Nerve Block Exam Prep Flashcards
1
Q
The adductor canal block is a modified______ nerve block that is performed more distally
A
femoral
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
3
Q
What 3 nerves does the adductor canal not block?
A
- femoral nerve
- lateral femoral cutaneous
- obturator nerves
4
Q
What is the advantage of the adductor canal block?
A
preserves ALL motor function
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)
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)
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
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
9
Q
In the adductor canal block, which 5 structures are used for anatomical landmarks?
A
- Sartorious
- adductor longus
- vastus medialis
- femoral artery
- femoral vein
10
Q
Between which two structures is the adductor canal nerve most likely to be found?
A
Sartorious and Vastus medialis muscles
11
Q
With the aid of US, the Saphenous Nerve presents as a hyperechoic structure anterolateral to the _____ Artery,
A
femoral
12
Q
in the adductor canal block, local anesthetic is injected lateral to the____artery
A
femoral
13
Q
What is the typical dose of local anesthetic for the adductor canal block?
A
10-15 mL
14
Q
What 3 blocks are used for the airway?
A
Transtracheal
Superior Laryngeal
Glossopharyngeal
15
Q
What nerve does the Transtracheal block?
A
recurrent laryngeal nerve
16
Q
The transtracheal block is used for anesthesia for the ______
A
larynx and trachea BELOW the cords
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
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
19
Q
What is a complication of the transtracheal block?
A
posterior laryngeal wall puncture if the needle is advanced too far
20
Q
The superior laryngeal nerve block is used for anesthesia ________
A
for the larynx ABOVE the cords (glottis closure reflex)
21
Q
What is the local anesthetic dose for the superior laryngeal nerve block?
A
2mL of 2% Lidocaine through a 25ga needle
22
Q
What are 4 complications of the superior laryngeal nerve block?
A
sore throat
cough
hoarseness
injection into the nearby superior laryngeal artery
23
Q
What is the glossopharyngeal block most useful for?
A
blocking the gag reflex/oropharynx
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
25
What are 3 complications of the glossopharyngeal nerve block?
dysphagia
loss of taste
throat hoarseness
26
What 5 different nerves does the ankle block anesthetize?
1. deep peroneal
2. superficial peroneal
3. saphenous
4. posterior tibial
5. sural nerves
27
Ankle block:
What 4 nerves are branches of the sciatic nerve?
Deep and superficial peroneal, tibial and sural
28
Ankle block:
What nerve is a branch of the femoral nerve?
Saphenous
29
The ankle block requires ___ deep injections of which nerves?
and ____ superficial injections of which nerves?
2 deep: deep peroneal, posterior tibial
| 3 superficial: superficial peroneal, saphenous, sural
think everything begins with "S" for superficial
30
The ankle block is effective for anesthetizing the ____ but not effective for anesthetizing the ____
foot
| ankle
31
What are the 4 major landmarks of the ankle block?
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)
32
What are 3 contraindications to the ankle block?
1. infection
2. compromised circulation to the foot
3. the use of epinephrine in the local anesthetic
33
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
15-20mL
3-5 mL
5mL for deep peroneal nerve
5mL for posterior tibial nerve
3-5mL for saphenous, superficial peroneal, and sural nerves
34
Ankle Block:
Which nerve anesthetizes the space between the first 2 toes?
Deep peroneal nerve
35
ankle block:
Which nerve anesthetizes the Dorsum of the foot and toes (except between the first two toes)
Superficial peroneal nerve
36
Ankle block:
Which nerve anesthetizes the Medial ankle and foot, medial sole?
saphenous nerve
37
Ankle block:
Which nerve anesthetizes the Lateral portion of the foot and heel, lateral/posterior sole?
