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Anatomy II > Nerve Block Exam Prep > Flashcards

Nerve Block Exam Prep Flashcards

1
Q

The adductor canal block is a modified______ nerve block that is performed more distally

A

femoral

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2
Q

The adductor canal block blocks the ______ nerve

at the _______ level, distal to the motor branches of the quadriceps

A

saphenous (branch of the femoral nerve)

mid-thigh

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3
Q

What 3 nerves does the adductor canal not block?

A
  1. femoral nerve
  2. lateral femoral cutaneous
  3. obturator nerves
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4
Q

What is the advantage of the adductor canal block?

A

preserves ALL motor function

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5
Q

What is the disadvantage of the adductor canal block?

A

only blocks the medial portion of the knee and medial lower leg (is a great option for partial knee replacement)

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6
Q

What surgery is the adductor canal block most popular in?

A

total knee replacement because it allows earlier ambulation, but it does not provide as much coverage as a femoral or fascia iliaca block (both of which are motor blocks)

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7
Q

The adductor canal block is supposed to be a motor sparing block, however the more _____ the block is, the more likely a motor block will occur

A

cephalad

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8
Q

In the adductor canal block, where is the ultrasound usually placed?

A

The ultrasound probe is usually placed above the knee on the medial side

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9
Q

In the adductor canal block, which 5 structures are used for anatomical landmarks?

A
  1. Sartorious
  2. adductor longus
  3. vastus medialis
  4. femoral artery
  5. femoral vein
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10
Q

Between which two structures is the adductor canal nerve most likely to be found?

A

Sartorious and Vastus medialis muscles

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11
Q

With the aid of US, the Saphenous Nerve presents as a hyperechoic structure anterolateral to the _____ Artery,

A

femoral

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12
Q

in the adductor canal block, local anesthetic is injected lateral to the____artery

A

femoral

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13
Q

What is the typical dose of local anesthetic for the adductor canal block?

A

10-15 mL

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14
Q

What 3 blocks are used for the airway?

A

Transtracheal
Superior Laryngeal
Glossopharyngeal

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15
Q

What nerve does the Transtracheal block?

A

recurrent laryngeal nerve

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16
Q

The transtracheal block is used for anesthesia for the ______

A

larynx and trachea BELOW the cords

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17
Q

Why do a transtracheal block and not a direct recurrent laryngeal nerve block?

A

Direct recurrent laryngeal nerve blocks are contraindicated on all patients due to the risk of bilateral vocal cord paralysis and airway obstruction

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18
Q

What two other nerve blocks is the transtracheal block used in combination with for an awake fiberoptic intubation?

A

superior laryngeal nerve block and glossopharyngeal nerve block

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19
Q

What is a complication of the transtracheal block?

A

posterior laryngeal wall puncture if the needle is advanced too far

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20
Q

The superior laryngeal nerve block is used for anesthesia ________

A

for the larynx ABOVE the cords (glottis closure reflex)

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21
Q

What is the local anesthetic dose for the superior laryngeal nerve block?

A

2mL of 2% Lidocaine through a 25ga needle

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22
Q

What are 4 complications of the superior laryngeal nerve block?

A

sore throat
cough
hoarseness
injection into the nearby superior laryngeal artery

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23
Q

What is the glossopharyngeal block most useful for?

A

blocking the gag reflex/oropharynx

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24
Q

What are the 2 ways in which a glossopharyngeal block can be achieved?

A

applying gauze soaked in local anesthetic directly over the nerve
OR
by direct injection of local anesthetic around the nerve

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25
Q

What are 3 complications of the glossopharyngeal nerve block?

A

dysphagia
loss of taste
throat hoarseness

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26
Q

What 5 different nerves does the ankle block anesthetize?

A
  1. deep peroneal
  2. superficial peroneal
  3. saphenous
  4. posterior tibial
  5. sural nerves
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27
Q

Ankle block:

What 4 nerves are branches of the sciatic nerve?

A

Deep and superficial peroneal, tibial and sural

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28
Q

Ankle block:

What nerve is a branch of the femoral nerve?

A

Saphenous

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29
Q

The ankle block requires ___ deep injections of which nerves?

and ____ superficial injections of which nerves?

A

2 deep: deep peroneal, posterior tibial

3 superficial: superficial peroneal, saphenous, sural
think everything begins with “S” for superficial

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30
Q

The ankle block is effective for anesthetizing the ____ but not effective for anesthetizing the ____

A

foot

ankle

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31
Q

What are the 4 major landmarks of the ankle block?

A
  1. Anterior tibial artery (deep peroneal, superficial peroneal, saphenous)
  2. Posterior tibial artery (posterior tibial nerve)
  3. Medial malleolus (saphenous, posterior tibial)
  4. Lateral malleolus (superficial peroneal, sural)
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32
Q

What are 3 contraindications to the ankle block?

A
  1. infection
  2. compromised circulation to the foot
  3. the use of epinephrine in the local anesthetic
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33
Q

The ankle block requires a total of _____ mL PER FOOT for a complete ankle block

____ mL of local anesthetic per nerve is sufficient enough for an effective block

A

15-20mL

3-5 mL

5mL for deep peroneal nerve
5mL for posterior tibial nerve
3-5mL for saphenous, superficial peroneal, and sural nerves

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34
Q

Ankle Block:

Which nerve anesthetizes the space between the first 2 toes?

