Maverick Modules (1-4) Regional Block Basics Flashcards
Which of the following if NOT considered when evaluating the use of regional techniques?
- cost effectiveness
- Safety and practicality
- Labor intensity
- clinical effectiveness
- easy to learn
Labor intensity
Regional anesthesia practice questions 1
What nerve type is more readily activated with a shorter duration of current?
Motor nerve fibers compared with sensory nerves
mod 2
Peripheral nerve stimulation technique is guided by the use of stimulation to ____ nerves.
Motor
mod 2
____ current is needed to elicit a motor response as the needle approaches the nerve.
Less
mod 2
Elicited motor response ≤ ____ mA is considered a good endpoint for successful neural blockade according to the literature.
0.5 mA
0.4 mA is best. This will result in a higher number of successful blocks that last longer (emperical findings)
mod 2
What are the four major advantages to using nerve stimulation technique?
- Nerve stimulators are very available
- Inexpensive
- Setup time is shorter
- Landmarks are consistent for reliability and repeatable
Mod 2
Disadvantages of Nerve stimulation blocks
- Patient variability of their body shape
- Needle-to-nerve relationship: not an absolute relationship based on strength of the nerve twitch and the distance to the needle
- Vatiation of anatomy: abnormal courses of various nerves (brachial plexus only has a normal path 60% of the time)
- Only 1 injection (can’t reposition needle safely)
mod 2
Advatages of using US for a nerve block
- Visualize anatomy
- Can reposition the needle after the injection
- Visualize the spread of local anesthetic
- Lower volume of local to be used while still giving the same quality of block
mod 2
Disadvantages of US for a nerve block
- Expensive
- Not as available
- Requires practitioner to learn new skills
- Takes longer to use (especially when learning)
mod 2
Order the following pre-block steps:
- Informed Consent
- Educate the Patient
- Determine block approach/technique
- Indications/Contraindications
- History & Physical
- Equipment
- History & Physical
- Indications/Contraindications
- Determine block approach/technique
- Informed Consent
- Educate the Patient
- Equipment
Mod 4
What are some absolute contraindications to regional block techniques?
- Patient refusal
- Uncooperative patient (mental health)
- Pre-op nerve involvement
- Intra-op nerve repair/transposition of a nerve
- Infection at block site
mod 4
What are relative contrindications to regional blocks?
- Surgeon Preference
- Coagulopathy or anticoagulation at the time of the block (are you doing a deep or uncompressible block?)
- Systemic Bacteremia
mod 4
Whats the sandwhich approach to educate your patients on your block?
- Start with the benefits: superior analgesia, decrease narcotics, avoid GETA, reduced PONV, and reduced days in hospital
- Then move to risks associated: incomplete block, toxicity, permanent/transient nerve damage
- Finally, re-emphasize the benefits and reassure the pt again
Mod 4
T/F: it is more important to consider the tightness and pressure during the injection of the block than the number of ccs the syringe holds
True
mod 4
T/F: To avoid creating a permanent tattoo on the skin when marking landmarks, use a fine point permanent marker
False
