Maverick Modules (17 - 19) Ultrasound SCB, ISB, & ANB

Question 1

Ultrasound guided supraclavicular brachial plexus blocks are performed at the level of the _______.

Answer 1

Trunks

Question 2

What landmarks are denoted by 1-5 below?

Answer 2

1. Cricoid Cartilage
2. Superior Thyroid Notch
3. Sternocleidomastoid
4. Puncture site
5. Vertical Infraclavicular puncture site

Question 3

What anatomical location procedures is the supraclavicular block appropriate for?

Answer 3

• Humerus
• Elbow
• Forearm
• Wrist

Question 4

The patient should be positioned _____ with the head slightly _____ for a supraclavicular block.

Answer 4

Lateral : Elevated

Question 5

Where should the probe be placed first for a supraclavicular block?

Answer 5

Supraclavicular fossa

Question 6

What three anatomical structures should be located first aiming one’s probe downward in the supraclavicular fossa?

Answer 6

• 1st rib
• Subclavian artery
• Brachial plexus bundle

Question 7

What structure is usually superior and lateral to the subclavian artery?

Answer 7

Brachial Plexus

Question 8

What type of approach is typically used for a supraclavicular block?

Answer 8

In-plane Approach

Question 9

What nerve might be missed if the corner pocket isn’t anesthetized?

Answer 9

Ulnar nerve & it’s distribution

Question 10

What ultrasound block is best suited for surgeries of the shoulder and upper arm?

Answer 10

Interscalene Block (ISB)

Question 11

Where should the probe be initially placed for an ISB?

Answer 11

Supraclavicular Fossa

Question 12

What structures need to be kept in the middle of your view while positioning for an ISB?

Answer 12

C5 nerve
C6 nerve
C7 nerve

Question 13

A ________ approach is suggested to avoid the jugular vein and carotid artery for an ISB.

Answer 13

Posterolateral

Question 14

Evidence suggests ______ cc’s of local is acceptable for an ISB.
Maverick suggests ______ cc’s.

Answer 14

10 - 15 cc’s
15 - 20 cc’s

Question 15

What technique should be utilized in respiratory compromised patients needing upper arm regional anesthesia?

Answer 15

Skip the ISB, do a supraclavicular block

Question 16

What three technique adjustments can be utilized to help avoid a phrenic nerve block?

Answer 16

• Hybrid SCB/ISB injecting at bundle stack
• Less LA volume (10-15mls)
• Lower LA concentration

Question 17

Place a ___________________ block in the lower plexus to avoid phrenic nerve block.

Answer 17

Hybrid low volume block

Question 18

The axillary nerve block (ANB) is suitable for what surgeries?

Answer 18

• Lower Forearm
• Hand
• ORIF of radius/ulna

Question 19

What nerves might be missed with an ISB that result in poor pain control in the lower extremity?
Which block solves this?

Answer 19

• C8 - T1
• Axillary Nerve Block

Question 20

What nerve requires care to anesthetize to complete an ANB?

Answer 20

Musculocutaneous nerve

Question 21

What patient positioning is necessary for an ANB?

Answer 21

Question 22

How many cc’s of LA should be injected around the musculocutaneous nerve?

Answer 22

5 cc’s

Question 23

What muscle response would be seen with stimulation of the musculocutaneous nerve?

Answer 23

Biceps contraction

Question 24

Would ropivacaine or bupivacaine w/ epi be better as the sole anesthetic for an AV fistula creation?

Answer 24

Bupivacaine. Creates a more dense block.

Question 26

The brachial plexus resides between the _____ and _______.

Answer 26

Anterior and Middle scalenes