A

Deep peroneal nerve

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35
Q

ankle block:

Which nerve anesthetizes the Dorsum of the foot and toes (except between the first two toes)

A

Superficial peroneal nerve

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36
Q

Ankle block:

Which nerve anesthetizes the Medial ankle and foot, medial sole?

A

saphenous nerve

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37
Q

Ankle block:

Which nerve anesthetizes the Lateral portion of the foot and heel, lateral/posterior sole?

A

Sural nerve

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38
Q

ankle block:

Which nerve anesthetizes

  1. Most of the heel
  2. Most of the sole (except saphenous and sural portions)
  3. Tips of the toes
A

posterior tibial nerve

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39
Q

The anterior suprascapular is an alternative to what block?

A

interscalene block

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40
Q

The anterior suprascapular block anesthetizes the _____ while minimizing anesthetization of the ____

A

shoulder

phrenic nerve

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41
Q

the anterior suprascapular block is an excellent choice for patients with ______

A

pulmonary dysfunction

research is variable about the efficacy of the anterior suprascapular block analgesia throughout the entire intraoperative period

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42
Q

The suprascapular nerve is a branch of ______

A

brachial plexus nerves C5 and C6

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43
Q

The suprascapular nerve can be located on ultrasound in the ______fossa, deep to the _____ muscle and lateral to the _____ and _____

A

supraclavicular
omohyoid
plexus
subclavian artery

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44
Q

Which nerves does the suprascapular block anesthetize?

A

nerves C5-C6

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45
Q

Which nerve is spared in the suprascapular block?

A

axillary nerve; less motor block

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46
Q

the axillary block is performed at the level of the _____

A

branches (median, radial, ulnar)

Even though it is called an “axillary” block, it does not target the axillary nerve

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47
Q

the musculocutaneous nerve block covers the _____

A

lateral forearm

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48
Q

Which nerve does the axillary block miss?

A

musculocutaneous nerve

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49
Q

The axillary block anesthetizes which 3 nerves?

A
  1. medial
  2. ulnar
  3. radial
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50
Q

What areas of the body does the axillary block anesthetize?

A

elbow, forearm, and hand

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51
Q

axillary block:

which nerve is the deepest?

A

radial nerve

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52
Q

axillary block:

the median, radial, and ulnar nerves make up the _______ around the axillary artery

A

neurovascular bundle

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53
Q

The musculocutaneous nerve innervates the______ and ______

A

lateral forearm

biceps brachii

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54
Q

Since the axillary block spares the musculocutaneous nerve, it does not anesthetize the ______

A

lateral forearm

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55
Q

What are 2 reasons a supplementary musculocutaneous nerve block should be considered?

A
  1. If the patient needs lateral forearm coverage

2. If the surgeon will be using a tourniquet on the forearm for hand surgery

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56
Q

what is the advantage of the axillary block over the supraclavicular or infraclavicular technique?

A

reduced risk of pneumothorax and phrenic nerve paralysis

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57
Q

What is the major landmark of the axillary block?

A

palpation of the axillary arterial pulse

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58
Q

The landmark of the musculocutaneous nerve is found between the _____muscle and the ______

A

coracobrachialis

biceps brachii

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59
Q

With the transarterial technique for the axillary block, how much local anesthetic is administered?

A

30-40 mL

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60
Q

with the US technique of the axillary block, how much local anesthetic is administered?

A

at least 20 mL

(5-7 mL per nerve)

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61
Q

What are 2 contraindications to the axillary block?

A
  1. axillary lymphadenopathy

2. preexisting neurologic disease of the upper extremity.

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62
Q

Digital block:

The anterior/ventral side of the hand/digits are innervated by what two nerves?

A

median and ulnar nerves

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63
Q

Digital block:

The posterior/dorsal side of the hand/digits are innervated by what two nerves?

A

ulnar and radial nerve

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64
Q

each digit has ____ nerves and each is accompanied by an ______

A

4

artery

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65
Q

The palmar digital nerves are branches of the____ and ____ nerves

A

median and ulnar nerves

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66
Q

The dorsal digital nerves are branches of the_____ and ____ nerves

A

radial and ulnar nerves

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67
Q

All digital blocks carry a risk of ______ if too high a volume of local anesthetic is administered

A

compartment syndrome

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68
Q

How much local anesthetic should be injected for finger blocks and small toe blocks

A

≤ 4mL

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69
Q

hoe much local anesthetic should be injected for great toe blocks?

A

≤ 6mL

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70
Q

When should a digital block be avoided?

A

When there is evidence of compromised circulation

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71
Q

Which drug in the local anesthetic solution should be avoided in digit blocks?

A

epinephrine

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72
Q

Rate the blocks in order of most painful to least painful for digital blocks:

Ring block
Transthecal approach
Subcutaneous volar injection

A
  1. Transthecal approach (most painful)
  2. Ring block
  3. Subcutaneous volar injection (least painful)
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73
Q

The ring block requires ____ injections:

Where is local anesthetic injected?
How much local anesthetic is injected?

A

2

Local is injected above and on both sides of the digit

Use a max volume of 2mL on each side of the finger, for a total max volume of 4mL per finger

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74
Q

the transthecal volar approach requires ____ injections:

Where is the needle inserted?

If there is pressure during injection, you are in the _______, and should simply withdraw the needle until no pressure is felt

how much local anesthetic is injected?

A

one

Needle is inserted at the distal palmar crease

flexor tendon

2-3mL per digit

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75
Q

The subcutaneous volar block requires ______injections

where is the needle inserted?

