesirable by anatomic problems

A

When other approaches to the brachial plexus are made difficult or undesirable by anatomic or pathologic problems (obesity or severe emphysema)

37
Q

interscalene- pain conditions

A

Pain conditions in the shoulder-arm area (reflex dystrophy, shoulder joint arthrosis, pain due to neoplasm, vessel pathology or injury)

38
Q

interscalene spread

A

Anesthesia extends to the caudal portion of the cervical plexus and the cranial portion of the brachial plexus.

39
Q

interscalene-not appropriate for surgeries-

A

Thus, this block is not appropriate for surgeries distal to the elbow

40
Q

interscalene Contraindications/Considerations

A

Contralateral phrenic or recurrent nerve paralysis (patients with severe pulmonary disease)
Contralateral pneumothorax
Patients who require bilateral blocks
Respiratory compromise

41
Q

Interscalene - Technique

A

Supine with head slightly elevated and turned 30 degrees or less to contralateral side
Palpate the interscalene groove
External jugular vein often crosses the interscalene groove (at the level of the cricoid cartilage), can have patient lift head up and push against resistance to help identify the groove
Use US if available

42
Q

what length needle is used for interscalene technique

A

5cm

43
Q

interscalene needle is aimed

A

slightly medial and caudal angle

44
Q

needle aimed- where for interscalene

A

Needle is aimed at the transverse process of C6 (medially, caudally)

45
Q

continue advancing the needle until a motor response is elicited at what two muscles

A

deltoid

bicips

46
Q

how much la is injected in interscalene

A

20-30ml of la

47
Q

side effects- horners syndrome

A

(myosis (variant of miosis), ptosis, and anhidrosis (inability to sweat),

48
Q

Side Effects/Complications: interscalene

phrenic nerve

A

(ipsilateral phrenic nerve paralysis)

Can lead to respiratory failure in pts. with inadequate pulmonary reserve. (C3-C5)

49
Q

side effects/complications- interscalene

Recurrent laryngeal nerve block

A

(Hoarseness)

In a pt with contralateral vocal cord paralysis, respiratory distress could occur

50
Q

interscalene- hematoma can do what

A

Compression of the lumen of the carotid artery

51
Q

interscalene Complications:

A 
Intravascular injection into a vessel in the neck, particularly the vertebral artery, and diffusion of the local anesthetic solution through the wall of the vertebral artery (CNS intoxication)
Subarachnoid injection (total spinal)
Epidural injection (high epidural)
pneumothorax

Regional Test 1 (12 decks)

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