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*Anesthesia Concepts 1 > Lower PB > Flashcards

Lower PB Flashcards

1
Q

What are risks of peripheral nerve blocks?

A
  • LA toxicity
  • allergic response
  • perm/transient nerve damage
  • uncomfortable pt positioning
  • incomplete blocks
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2
Q

What are the two classes of LA’s? How are they metabolized?

A
  • esters: metabolized by plasma, higher potential for allergic reaction
  • amides: metabolized by liver
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3
Q

Name sites in order of max to min rate of absorption.

A
  1. Intercostals
  2. Caudal
  3. Epidural
  4. Brachial plexus
  5. Sciatic
  6. Lumbar plexus
  7. Femoral
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4
Q

What can systemic absorption lead to?

A
  • CNS toxicity

- Cardiac toxicity

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5
Q

What does epinephrine do to LA? What does it allow?

A
  • It prolongs anesthesia
  • allows low concentrations of LA in a large volume
  • used as alternative or with anesthesia
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6
Q

What are s/s of CNS toxicity from LA toxicity? What are other effects?

A
  • tongue numbness
  • lightheaded/dizzy
  • tinnitus
  • disoriented
  • visual disturbances
  • seizures
  • lead to CNS depression, resp depression/arrest
  • CV instability
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7
Q

How can you prevent LA toxicity?

A
  • vigilant monitoring
  • limit dose
  • aspirate before each injection of 5 ml at a time
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8
Q

What is nerve localization and how do you perform it?

A
  • anatomic relationship of nerves to muscles, bones, arteries
  • cause paresthesias via nerve stimulator technique
  • or ultrasound guided
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9
Q

What nerves does the sciatic nerve block include?

A

-L4-S3: ventral branches of LS trunk

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10
Q

What structures does the sciatic nerve block anesthetize?

A
  • foot, lower extremity distal to knee and posterior leg
  • sciatic n, fibular n, peroneal n

usually combined with fem or popliteal block for achile’s tendon surgery

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11
Q

What are the landmarks for a sciatic nerve block?

A
  • draw line 1 from greater trochanter to post/sup iliac spine and bisect it over the gluteal muscle
  • draw line 2 from greater trochanter to sacral hiatus
  • point where line 2 intersects with bisect line is injection site
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12
Q

What twitch will occur with common peroneal nerve of sciatic block? What does this indicate?

A
  • dorsiflexion or eversion of foot
  • more lateral
  • “P.E.D”
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13
Q

What twitch will occur with tibial nerve block of sciatic block?

A
  • plantar flexion of foot and toes
  • more medial
  • “T.I.P”
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14
Q

What are complications of a sciatic nerve block?

A
  • block failure

- hematoma

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15
Q

What is the largest branch of the lumbar plexus?

A

Femoral nerve

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16
Q

What is the course of the femoral nerve?

A

-thru psoas into groove between psoas and iliacus and under inguinal ligament supplying several branches to anterior thigh, knee, and hip

17
Q

What does the femoral nerve block anesthetize?
What motor function does it eliminate?
What does it do for postop pain?

A
  • anterior thigh, knee, medial foot (small part)
  • inability to abduct leg or extend lower leg
  • excellent adjunct for postop pain relief
18
Q

What are the landmarks for femoral n block?

A
  • inuguinal ligament
  • femoral “NAVEL”
  • adductor longus
  • lateral to fem artery and inferior to inguinal ligament
19
Q

What are complications of femoral block?

A
  • IV injection
  • hematoma
  • direct nerve injury
20
Q

What is the indication for a popliteal nerve block?

A

-foot and ankle surgery

21
Q

What are the landmarks for popliteal nerve block?

A
  • popliteal fossa crease
  • biceps femoris tendon
  • semitendinosus and semimembranosus muscles
  • inject 7 cm above crease
22
Q

What is the twitch response for popliteal bock?

A

foot or toe twitch

23
Q

What is an ankle block used for?

A

below ankle procedures

24
Q

How do you detect location for ankle block placement?

A
  • is a field block

- no nerve stimulator

25
Q

What cannot be used for ankle blocks?

A

no epi

26
Q

What are the 5 nerves of an ankle block?

A
  1. posterior tibial
  2. deep peroneal
  3. superficial peroneal
  4. saphenous
  5. sural
27
Q

Which nerve to block first in ankle block?

A

posterior tibial

28
Q

What is the landmark for the deep peroneal ankle block?

A

lateral to hallucis longus tendon

29
Q

What is the landmark for the posterior tibial ankle block?

A
  • posterior tip of medial maleolus

- post to tibial artery

30
Q

What is the landmark for the saphenous ankle block?

A
  • above medial malleolus

- inject in circular fashion

31
Q

What is the landmark for the superficial peroneal ankle block?

A
  • lateral malleolus

- inject from ant to post

32
Q

What is the landmark for the sural ankle block?

A

behind lateral malleolus

33
Q

How to be successful with extremity blocks?

A
  • equipment and monitoring
  • needles with pH adjusted local for skin wheels
  • education/medication
  • use nerve stimulator or ultrasound

*Anesthesia Concepts 1 (4 decks)

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