At what depth is local anesthetic injected?

How much local anesthetic is injected?

A

one

Needle is inserted at the proximal flexion crease of the digit (where the finger meets the palm)

The local is injected at subcutaneous depth

2-3 mL per digit

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76
Q

What 3 nerves does the Fascia Iliaca block anesthetize?

A
  1. femoral
  2. lateral femoral cutaneous
  3. obturator nerves

single injection

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77
Q

what are the 3 landmarks for the fascia iliaca block?

A
  1. Anterior superior iliac spine
  2. Ipsilateral pubic tubercle
  3. Femoral arterial pulse
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78
Q

What 4 areas does the fascia iliaca block?

A
  1. Hip & knee joints
  2. Anterior knee & medial posterior knee
  3. Femur, anterior thigh, and lateral thigh
  4. Medial lower leg and medial foot
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79
Q

Compared with the femoral nerve block, the fascia iliaca block provides better coverage to the______ and _______

A

lateral femoral cutaneous

obturator nerves

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80
Q

fascia iliaca block needle insertion:

  1. Draw a line between the_______and _____
  2. Mark a point on that line ____the distance from the anterior superior iliac spine, and insert the needle 1cm (caudad/cephalad) to that point
  3. Advance the needle until two distinct pops are felt as it perforates the ____ and_____
A
  1. anterior superior iliac spine and ipsilateral pubic tubercle
  2. 1/3, caudal
  3. fascia lata, fascia iliaca
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81
Q

how much local anesthetic is injected for a fascia iliaca block?

A

A total of 30-40mL of local anesthetic should be injected between the fascia iliaca and iliacus muscle

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82
Q

What 3 nerves does the femoral block anesthetize?

A
  1. femoral
  2. lateral femoral cutaneous
  3. obturator nerves

Anesthetizes:

 1. Hip & knee joints
 2. Anterior knee & medial posterior knee
 3. Femur, anterior thigh, and lateral thigh
 4. Medial lower leg, ankle, medial foot

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83
Q

What 2 landmarks are used for the femoral block?

A

navel

inguinal ligament

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84
Q

For the femoral block, always insert the needle (medially/ laterally) to the femoral artery during palpitation

A

laterally

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85
Q

During a femoral nerve block, what two twitches are we looking for?

A

a patellar and quadriceps twitch

If sartorius muscle twitching is observed (lateral to medial diagonal muscle twitch), the needle should be redirected laterally (closer to the femoral nerve) until the patellar twitch is observed

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86
Q

the femoral nerve block commonly uses_____mL of local anesthetic w/ _______

A

15-20 mL

1:200,000 Epi

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87
Q

If a continuous nerve block catheter is used for a femoral nerve block, it should be removed within _____ (due to infection risk)

A

48 hours

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88
Q

Block of the iliohypogastric and ilioinguinal nerves results in anesthesia of what 3 regions? the hypogastric region, the inguinal crease, the upper medial thigh

A
  1. the hypogastric region
  2. the inguinal crease
  3. the upper medial thigh
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89
Q

What types of surgeries is the iliohypogastric and ilioinguinal block used for?

A

The block is indicated for inguinal hernia repair and other inguinal surgeries, including orchiopexy, hydrocele repair, and varicocele repair

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90
Q

Correct injectate placement for the iliohypogastric and ilioinguinal block is between the _______and ________ around the Ilioinguinal & Iliohypogastric nerves

A

transversus abdominis

internal oblique muscle planes

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91
Q

Where is the ultrasound probe placed for the iliohypogastric and ilioinguinal block?

A

over the superior anterior iliac spine

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92
Q

What are the 2 complications of the iliohypogastric and ilioinguinal block

A
  1. transient femoral nerve palsy

2. deep circumflex iliac artery puncture

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93
Q

What areas does an intercostal nerve block anesthetize?

A

areas of the chest wall

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94
Q

What 2 nerves does the intercostal nerve block anesthetize?

A

anterior and lateral cutaneous branches of the intercostal nerve

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95
Q

What are 2 possible indications to use an intercostal block?

A

thoracotomy or mastectomy

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96
Q

What dermatomes should an intercostal block include?

A

2 dermatomes above and below the surgical incision site

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97
Q

Intercostal block needle insertion is very (deep/shallow) (1 cm until you hit bone), and should be inserted in a (cephalad/caudad) position

A

shallow
cephalad

The distance to the pleura is 8mm deep to the rib, so avoid pneumothorax

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98
Q

The intercostal block is commonly performed 6-8 cm (lateral/medial) to the ______(angle of the rib) where rib is easy to palpate and the costal groove is the widest

A

lateral

spinous processes

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99
Q

intercostal block:

behind the rib, what is the order from superior to inferior of the artery, vein, and nerve?

A

vein, artery, nerve

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100
Q

Out of all the peripheral nerve blocks, the intercostal block results in the (highest/lowest) blood level of local anesthetic per volume injected

A

highest

(carries the highest local anesthetic toxicity risk)

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101
Q

What levels do the intercostal nerves expand?

A

T1-T12

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102
Q

The block is more complicated above ____ because the scapula prevents access to the ribs

A

T7

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103
Q

Which block is an alternative approach to the intercostal block for anesthetizing the intercostal nerves?