Sural nerve
38
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
posterior tibial nerve
39
The anterior suprascapular is an alternative to what block?
interscalene block
40
The anterior suprascapular block anesthetizes the _____ while minimizing anesthetization of the ____
shoulder
| phrenic nerve
41
the anterior suprascapular block is an excellent choice for patients with ______
pulmonary dysfunction
research is variable about the efficacy of the anterior suprascapular block analgesia throughout the entire intraoperative period
42
The suprascapular nerve is a branch of ______
brachial plexus nerves C5 and C6
43
The suprascapular nerve can be located on ultrasound in the ______fossa, deep to the _____ muscle and lateral to the _____ and _____
supraclavicular
omohyoid
plexus
subclavian artery
44
Which nerves does the suprascapular block anesthetize?
nerves C5-C6
45
Which nerve is spared in the suprascapular block?
axillary nerve; less motor block
46
the axillary block is performed at the level of the _____
branches (median, radial, ulnar)
Even though it is called an “axillary” block, it does not target the axillary nerve
47
the musculocutaneous nerve block covers the _____
lateral forearm
48
Which nerve does the axillary block miss?
musculocutaneous nerve
49
The axillary block anesthetizes which 3 nerves?
1. medial
2. ulnar
3. radial
50
What areas of the body does the axillary block anesthetize?
elbow, forearm, and hand
51
axillary block:
which nerve is the deepest?
radial nerve
52
axillary block:
the median, radial, and ulnar nerves make up the _______ around the axillary artery
neurovascular bundle
53
The musculocutaneous nerve innervates the______ and ______
lateral forearm
biceps brachii
54
Since the axillary block spares the musculocutaneous nerve, it does not anesthetize the ______
lateral forearm
55
What are 2 reasons a supplementary musculocutaneous nerve block should be considered?
1. If the patient needs lateral forearm coverage
| 2. If the surgeon will be using a tourniquet on the forearm for hand surgery
56
what is the advantage of the axillary block over the supraclavicular or infraclavicular technique?
reduced risk of pneumothorax and phrenic nerve paralysis
57
What is the major landmark of the axillary block?
palpation of the axillary arterial pulse
58
The landmark of the musculocutaneous nerve is found between the _____muscle and the ______
coracobrachialis
biceps brachii
59
With the transarterial technique for the axillary block, how much local anesthetic is administered?
30-40 mL
60
with the US technique of the axillary block, how much local anesthetic is administered?
at least 20 mL
| (5-7 mL per nerve)
61
What are 2 contraindications to the axillary block?
1. axillary lymphadenopathy
| 2. preexisting neurologic disease of the upper extremity.
62
Digital block:
The anterior/ventral side of the hand/digits are innervated by what two nerves?
median and ulnar nerves
63
Digital block:
The posterior/dorsal side of the hand/digits are innervated by what two nerves?
ulnar and radial nerve
64
each digit has ____ nerves and each is accompanied by an ______
4
| artery
65
The palmar digital nerves are branches of the____ and ____ nerves
median and ulnar nerves
66
The dorsal digital nerves are branches of the_____ and ____ nerves
radial and ulnar nerves
67
All digital blocks carry a risk of ______ if too high a volume of local anesthetic is administered
compartment syndrome
68
How much local anesthetic should be injected for finger blocks and small toe blocks
≤ 4mL
69
hoe much local anesthetic should be injected for great toe blocks?
≤ 6mL
70
When should a digital block be avoided?
When there is evidence of compromised circulation
71
Which drug in the local anesthetic solution should be avoided in digit blocks?
epinephrine
72
Rate the blocks in order of most painful to least painful for digital blocks:
Ring block
Transthecal approach
Subcutaneous volar injection
1. Transthecal approach (most painful)
2. Ring block
3. Subcutaneous volar injection (least painful)
73
The ring block requires ____ injections:
Where is local anesthetic injected?
How much local anesthetic is injected?
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
74
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?
one
Needle is inserted at the distal palmar crease
flexor tendon
2-3mL per digit
75
The subcutaneous volar block requires ______injections
where is the needle inserted?
At what depth is local anesthetic injected?
How much local anesthetic is injected?
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
76
What 3 nerves does the Fascia Iliaca block anesthetize?
1. femoral
2. lateral femoral cutaneous
3. obturator nerves
single injection
77
what are the 3 landmarks for the fascia iliaca block?
1. Anterior superior iliac spine
2. Ipsilateral pubic tubercle
3. Femoral arterial pulse
78
What 4 areas does the fascia iliaca block?
