Mod 5: Hallux Digital blocks, Lesser digital blocks, and LA infiltration Flashcards

1
Q

How many nerves is each digit supplied by?

A

Four. 2 dorsal, 2 plantar running on the medial and lateral aspects of the digit

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2
Q

Sensation to the dorsal aspect of the Hallux is provided by?

A

Medial:Medial dorsal digital nerve from medial cutaneous nerve of Superficial Peroneal.
Lateral:Lateral dorsal digital nerve from medial terminal branch of Deep Peroneal.

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3
Q

Sensation to the plantar aspect of the Hallux is provided by?

A

Medial:1st proper planter digital nerve of Medial Plantar nerve.
Lateral: Terminal branch of 1st common digital nerve from Medial Plantar Nerve.

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4
Q

At the level of the proximal phalanx base, the dorsal digital arteries,veins, and nerves are larger or smaller than their plantar counterparts?

A

Smaller.

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5
Q

What is the usual volume of LA required for Hallux block?

A

3-5ml of 1% Xylocaine per Hallux

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6
Q

What is the the dose required for Hallux block?

A

30-50mg of Xylocaine per Hallux

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7
Q

What are the most suitable syringes for Hallux block?

A

1 x 5cc or 2 x 3cc

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8
Q

What is the most suitable needle for Hallux block?

A

25-30 gauge 1 and half inch needle

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9
Q

What is the most suitable needle for drawing up LA solution?

A

18-21 gauge needle 1 inch

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10
Q

There are 2 techniques to block digits, these are?

A

2 point Hallux ring block

2 point Hallux block

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11
Q

When documenting the Injection it is important to state what?

A
  1. Injection site and technique (block type)
  2. Quantity, %, type of drug administered
  3. Effectiveness of block achieved
  4. Lack of presenting adverse reactions
  5. Signature.
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12
Q

LA infiltration is not a block of a specific nerve but rather….

A

…a block of a specific infiltrated area independent of nerve sensory dermatomes and neurotomes.

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13
Q

When is LA infiltration useful?

A
  1. Anesthetizing areas difficult to block by regional or specific nerve block.
  2. For procedures limited to well defined area of the skin or subcutaneous tissue
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14
Q

Name the 2 typre of infiltration.

A
Deep Infitration (sub q tissues)
Superficial Infiltration (dermal tissues)
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15
Q

What are the characteristics of Deep Infiltration (Sub q)?

A
  1. May/may not produce wheal
  2. Can be used for Punch, Incisional, and Excisional biopsies
  3. Less painful than dermal infiltration
  4. May take up to 10 mins to work
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16
Q

What are the characteristics of Dermal Infiltration?

A
  1. Produces a wheal
  2. Can be used for shave biopsy of in prep for larger needle
  3. rapid onset
  4. More painful than deep infiltration
17
Q

Name the 3 LA infiltration techniques.

A
  1. Raising a wheal
  2. Diamond Block
  3. Proximal ‘V’ Block
18
Q

What are the 6 general rules of LA Infiltration?

A
  1. Do not inject directly into a lesion
  2. Anatomical landmarks should be palpated, Identified and marked (if desired) PRIOR.
  3. NV structures should be palpated, identified, and marked PRIOR
  4. Borders and margins of the lesion should be marked PRIOR
  5. Skin quality and integrity should be evaluated before deciding on infiltration technique, poor quality may require nerve/regional block
  6. Do not inject directly into marked area to avoid tattoo effect