A

The paravertebral block

It blocks the intercostal nerves within the paravertebral space (wedge shaped spaced on either side of the vertebral column)

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104
Q

in the paravertebral block:

  1. the needle is inserted until it hits the _____
  2. It is then “walked off” the transverse process in a ______ direction and advanced ____

3 .tip of the needle is placed in the _____

A
  1. transverse process
  2. cephalad, 1cm
  3. paravertebral space
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105
Q

The interscalene block targets the brachial plexus at the level of the _____

A

ROOTS

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106
Q

the interscalene block anesthetizes _____, but not _____

A

C5-T1

C8-T1

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107
Q

The interscalene block is a _____ sparing block

A

ulnar

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108
Q

What 3 areas does the interscalene block anesthetize?

A
  1. shoulder
  2. upper arm (lateral 2/3 of clavicle)
  3. lateral arm/hand
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109
Q

What areas does the interscalene block NOT anesthetize?

A
  1. medial arm
  2. hand
  3. elbow
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110
Q

in the interscalene block:

The needle is inserted in the ______ (located between the anterior and middle scalene muscles; just (lateral/medial) to the clavicular head of the sternocleidomastoid) and at the level of the ______ (C6)

A

interscalene groove

lateral

cricoid cartilage

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111
Q

in the interscalene block:

The scalene groove is often palpated just in front or behind the ________

A

external jugular vein

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112
Q

What is the most common complication of the interscalene block?

A

ipsilateral hemidiaphragmatic paresis

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113
Q

What type of patients should an interscalene block be avoided?

A

patients with any degree of pulmonary disease

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114
Q

What are 5 other complications of an interscalene block?

A
  1. . Can cause Horner’s Syndrome, including: miosis, ptosis, and anhidrosis
  2. Possible pneumothorax
  3. Possible hoarseness due to possible blockage of the recurrent laryngeal nerve
  4. Possible accidental epidural or subarachnoid injection
  5. Vertebral artery injection, leading to immediate seizure
    “As little as 1mL of local anesthetic into the vertebral artery may induce a seizure”
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115
Q

What is the advantage of the interscalene block over the supraclavicular block?

A

blocks part of the cervical plexus

The cervical plexus can be easily blocked with a field block along the posterior border of the sternocleidomastoid

116
Q

What kind of block is the IPACK block and where does it anesthetize?

A

a sensory block to the posterior aspect of the knee while

117
Q

What does the IPACK block preserve?

A

PRESERVES MOTOR FUNCTION (does NOT cause a motor block)

118
Q

What other block is the IPACK block typically used in combination with?

A

an adductor canal block for total knee replacement, because both blocks are motor sparing

119
Q

Where is the IPACK block performed?

A

posterior knee joint

120
Q

What 4 nerves does the IPACK block anesthetize?

A
  1. Branches of the superior and medial genicular nerves
  2. Obturator nerve
  3. Common peroneal nerve
  4. Articular branch of the tibial nerve
121
Q

What are the 4 landmarks of the IPACK block?

A
  1. vastus medialis
  2. femoral shaft
  3. popliteal artery
  4. semimembranosus muscle
122
Q

what 2 structures does the IPACK block preserve?

A

tibial and peroneal nerve trunks

123
Q

IPACK Block:

  1. The needle will go through the _____
  2. ____mL local anesthetic will be injected
  3. injection is between the _____ and the _____
A
  1. vastus medialis
  2. 15 mL
  3. popliteal artery and lateral femoral condyle
124
Q

The brachial plexus is formed between the _____ nerve roots

A

C5-T1

125
Q

The brachial plexus covers the shoulder and all of the upper limb except for the _____

A

upper medial arm

-which is covered by T2

126
Q

Proximal to distal, the brachial plexus is divided into:

 branches/terminal nerves
divisions
roots
cords
roots
A

roots, trunks, divisions, cords, and branches/terminal nerves

127
Q

What are the 5 main branches/terminal nerves of the brachial plexus?

A
  1. axillary
  2. radial
  3. ulnar
  4. median
  5. musculocutaneous nerves
128
Q

What are 3 supplemental blocks to the brachial plexus block?

A
  1. the intercostobrachial (T2)
  2. medial cutaneous nerve block
  3. musculocutaneous nerve block
129
Q

The intercostobrachial (T2) nerve block is used if the patient will require surgery involving what area?

A

upper medial arm surgery.

It can also be considered for medial elbow surgery, since it innervates the medial elbow in 1/3 of patients

This block can also be considered to help out with tourniquet pain (in combination with a supraclavicular, infraclavicular, or axillary block) for forearm and hand surgery if a tourniquet will be used, although its effectiveness in alleviating tourniquet pain is questionable

130
Q

The ______ nerve block can provide medial (C8-T1) coverage to the arm when an interscalene block is used (since the interscalene block does not cover the medial portion of the arm (C8-T1))

A

medial cutaneous

131
Q

The______ nerve block can provide coverage to the lateral forearm when an axillary block is used (since the axillary brachial plexus block does not block the musculocutaneous nerve)

A

musculocutaneous

132
Q

Brachial plexus coverage of the shoulder and lateral arm (nerves)

A

C5-C7

133
Q

brachial plexus coverage of medial arm and hand (nerve)

A

C8-T1

134
Q

Brachial plexus coverage of the forearm? (nerves)

A
  1. Medial cutaneous nerve (C8-T1) (medial forearm)
  2. Musculocutaneous nerve (C5-C7) (lateral forearm)
  3. Radial nerve (C5-C6) (Posterior medial forearm)
135
Q

brachial plexus coverage of the elbow? (nerves)