1. Hip & knee joints
2. Anterior knee & medial posterior knee
3. Femur, anterior thigh, and lateral thigh
4. Medial lower leg and medial foot
79
Compared with the femoral nerve block, the fascia iliaca block provides better coverage to the______ and _______
lateral femoral cutaneous
| obturator nerves
80
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_____
1. anterior superior iliac spine and ipsilateral pubic tubercle
2. 1/3, caudal
3. fascia lata, fascia iliaca
81
how much local anesthetic is injected for a fascia iliaca block?
A total of 30-40mL of local anesthetic should be injected between the fascia iliaca and iliacus muscle
82
What 3 nerves does the femoral block anesthetize?
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
83
What 2 landmarks are used for the femoral block?
navel
| inguinal ligament
84
For the femoral block, always insert the needle (medially/ laterally) to the femoral artery during palpitation
laterally
85
During a femoral nerve block, what two twitches are we looking for?
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
86
the femoral nerve block commonly uses_____mL of local anesthetic w/ _______
15-20 mL
| 1:200,000 Epi
87
If a continuous nerve block catheter is used for a femoral nerve block, it should be removed within _____ (due to infection risk)
48 hours
88
Block of the iliohypogastric and ilioinguinal nerves results in anesthesia of what 3 regions? the hypogastric region, the inguinal crease, the upper medial thigh
1. the hypogastric region
2. the inguinal crease
3. the upper medial thigh
89
What types of surgeries is the iliohypogastric and ilioinguinal block used for?
The block is indicated for inguinal hernia repair and other inguinal surgeries, including orchiopexy, hydrocele repair, and varicocele repair
90
Correct injectate placement for the iliohypogastric and ilioinguinal block is between the _______and ________ around the Ilioinguinal & Iliohypogastric nerves
transversus abdominis
| internal oblique muscle planes
91
Where is the ultrasound probe placed for the iliohypogastric and ilioinguinal block?
over the superior anterior iliac spine
92
What are the 2 complications of the iliohypogastric and ilioinguinal block
1. transient femoral nerve palsy
| 2. deep circumflex iliac artery puncture
93
What areas does an intercostal nerve block anesthetize?
areas of the chest wall
94
What 2 nerves does the intercostal nerve block anesthetize?
anterior and lateral cutaneous branches of the intercostal nerve
95
What are 2 possible indications to use an intercostal block?
thoracotomy or mastectomy
96
What dermatomes should an intercostal block include?
2 dermatomes above and below the surgical incision site
97
Intercostal block needle insertion is very (deep/shallow) (1 cm until you hit bone), and should be inserted in a (cephalad/caudad) position
shallow
cephalad
The distance to the pleura is 8mm deep to the rib, so avoid pneumothorax
98
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
lateral
| spinous processes
99
intercostal block:
behind the rib, what is the order from superior to inferior of the artery, vein, and nerve?
vein, artery, nerve
100
Out of all the peripheral nerve blocks, the intercostal block results in the (highest/lowest) blood level of local anesthetic per volume injected
highest
| (carries the highest local anesthetic toxicity risk)
101
What levels do the intercostal nerves expand?
T1-T12
102
The block is more complicated above ____ because the scapula prevents access to the ribs
T7
103
Which block is an alternative approach to the intercostal block for anesthetizing the intercostal nerves?
The paravertebral block
It blocks the intercostal nerves within the paravertebral space (wedge shaped spaced on either side of the vertebral column)
104
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 _____
1. transverse process
2. cephalad, 1cm
3. paravertebral space
105
The interscalene block targets the brachial plexus at the level of the _____
ROOTS
106
the interscalene block anesthetizes _____, but not _____
C5-T1
C8-T1
107
The interscalene block is a _____ sparing block
ulnar
108
What 3 areas does the interscalene block anesthetize?
1. shoulder
2. upper arm (lateral 2/3 of clavicle)
3. lateral arm/hand
109
What areas does the interscalene block NOT anesthetize?
