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Regional FINAL > Miscellaneous Blocks > Flashcards

Miscellaneous Blocks Flashcards

1
Q

When doing a topical block to nasal area, what are the nerves that innervate the area?

A

originate from opthalmic, maxillary divisions of trigeminal nerve

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2
Q

How do you do topical nasal block?

A

5 ML viscous lidocaine down each side of nose. 4 mL 4% lido with 1 mL 1% phenyl –> nebulized, rare, takes 10-20 min

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3
Q

How do you use atomizer?

A

5-8 breaths with each atomization. Provides denser block.

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4
Q

When blocking mouth/oropharynx to decrease gag reflex, what are the nerves?

A

originate from tigeminal, glossopharyngeal

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5
Q

What is hurricaine?

A

20% benzocaine – quick onset, short duration

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6
Q

What is cetacaine?

A

14% benzocaine, 2% tetracaine, 2% betyl aminobenzoate – shorter onset, shorter DOA

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7
Q

What is lidocaine lollipop?

A

coat tongue blade with lido ointment, place on back of tongue for 1-2 minutes. SUPPLEMENTAL with other modalities

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8
Q

How do you use LTA for vocal cords?

A

topicalize nasopharynx first. Deep breath then spray 2 mL of 5% lidocaine

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9
Q

How do you do glossopharyngeal block?

A

topicalize tongue. stick tongue out, move it to side. use 23-25g spinal needle 0.25-0.5 cm aspirate for air (too deep). 1-2 mL of 2% lidocaine on each side

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10
Q

What does the lingual branch of glossopharyngeal supply?

A

sensory to posterior 1/3 of tongue

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11
Q

What do you block when you do SLN block?

A

dense block of supraglottic region

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12
Q

How much volume do you give for SLN block?

A

1 mL 2% lidocaine. Advance needle 2-3 mm and give 2mL more – repeat on other side

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13
Q

What needle/dose do you use for transtracheal block?

A

22-24g angiocath. 5 mL 2% lidocaine. pt breathes, inject on inspiration

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14
Q

What CN are you trying to block for cervical plexus?

A

CN II, III, IV

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15
Q

Will you still have motor movement with sub-tenon block?

A

maybe

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16
Q

What does ocular LA refer to, and what CN are you aiming for?

A

retrobulbar, peribulbar. CN III, IV, V, VI, VII

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17
Q

What are some problems with retrobulbar block?

A

trauma, respiratory arrest if LA get to CSF, seizures if LA into blood stream. Pt sees needle

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18
Q

How much volume is used for retrobulbar block?

A

2-4 mL

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19
Q

How much volume is used for peribulbar block?

A

8-12 mL

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20
Q

How does peribulbar block work?

A

the LA creates positive extraconal pressure that spreads it into the muscle cone to anesthetize the CN

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21
Q

What is modified retrobulbar block?

A

inject but then come out and inject again

22
Q

What are the 3 types of peribulbar extraconal blocks?

A

supraorbital, inferotemporal, combination 10-12 mL

23
Q

How long will it take for surgical anesthesia to be established from an extraconal peribulbar block?

A

10 min. if you did supraorbital and it didn’t work, CANNOT do it again because you could damage levator muscle. do inferior technique

24
Q

What happens when you do medial extraconal peribulbar block?

A

anterior spread of block to CN VII

25
Q

How long do you wait after retrobulbar block to see if it worked?

A

2 min

26
Q

How do you assess ocular block?

A

assess eye movement in all 4 quadrants

27
Q

What happens when CN VII is blocked?

A

partial or complete akinesia of orbicular muscle. 3 different techniques (obrien/nadbath, van lint, orbicularis oculi)

28
Q

What muscle is blocked for tourniquet anesthesia?

A

coracobrachial at level of shoulder

29
Q

Where is the insertion point for ulnar block at elbow and volume given?

A

between medial condyle of humerus, olecranon process of ulna. 3-5 mL

30
Q

What is blocked with median block at elbow?

A

cutaneous portion of lower forearm, hand, 2/3/4th fingers.

31
Q

What can median block at elbow be used for?

A

in combo with ulnar block, forearm/hand surgery

32
Q

Who should you avoid median block in?

A

carpal tunnel, neuritis, arterial perforation patients

33
Q

Are wrist blocks good for motor blockade?

A

no

34
Q

Is it okay to use epi in wrist block?

A

no – because of small blood vessels in hand/wrist/fingers

35
Q

What is length of procedure Bier block is good for?

A

1 hour or less, upper extremity soft tissue procedures

36
Q

What pressure is the proximal tourniquet inflated to?

A

250 mmHg, or 100 mmHg over SBP

37
Q

How much drug is given for Bier block?

A

50 mL of 0.5% lidocaine PRESERVATIVE FREE, NO EPI

38
Q

What other drugs can be injected for Bier block?

A

opioid, clonidine, NMB, 15-30 mg ketorolac

39
Q

What are the 2 big differences between UE/LE Bier blocks?

A

LE is twice the volume so increased LAST risk. LE higher pressures 300-400 mmHg

40
Q

What kind of tourniquets do you use for LE Bier?

A

x2 9 cm wide. Pneumatic part must surround thigh by 1.5 turns

41
Q

If procedure is short on foot/ankle where can you put the distal tourniquet?

A

on the calf below head of fibula. LEAVE PROXIMAL ON THIGH

42
Q

What is dose for shorter LE Bier?

A

same as upper.

43
Q

Where does the intercostal nerve emerge from?

A

intervertebral foramen, follows rib along intercostal groove

44
Q

Where does intercostal nerve branch and what happens?

A

midaxillary line. sensory anterior/posterior to supply skin, SQ

45
Q

What can happen when using a catheter for intercostal cont block?

A

tachyphylaxis – let block wear off then reinject. can use different agents as well.

46
Q

How can you reduce complications with catheter intercostal?

A

use short B bevel needle

47
Q

How can you avoid intraneural injection when doing catheter intercostal?

A

direct needle cephalad as it passes over ridge of rib

48
Q

How can you avoid PTX with catheter intercostal?

A

22g short B bevel

49
Q

What do you want to block with transversus abdominal plane block?

A

block segmental nerves T9-L1

50
Q

Where do you inject for transversus abdominal plane block?

A

between margin of 12th rib and anterior superior iliac spine

51
Q

How much volume do you inject for transversus abdominal plane block?

A

20 mL on each side

Regional FINAL (4 decks)

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