A
  1. Medial cutaneous nerve (C8-T1) (medial anterior elbow)
  2. Musculocutaneous nerve (C5-C7) (lateral anterior elbow)
  3. Radial nerve (C5-C6) (posterior elbow)
136
Q

Brachial plexus coverage of the medial hand (nerves)

A

Ulnar nerve (C8-T1)

137
Q

Brachial plexus coverage of the posterior lateral hand (nerves)

A

Radial nerve (C5-C6)

138
Q

brachial plexus coverage of the Anterior lateral hand and fingertips of first three digits and half of the fourth digit

A

Median nerve (C6-C8)

139
Q

Block options for Shoulder/Proximal Humerus

A

interscalene

140
Q

block options for mid humerus (2)

A

Interscalene or supraclavicular

141
Q

block options for elbow (4)

A

Supraclavicular, infraclavicular, or axillary + musculocutaneous

• May consider a intercostobrachial (T2) block for medial elbow surgery since T2 extends to the elbow joint in 1/3 of patients

142
Q

block options for forearm (4)

A

Supraclavicular, infraclavicular, or axillary+ musculocutaneous

143
Q

block options for wrist (3)

A

Supraclavicular, infraclavicular, or axillary

144
Q

block options for hand (4)

A

Supraclavicular, infraclavicular, axillary, or wrist block

145
Q

block options for fingers (5)

A

Supraclavicular, infraclavicular, axillary, wrist block, or digital block

146
Q

The supraclavicular approach to the brachial plexus block targets the ________ of the brachial plexus

A

trunks and divisions

147
Q

Which artery is used as a landmark in the supraclavicular approach to the brachial plexus block?

A

subclavian artery

148
Q

What dermatomes does the supraclavicular approach block?

A

C8-T1: Entire arm/hand except the upper medial portion (which is covered by T2)

Even though it blocks C5-C7 (which includes the shoulder), it doesn’t cover the whole shoulder because the needle insertion site is too distal

149
Q

What area does the supraclavicular approach NOT block due to a more distal injection?

A

It doesn’t block the shoulder

150
Q

What part of the brachial plexus does the infraclavicular approach target?

A

the CORDS of the brachial plexus

there are three cords: lateral, medial, and posterior

151
Q

Which artery is used as a landmark with the infraclavicular approach to the brachial plexus?

A

Axillary artery

152
Q

what area is covered by the infraclavicular approach to the brachial plexus?

A

same as supraclavicular

It essentially provides the same coverage as the supraclavicular block, but is just a different approach as far as needle location is concerned

153
Q

What part of the brachial plexus does the axillary approach target?

A

the BRANCHES of the brachial plexus

154
Q

What 3 nerves of the brachial plexus does the axillary approach anesthetize?

A
  1. median
  2. radial
  3. ulnar
155
Q

What area does the axillary approach of the brachial plexus anesthetize?

A

hand, medial arm, and most of the elbow

156
Q

Which 2 nerves does the axillary approach spare?

A
  1. axillary

2. musculocutaneous nerve

157
Q

What 2 areas does the axillary approach miss?

A
  1. upper arm (due to axillary sparing) or

2. lateral forearm (due to musculocutaneous sparing)

158
Q

Which nerve blocks have a complication of Ipsilateral phrenic nerve palsy?

A

interscalene (100%)

supraclavicular (50%)

159
Q

Which nerve block is the best for COPD patients?

A

infraclavicular

160
Q

Which blocks have a complication of Recurrent laryngeal nerve palsy & subsequent hoarseness?

A

interscalene

supraclavicular (less common than interscalene)

161
Q

Which blocks have a complication of Horner’s syndrome

(miosis, ptosis, and anhidrosis)?

A

interscalene

supraclavicular (less common than interscalene)

infraclavicular (less common than interscalene)

162
Q

Which block has a complication of Epidural/subarachnoid injection?

A

interscalene block

163
Q

Which block has a complication of pneumothorax?

A

supraclaviular (highest)

infraclavicular

interscalene (more rare)

164
Q

Which blocks have a complication of subclavian artery puncture?

A

supraclavicular

165
Q

Which block has a complication of vertebral artery puncture?

A

interscalene

166
Q

Which blocks have a complication of axillary artery puncture?

A

infraclavicular

axillary

167
Q

Which block spares the musculocutaneous nerve?

A

axillary

168
Q

which block spares the ulnar nerve?

A

interscalene

supraclavicular and infraclavicular are less likely but possible

169
Q

Which block receives upper arm tourniquet pain?

A

interscalene (from T1-T2)

Supraclavicular (from T2)

Infraclavicular (from T2)

Axillary (from T2)

170
Q

Which blocks have a contraindications of respiratory disease/ COPD?

A

interscalene

supraclavicular

171
Q

Which blocks have a contraindication with Contralateral phrenic nerve dysfunction

A

interscalene

supraclavicular

172
Q

which blocks have a contraindication with Ipsilateral central line or pacemaker?

A

infraclavicular

173
Q

What is the motor component of the femoral nerve?

A

quadriceps: leg/knee extension

174
Q

What is the sensory branch of the femoral nerve?

A

saphenous nerve

175
Q

What area of the body does the lateral femoral cutaneous nerve cover?

A
  1. hip joint

2. lateral thigh

176
Q

What 2 blocks anesthetize the lateral femoral cutaneous nerve?