1. medial arm
2. hand
3. elbow
110
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)
interscalene groove
lateral
cricoid cartilage
111
in the interscalene block:
The scalene groove is often palpated just in front or behind the ________
external jugular vein
112
What is the most common complication of the interscalene block?
ipsilateral hemidiaphragmatic paresis
113
What type of patients should an interscalene block be avoided?
patients with any degree of pulmonary disease
114
What are 5 other complications of an interscalene block?
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"
115
What is the advantage of the interscalene block over the supraclavicular block?
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
What kind of block is the IPACK block and where does it anesthetize?
a sensory block to the posterior aspect of the knee while
117
What does the IPACK block preserve?
PRESERVES MOTOR FUNCTION (does NOT cause a motor block)
118
What other block is the IPACK block typically used in combination with?
an adductor canal block for total knee replacement, because both blocks are motor sparing
119
Where is the IPACK block performed?
posterior knee joint
120
What 4 nerves does the IPACK block anesthetize?
1. Branches of the superior and medial genicular nerves
2. Obturator nerve
3. Common peroneal nerve
4. Articular branch of the tibial nerve
121
What are the 4 landmarks of the IPACK block?
1. vastus medialis
2. femoral shaft
3. popliteal artery
4. semimembranosus muscle
122
what 2 structures does the IPACK block preserve?
tibial and peroneal nerve trunks
123
IPACK Block:
1. The needle will go through the _____
2. ____mL local anesthetic will be injected
3. injection is between the _____ and the _____
1. vastus medialis
2. 15 mL
3. popliteal artery and lateral femoral condyle
124
The brachial plexus is formed between the _____ nerve roots
C5-T1
125
The brachial plexus covers the shoulder and all of the upper limb except for the _____
upper medial arm
| -which is covered by T2
126
Proximal to distal, the brachial plexus is divided into:
```
branches/terminal nerves
divisions
roots
cords
roots
```
roots, trunks, divisions, cords, and branches/terminal nerves
127
What are the 5 main branches/terminal nerves of the brachial plexus?
1. axillary
2. radial
3. ulnar
4. median
5. musculocutaneous nerves
128
What are 3 supplemental blocks to the brachial plexus block?
1. the intercostobrachial (T2)
2. medial cutaneous nerve block
3. musculocutaneous nerve block
129
The intercostobrachial (T2) nerve block is used if the patient will require surgery involving what area?
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
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))
medial cutaneous
131
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)
musculocutaneous
132
Brachial plexus coverage of the shoulder and lateral arm (nerves)
C5-C7
133
brachial plexus coverage of medial arm and hand (nerve)
C8-T1
134
Brachial plexus coverage of the forearm? (nerves)
1. Medial cutaneous nerve (C8-T1) (medial forearm)
2. Musculocutaneous nerve (C5-C7) (lateral forearm)
3. Radial nerve (C5-C6) (Posterior medial forearm)
135
brachial plexus coverage of the elbow? (nerves)
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
Brachial plexus coverage of the medial hand (nerves)
Ulnar nerve (C8-T1)
137
Brachial plexus coverage of the posterior lateral hand (nerves)
Radial nerve (C5-C6)
138
brachial plexus coverage of the Anterior lateral hand and fingertips of first three digits and half of the fourth digit
Median nerve (C6-C8)
139
Block options for Shoulder/Proximal Humerus
interscalene
140
block options for mid humerus (2)
Interscalene or supraclavicular
141
block options for elbow (4)
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
block options for forearm (4)
Supraclavicular, infraclavicular, or axillary+ musculocutaneous
143
block options for wrist (3)
Supraclavicular, infraclavicular, or axillary
144
block options for hand (4)
Supraclavicular, infraclavicular, axillary, or wrist block
145
block options for fingers (5)
Supraclavicular, infraclavicular, axillary, wrist block, or digital block
146
The supraclavicular approach to the brachial plexus block targets the ________ of the brachial plexus
trunks and divisions
147
Which artery is used as a landmark in the supraclavicular approach to the brachial plexus block?
subclavian artery
148
What dermatomes does the supraclavicular approach block?
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
What area does the supraclavicular approach NOT block due to a more distal injection?
