Maverick Modules (17 - 19) Ultrasound SCB, ISB, & ANB Flashcards
Ultrasound guided supraclavicular brachial plexus blocks are performed at the level of the _______.
Trunks
What landmarks are denoted by 1-5 below?
- Cricoid Cartilage
- Superior Thyroid Notch
- Sternocleidomastoid
- Puncture site
- Vertical Infraclavicular puncture site
What anatomical location procedures is the supraclavicular block appropriate for?
- Humerus
- Elbow
- Forearm
- Wrist
The patient should be positioned _____ with the head slightly _____ for a supraclavicular block.
Lateral : Elevated
Where should the probe be placed first for a supraclavicular block?
Supraclavicular fossa
What three anatomical structures should be located first aiming one’s probe downward in the supraclavicular fossa?
- 1st rib
- Subclavian artery
- Brachial plexus bundle
What structure is usually superior and lateral to the subclavian artery?
Brachial Plexus
What type of approach is typically used for a supraclavicular block?
In-plane Approach
What nerve might be missed if the corner pocket isn’t anesthetized?
Ulnar nerve & it’s distribution
What ultrasound block is best suited for surgeries of the shoulder and upper arm?
Interscalene Block (ISB)
Where should the probe be initially placed for an ISB?
Supraclavicular Fossa
What structures need to be kept in the middle of your view while positioning for an ISB?
C5 nerve
C6 nerve
C7 nerve
A ________ approach is suggested to avoid the jugular vein and carotid artery for an ISB.
Posterolateral
Evidence suggests ______ cc’s of local is acceptable for an ISB.
Maverick suggests ______ cc’s.
10 - 15 cc’s
15 - 20 cc’s
What technique should be utilized in respiratory compromised patients needing upper arm regional anesthesia?
Skip the ISB, do a supraclavicular block
What three technique adjustments can be utilized to help avoid a phrenic nerve block?
- Hybrid SCB/ISB injecting at bundle stack
- Less LA volume (10-15mls)
- Lower LA concentration
Place a ___________________ block in the lower plexus to avoid phrenic nerve block.
Hybrid low volume block
The axillary nerve block (ANB) is suitable for what surgeries?
- Lower Forearm
- Hand
- ORIF of radius/ulna
What nerves might be missed with an ISB that result in poor pain control in the lower extremity?
Which block solves this?
- C8 - T1
- Axillary Nerve Block
What nerve requires care to anesthetize to complete an ANB?
Musculocutaneous nerve
What patient positioning is necessary for an ANB?
How many cc’s of LA should be injected around the musculocutaneous nerve?
5 cc’s
What muscle response would be seen with stimulation of the musculocutaneous nerve?
Biceps contraction
Would ropivacaine or bupivacaine w/ epi be better as the sole anesthetic for an AV fistula creation?
Bupivacaine. Creates a more dense block.
The brachial plexus resides between the _____ and _______.
Anterior and Middle scalenes