A
  1. femoral nerve block

2. fascial iliaca block

177
Q

What 3 areas of the body does the obturator nerve supply?

A
  1. Hip and knee joints
  2. Posterior knee joint
  3. A portion of the medial thigh (the part not covered by the femoral nerve)
178
Q

Does the femoral nerve block and the fascia iliaca block anesthetize the obturator nerve?

A

NO, NOT reliably blocked with a femoral nerve block or fascia iliaca block

179
Q

What 4 areas of the body does the sciatic nerve block?

A
  1. Hip and knee joints
  2. Posterior thigh
  3. Posterior lateral knee
  4. Everything below the knee except for the medial aspect of the lower leg (which is innervated by the saphenous nerve)
180
Q

What 4 nerves does the sciatic nerve branch into?

A
    1. Deep peroneal
    1. Superficial peroneal
    1. Tibial
    1. Sural
181
Q

The sciatic nerve provides (motor/sensory )innervation to the posterior thigh muscles and lateral muscles distal to the knee

A

motor

182
Q

Femoral, “3 in 1,” and Fascia Iliaca Blocks all reliably block the ______ and ______ nerves; less reliably block the _____ nerve

A

femoral
lateral femoral cutaneous
obturator

183
Q

The transgluteal approach of the sciatic block anesthetizes what 3 areas of the body?

A
  1. Portion of the hip
  2. Posterior knee and thigh
  3. Everything below the knee except the medial portion of the lower leg
184
Q

The popliteal approach of the sciatic block anesthetizes what areas of the body?

A

Everything below the knee except for the medial aspect of the lower leg

185
Q

What block is the same location as the femoral nerve block but uses a larger volume (25-30mL) and distal pressure (2-4cm below the injection site) to encourage the anesthetic to drift cranially and better involve the lateral femoral cutaneous and obturator nerves

A

“3 in 1”

186
Q

this block Is more lateral than the femoral nerve block and also involves a larger volume of local anesthetic (30-40mL)

A

Fascia iliaca

Because of the larger volume, it’s probably not as good of an option as the femoral nerve block to combine it with other blocks (such as the sciatic)

187
Q

This block appears to have better success at anesthetizing the lateral femoral cutaneous AND obturator nerves than the femoral nerve block approach

A

Fascia Iliaca

188
Q

The______ block covers the medial thigh, and can also be used to abolish the obturator reflex during TURBT surgery

A

obturator

189
Q

Complete anesthesia of the lower limb is possible with a _______ nerve block combination

A

femoral/sciatic

190
Q

What are the 2 approaches to the sciatic nerve block?

A
  1. transgluteal approach

2. popliteal approach

191
Q

The ____ approach to the sciatic nerve bock is used for posterior thigh surgery

A

transgluteal (through the gluteal muscle)

192
Q

The ______ approach to the sciatic nerve block is used for lower leg surgery, and covers the entire lower leg and foot except for the medial portion

A

popliteal (behind the knee)

193
Q

The ____ block of the sciatic nerve is the most popular block for ankle surgery, since it covers the majority of the ankle

A

popliteal

194
Q

What 4 block choices can anesthetize the hip area?

A
  1. Fascia Iliaca
  2. 3-in-1,
  3. Femoral;
  4. +/- Sciatic
195
Q

What 3 block choices can anesthetize the anterior thigh?

A
  1. Fascia Iliaca
  2. 3-in-1
  3. Femoral
196
Q

What 4 block choices can anesthetize the knee?

A
  1. Fascia Iliaca
  2. 3-in-1
  3. Femoral;
  4. +/- Sciatic
197
Q

What block choice anesthetizes the tibia?

A

popliteal

198
Q

What 2 block choices anesthetize the ankle?

A
  1. Popliteal;

2. +/- Saphenous

199
Q

What 2 block choices anesthetize the foot?

A
  1. ankle

2. popliteal

200
Q

This block anesthetizes the abdominal region somatically & in part viscerally

A

Quadratus Lumborum

201
Q

What dermatomes does the quadrates lumborum cover?

A

T7-L1

thus provides a broader, longer block compared to TAP block (T10-T12 dermatomes)

202
Q

There are how many approaches to quadratus lumborum block based on need tip placement in relation to the quadratus lumborum?

A

4

203
Q

Which approach to the quadrates lumborum block is the needle tip placed laterally?

A

Type 1 QLB

204
Q

Which approach to the quadrates lumborum block is the needle tip placed posterior?

A

Type 2 QLB

205
Q

Which approach to the quadrates lumborum block is the needle tip placed anterior/ transmuscular?

A

Type 3 QLB

206
Q

Which approach to the quadrates lumborum block is the needle tip placed intramuscular?

A

Type 4 QLB (not common)

207
Q

For QLB 1, 2, & 4, the patient is positioned ______

A

supine

208
Q

For QLB 3, the patient is positioned ____

A

lateral

209
Q

Which QLB are the most common?

A

1 & 2

210
Q

Which QLB provides the most coverage?

A

3

211
Q

For the Quadratus Lumborum block, where is the ultrasound transducer placed?

A

superior to the iliac crest

212
Q

For which block do the landmark represent a shamrock leaf?