It doesn’t block the shoulder
150
What part of the brachial plexus does the infraclavicular approach target?
the CORDS of the brachial plexus
| there are three cords: lateral, medial, and posterior
151
Which artery is used as a landmark with the infraclavicular approach to the brachial plexus?
Axillary artery
152
what area is covered by the infraclavicular approach to the brachial plexus?
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
What part of the brachial plexus does the axillary approach target?
the BRANCHES of the brachial plexus
154
What 3 nerves of the brachial plexus does the axillary approach anesthetize?
1. median
2. radial
3. ulnar
155
What area does the axillary approach of the brachial plexus anesthetize?
hand, medial arm, and most of the elbow
156
Which 2 nerves does the axillary approach spare?
1. axillary
| 2. musculocutaneous nerve
157
What 2 areas does the axillary approach miss?
1. upper arm (due to axillary sparing) or
| 2. lateral forearm (due to musculocutaneous sparing)
158
Which nerve blocks have a complication of Ipsilateral phrenic nerve palsy?
interscalene (100%)
supraclavicular (50%)
159
Which nerve block is the best for COPD patients?
infraclavicular
160
Which blocks have a complication of Recurrent laryngeal nerve palsy & subsequent hoarseness?
interscalene
supraclavicular (less common than interscalene)
161
Which blocks have a complication of Horner’s syndrome
| (miosis, ptosis, and anhidrosis)?
interscalene
supraclavicular (less common than interscalene)
infraclavicular (less common than interscalene)
162
Which block has a complication of Epidural/subarachnoid injection?
interscalene block
163
Which block has a complication of pneumothorax?
supraclaviular (highest)
infraclavicular
interscalene (more rare)
164
Which blocks have a complication of subclavian artery puncture?
supraclavicular
165
Which block has a complication of vertebral artery puncture?
interscalene
166
Which blocks have a complication of axillary artery puncture?
infraclavicular
axillary
167
Which block spares the musculocutaneous nerve?
axillary
168
which block spares the ulnar nerve?
interscalene
supraclavicular and infraclavicular are less likely but possible
169
Which block receives upper arm tourniquet pain?
interscalene (from T1-T2)
Supraclavicular (from T2)
Infraclavicular (from T2)
Axillary (from T2)
170
Which blocks have a contraindications of respiratory disease/ COPD?
interscalene
supraclavicular
171
Which blocks have a contraindication with Contralateral phrenic nerve dysfunction
interscalene
supraclavicular
172
which blocks have a contraindication with Ipsilateral central line or pacemaker?
infraclavicular
173
What is the motor component of the femoral nerve?
quadriceps: leg/knee extension
174
What is the sensory branch of the femoral nerve?
saphenous nerve
175
What area of the body does the lateral femoral cutaneous nerve cover?
1. hip joint
| 2. lateral thigh
176
What 2 blocks anesthetize the lateral femoral cutaneous nerve?
1. femoral nerve block
| 2. fascial iliaca block
177
What 3 areas of the body does the obturator nerve supply?
1. Hip and knee joints
2. Posterior knee joint
2. A portion of the medial thigh (the part not covered by the femoral nerve)
178
Does the femoral nerve block and the fascia iliaca block anesthetize the obturator nerve?
NO, NOT reliably blocked with a femoral nerve block or fascia iliaca block
179
What 4 areas of the body does the sciatic nerve block?
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
What 4 nerves does the sciatic nerve branch into?
* 1. Deep peroneal
* 2. Superficial peroneal
* 3. Tibial
* 4. Sural
181
The sciatic nerve provides (motor/sensory )innervation to the posterior thigh muscles and lateral muscles distal to the knee
motor
182
Femoral, “3 in 1,” and Fascia Iliaca Blocks all reliably block the ______ and ______ nerves; less reliably block the _____ nerve
femoral
lateral femoral cutaneous
obturator
183
The transgluteal approach of the sciatic block anesthetizes what 3 areas of the body?
1. Portion of the hip
2. Posterior knee and thigh
3. Everything below the knee except the medial portion of the lower leg
184
The popliteal approach of the sciatic block anesthetizes what areas of the body?
