Module 17 Regional Anesthesia Flashcards
Highest points of spinal column
L3
C3
Lowest points of spinal column
T6
S2
Spinal cord extends from foramen magnum to what level in adults
Newborn
L1 adult
L3 newborn
Widest area of epidural space
Narrowest
L2 widest
C5 narrowest
Principle site of action for neuraxial is
Nerve root of spinal cord
Total amount of CSF
150ml
Amount of CSF produced and absorbed daily
500ml/day
Apnea with neuraxial occurs due to
Hypoperfusion of respiratory centers in medulla 2/2 severe hypotension
Midline approach for spinal pass through what structures
Skin SQ Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space Dura mater Arachnoid mater
For lateral approach will not pass through what structures
Supraspinous ligament
Interspinous ligament
Volume calculation for epidural
1-2ml of LA per segment to be blocked
Order in which nerves are blocked with neuraxial
B C and A-delta A-gamma A-beta A-alpha
Average distance from skin to epidural space in adult
4-6cm
Volume of LA for caudal block
1ml/kg to get to T10-12
Typical US frequency for clinical imaging
2-12 MHz
Pneumonic for nerves supplied by each cord of brachial plexus
MUM
PAR
LMM
Nerve responsible for
Extension of elbow
Supination of forearm
Extension of wrist and fingers
Radial
Nerve responsible for
Pronation of forearm
Flexion of wrist
Opposition of middle, forefinger and thumb
Flexion of lateral 3 fingers
Median
Nerve responsible for
Flexion of wrist
Adduction of all fingers
Flexion and opposition of medial two fingers to thumb
Ulnar
Nerve responsible for
Flexion at elbow
Musculocutaneous
Cervical plexus block
Volume
4ml per level
Block for shoulder surgery
Interscalene
Interscalene block frequently misses what nerve
Ulnar
Volume for interscalene block
40ml
Block known as spinal of arm
Supraclavicular
Greatest risk of supraclavicular block
Pneumothorax
Volume for supraclavicular block
20-30ml
Block for forearm and hand procedures
Infraclavicular
Volume for infraclavicular
20-30ml
Block for surgery at or below the elbow
Axillary block
Volume of axillary block
40ml
Nerve blocks at elbow (ulnar, median, and radial) what volume
4ml
Which block at elbow has high incidence of neuritis
Ulnar
Volume for ulnar and median wrist block
3ml
Radial nerve block at wrist what volume
6ml
Digit block volume
2ml per side of finger
Block to provide anesthesia for anterior thigh, knee, medial foot
Femoral “3 in one”
Volume for femoral
30ml
Sensation to heel and medial sole of foot
Posterior tibial
Sensation to dorsum of foot and toes 2-5
Superficial peroneal
Sensory or medial legs angle and upper foot
Saphenous
Supplies posterolateral calf and lateral foot. 5th toe
Dural
Supplied toe Elenor’s and sensation to medial dorsal for toe 1 and 2
Deep peroneal
For a procedure requiring a tourniquet on the leg, a minimum sensory level of what is required for block?
T8
Landmarks for caudal block
Sacral Cornu and sacra hiatus
For caudal block in children what is LA dose
0.5ml/kg
Damage to what nerve causes inability to adduct thumb
Ulnar
Damage to what nerve causes inability to abduct thumb
Radial
Which nerve can be damaged by AC IV
Median
What nerves are anesthetized in popliteal block
Tibial and common peroneal (branches of sciatic)
Sural nerve is branch of what nerve
Tibial nerve (branch of sciatic)
Ankle block placed laterally between lateral malleolus and Achilles blocks which nerve
Sural
infiltration on dorsal foot from medial malleolus to extensor digitorum longus blocks which nerve
Saphenous and superficial peroneal
Block placed at intermalleolar line between extensor difitorum longus and extensor hallucis longus blocks which nerve
Deep peroneal
Block placed posterior to medial malleolus blocks which nerve
Posterior tibial nerve
Dose for intralipid in LAST treatment
20% intralipid 1.5 ml/kg over 1 minute
Infusion 0.25 ml/kg/min
What are medication adjustments for ACLS with LAST
Decrease epi dose
Avoid calcium channel blockers and beta blockers
Avoid LA
Amiodarone preferred for ventricular dysrhythmias
Diplopipa following spinal results from palsy of what nerve
CN VI abducens
Most common complication of neuraxial
Backache
Early opioid induced depression of ventilation occurs when?
Is due to what
Within 2 hours
Due to systemic absorption of opioid
Late (delayed) opioid induced ventilatory depression occurs when?
Is due to what?
6-12 hours after injection
Due to cephalad spread in CSF to respiratory centers in medulla
MORHPINE
Most common side effect of spinal opioids
Puritis
Pain initiated or caused by primary lesion, dysfunction, or transitory perturbation in PNS or CNS
Neurogenic pain
Pain initiated or caused by primary lesion or dysfunction in nervous system
Neuropathic pain
Pain due to a stimulus which does not normally provoke pain
Allodynia
Increased response to stimulus which is normally painful
Hyperalgesia
Disturbance of function or pathological change in a nerve
Neuropathy
Signs of dysfunction including numbness, weakness, or loss of DTR referable to a specific spinal nerve
Radiculopathy