A

Quadratus Lumborum

213
Q

Quadratus Lumborum block:

The STEM of the leaf represents the _______

A

transverse process of T4

214
Q

Quadratus Lumborum block:

The _______ makes up the POSTERIOR leaf

A

erector spinae muscle

215
Q

Quadratus Lumborum block:

The ______ makes up the ANTERIOR leaf

A

psoas muscle

216
Q

Quadratus Lumborum:

The ______ represents the LATERAL leaf

A

quadratus lumborum

217
Q

Quadratus Lumborum:

The needle is inserted and local anesthetic is injected adjacent to the quadratus lumborum muscle with the goal of anesthetizing the ______ nerves

A

thoracolumbar

218
Q

Complications of the Quadratus Lumborum block include puncture of what 3 organs?

A

liver, kidney, spleen

219
Q

The rectus sheath block anesthetizes which part of the abdomen and which dermatomes?

A

middle abdomen and dermatomes T7-T12 thoracoabdominal nerves from the xiphoid process to the symphysis pubis

220
Q

What type of surgeries is a rectus sheath block indicated for?

A

any umbilical surgery (umbilical hernia repair) or laparotomy

221
Q

in the rectus sheath block, between what 2 structures is the local anesthetic injected?

A

rectus muscle and posterior rectus sheath

10 mL of local anesthetic is injected on both sides of the umbilicus

222
Q

for the Rectus sheath block, where is the ultrasound probe placed?

A

transverse on the abdomen immediately lateral to umbilicus

223
Q

Because the ______ nerve is the largest spinal nerve in the body, it has the longest onset time and duration of all the peripheral nerve blocks commonly performed by anesthesiologists

A

sciatic

224
Q

Popliteal approach to the sciatic nerve block:

In the popliteal fossa, the sciatic nerve bifurcates into the ____ and _____nerves

A

tibial

common peroneal

225
Q

Posterior popliteal approach (with the patient prone) for the sciatic nerve block:

The needle is inserted between the ____(laterally) and _____ and _____ muscles (medially)

A

biceps femoris

semitendinosus; semimembranosus

226
Q

Lateral approach (with the patient supine) for the sciatic nerve block:

The needle is inserted between the ______ muscle and the _______ muscle

A

biceps femoris

vastus lateralis

227
Q

In either approach for the sciatic nerve block:

local anesthetic is injected near the ______ of the sciatic nerve

A

bifurcation

in between the tibial and common peroneal nerves

228
Q

What advantage does the popliteal approach to the sciatic nerve block have that the transgluteal approach does not offer?

A

knee flexion

229
Q

Which approach to the sciatic nerve block can a continuous catheter infusion be used?

A

popliteal approach

230
Q

For the transgluteal approach to the sciatic nerve block:
The needle is inserted ≈____cm (caudad/cephalad) to the midline point between the greater trochanter and posterior superior iliac spine

A

5

caudad

231
Q

What 3 nerves does the Serratus plane block anesthetize?

A
  1. thoracodorsal
  2. long thoracic
  3. lateral intercostal
232
Q

What surgeries does the serratus plane block provide pain relief for?

A
  1. breast surgery
  2. thoracotomy
  3. rib fractures
233
Q

Where is the ultrasound probe placed for the serratus plane block?

A

The ultrasound probe and needle are placed just superior to the 5th rib (around the level of the nipple) on the mid axillary line

234
Q

Between what 2 structures is the local anesthetic injected for the serratus plane block?

A

Local anesthetic is injected between the latissimus dorsi and serratus muscles (approx. 1-2cm deep)

235
Q

The serratus plane block is a more superficial block, so it carries a lower risk of ______

A

pneumothorax

236
Q

Both PECS blocks provide analgesia for the _______

A

anterior chest wall

237
Q

PECS 1 anesthetizes which 2 nerves?

What muscle do these nerves innervate?

A

medial and lateral pectoral nerves

pectoralis muscles

238
Q

In the PECS 1 block:

Local anesthetic and needle is injected in the fascial plane between the _____ and_____ muscles

A

pectoralis major and minor

239
Q

The Pecs II block (which also includes the Pecs I block) is an extension that involves a second injection lateral to the Pecs I injection point in the plane between the pectoralis minor and _______ muscles with the intention of providing blockade of the _____ nerves

A

serratus anterior

upper intercostal

240
Q

For the PECS II block:

The needle insertion site is between the______ ribs, just medial to where the arm attaches

A

3rd and 4th

• First advance needle all the way between the pectoralis minor and serratus and administer a dose (Pecs I), then pull back between the pectoralis major and minor and administer a second dose (Pecs II)

241
Q

Which 2 blocks are both found to give better and longer lasting analgesia than intercostal blocks for post-thoracotomy pain?

A

Serratus plane and PECS block

242
Q

Between the serratus plane and the PECS block: which one requires 1 injection, and may offer better pain management

A

serratus plane

243
Q

between the serratus plane and the PECS block:

Which one requires 2 injections for full block, and may take more expertise to obtain view with ultrasound

A

PECS block

244
Q

The SPEDI block is indicated for anesthesia and analgesia of the ______

A

entire lower leg

245
Q

The SPEDI block is a combination block that covers the ______ nerve, and the two branches of the______ nerve in the popliteal fossa (tibial and common peroneal nerves)

A

Saphenous

sciatic

246
Q

Which block is a faster version of the traditional popliteal-sciatic/ saphenous combination block?

A

SPEDI block

247
Q

For the SPEDI block, where is the ultrasound probe and needle placed?

How many injections are made?

A

over the proximal thigh, and 2 injections are made at different depths (to cover both the sciatic and saphenous nerves)

248
Q

What are the 2 landmarks that help guide insertion for the SPEDI block?

A

inguinal ligament and the lesser trochanter

249
Q

For the SPEDI block: ___mL of 0.75% Ropivacaine is injected near the sciatic nerve, and____mL near the saphenous nerve.

A

15

5

250
Q

What is the risk associated with the SPEDI block?

A

increased risk of femoral artery puncture

251
Q

Which block has a higher risk of pneumothorax?

supraclavicular infraclavicular

A

supraclavicular (cautioned in outpatient surgery)

252
Q

Which block has a higher risk of phrenic nerve palsy?

supraclavicular or infraclavicular

A

supraclavicular

253
Q

Which block has a better use with an indwelling catheter?

supraclaviuclar or infraclavicular

A

infraclavicular (because of the stabilization from the pectoralis muscles)

254
Q

Why is the supraclavicular block difficult in obese patients?

A

due to the presence of supraclavicular fat pads

255
Q

Why is the infraclavicular block difficult in obese patients?

A

because the brachial plexus is deeper with the infraclavicular approach

256
Q

Which block is acceptable for use in COPD patients?

supraclavicular or infraclavicular

A

infraclavicular

257
Q

Which block has a faster onset?

supraclavicular or infraclavicular

A

infraclavicular

258
Q

Which block has better visualization?

supraclavicular or infraclavicular

A

supraclavicular (more superficial)

infraclavicular is worse (deeper), but decreased risk of complications with ultrasound

259
Q

Which block has a higher incidence of hematoma with accidental vascular puncture?
supraclavicular or infraclavicular

A

infraclavicular (due to difficulty of applying pressure)

260
Q

What area and dermatomes does the TAP block anesthetize?

A

sub-umbilical abdomen; T10-L1

261
Q

What surgeries is the TAP block indicated for?

A

LOWER abdominal surgeries

appendectomy, hernia repair, caesarean section, abdominal hysterectomy, prostatectomy, etc

262
Q

TAP blockade is limited to (visceral/somatic) anesthesia & provides no (visceral/somatic) anesthesia

A

somatic
visceral

  • Somatic pain comes from the skin, muscles, and soft tissues
  • Visceral pain comes from internal organs
263
Q

Is the TAP block bilateral or unilateral?

A

usually performed on both sides (and bilateral blocks are required for midline incisions).

264
Q

If doing a bilateral TAP block, how should it be dosed?

A

It’s a fairly large volume block (10-20mL per side)

If completing a bilateral block, take into account the total amount of local anesthetic injected (decrease the dose per side)

265
Q

When performing a blind TAP block, what landmark should be identified for needle entry/ injection site?

A

Triangle of Petit

266
Q

What 3 structures does the Triangle of Petit include?

A

iliac crest, external oblique, and latissimus dorsi

267
Q

For the TAP block:

The needle should advance through the external and internal oblique muscles, and local anesthetic should be injected between the____ and ______muscles

A

internal oblique

transverse abdominus

268
Q

The two pops that are felt in the TAP block are the needle passing through what two muscle layers?

A

external oblique and internal oblique

269
Q

What are the 4 approaches to the TAP block?

A
  1. Subcostal
  2. Lateral
  3. Posterior
  4. Oblique Subcostal
270
Q

What 2 of the 4 approaches to the TAP block are the most common?

A

subcostal and lateral

271
Q

What are 2 potential complications of the TAP block?

A

visceral organ damage and intraperitoneal injection if the needle is inserted too far

272
Q

What 2 areas does the wrist block provide analgesia for?

A

entire hand and digits

273
Q

What are the 2 nerves anesthetized in a wrist block?

A
  1. radial
  2. ulnar
  3. median
274
Q

wrist block:

this nerve lies between the Flexor Carpi Radialis and the Flexor Palmaris Longus

A

median nerve

275
Q

wrist block:

this nerve lies medially and deep to the Flexor Carpi Ulnaris tendon
It’s branches are both palmar and dorsal.

A

ulnar nerve

276
Q

wrist block:

this nerve is between the ulnar artery and flexor carpi ulnaris (which is just superficial to the ulnar nerve)

A

radial nerve

It is anesthetized proximal to the radial styloid in both medial and lateral directions.

277
Q

wrist block:

The ______ side of the hand/digits are innervated by the median and ulnar nerves

A

anterior/ventral

278
Q

wrist block:

The ______ side of the hand/digits are innervated by the ulnar and radial nerve

A

posterior/dorsal

279
Q

wrist block:

____mL’s of local anesthetic are injected at each site

A

5

280
Q

what drug should not be used in a wrist block?

A

epinephrine

281
Q

brachial plexus block VS wrist block:

The ____ block only anesthetizes the hand, while the ______ blocks anesthetize most of the upper limb (wrist blocks preserve upper limb mobility)

A

wrist

brachial plexus

282
Q

brachial plexus block VS wrist block:

The ____ block is primarily a sensory block and thus better preserves motor function

A

wrist

283
Q

brachial plexus block VS wrist block:

Because of the superficial location of the nerves, the _____ block is a relatively easy block to perform

A

wrist

284
Q

brachial plexus block VS wrist block:

_____ blocks don’t block sensation in the area of the tourniquet, so they are worse for surgeries that will utilize a tourniquet

A

wrist

285
Q

brachial plexus block VS wrist block:

A ____ block requires more needle sticks

A

wrist

Anatomy II (1 decks)

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