Everything below the knee except for the medial aspect of the lower leg
185
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
“3 in 1”
186
this block Is more lateral than the femoral nerve block and also involves a larger volume of local anesthetic (30-40mL)
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
This block appears to have better success at anesthetizing the lateral femoral cutaneous AND obturator nerves than the femoral nerve block approach
Fascia Iliaca
188
The______ block covers the medial thigh, and can also be used to abolish the obturator reflex during TURBT surgery
obturator
189
Complete anesthesia of the lower limb is possible with a _______ nerve block combination
femoral/sciatic
190
What are the 2 approaches to the sciatic nerve block?
1. transgluteal approach
| 2. popliteal approach
191
The ____ approach to the sciatic nerve bock is used for posterior thigh surgery
transgluteal (through the gluteal muscle)
192
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
popliteal (behind the knee)
193
The ____ block of the sciatic nerve is the most popular block for ankle surgery, since it covers the majority of the ankle
popliteal
194
What 4 block choices can anesthetize the hip area?
1. Fascia Iliaca
2. 3-in-1,
3. Femoral;
4. +/- Sciatic
195
What 3 block choices can anesthetize the anterior thigh?
1. Fascia Iliaca
2. 3-in-1
3. Femoral
196
What 4 block choices can anesthetize the knee?
1. Fascia Iliaca
2. 3-in-1
3. Femoral;
4. +/- Sciatic
197
What block choice anesthetizes the tibia?
popliteal
198
What 2 block choices anesthetize the ankle?
1. Popliteal;
| 2. +/- Saphenous
199
What 2 block choices anesthetize the foot?
1. ankle
| 2. popliteal
200
This block anesthetizes the abdominal region somatically & in part viscerally
Quadratus Lumborum
201
What dermatomes does the quadrates lumborum cover?
T7-L1
thus provides a broader, longer block compared to TAP block (T10-T12 dermatomes)
202
There are how many approaches to quadratus lumborum block based on need tip placement in relation to the quadratus lumborum?
4
203
Which approach to the quadrates lumborum block is the needle tip placed laterally?
Type 1 QLB
204
Which approach to the quadrates lumborum block is the needle tip placed posterior?
Type 2 QLB
205
Which approach to the quadrates lumborum block is the needle tip placed anterior/ transmuscular?
Type 3 QLB
206
Which approach to the quadrates lumborum block is the needle tip placed intramuscular?
Type 4 QLB (not common)
207
For QLB 1, 2, & 4, the patient is positioned ______
supine
208
For QLB 3, the patient is positioned ____
lateral
209
Which QLB are the most common?
1 & 2
210
Which QLB provides the most coverage?
3
211
For the Quadratus Lumborum block, where is the ultrasound transducer placed?
superior to the iliac crest
212
For which block do the landmark represent a shamrock leaf?
Quadratus Lumborum
213
Quadratus Lumborum block:
The STEM of the leaf represents the _______
transverse process of T4
214
Quadratus Lumborum block:
The _______ makes up the POSTERIOR leaf
erector spinae muscle
215
Quadratus Lumborum block:
The ______ makes up the ANTERIOR leaf
psoas muscle
216
Quadratus Lumborum:
The ______ represents the LATERAL leaf
quadratus lumborum
217
Quadratus Lumborum:
The needle is inserted and local anesthetic is injected adjacent to the quadratus lumborum muscle with the goal of anesthetizing the ______ nerves
thoracolumbar
218
Complications of the Quadratus Lumborum block include puncture of what 3 organs?
liver, kidney, spleen
219
The rectus sheath block anesthetizes which part of the abdomen and which dermatomes?
middle abdomen and dermatomes T7-T12 thoracoabdominal nerves from the xiphoid process to the symphysis pubis
220
What type of surgeries is a rectus sheath block indicated for?
any umbilical surgery (umbilical hernia repair) or laparotomy
221
in the rectus sheath block, between what 2 structures is the local anesthetic injected?
rectus muscle and posterior rectus sheath
10 mL of local anesthetic is injected on both sides of the umbilicus
222
for the Rectus sheath block, where is the ultrasound probe placed?
transverse on the abdomen immediately lateral to umbilicus
223
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
sciatic
224
Popliteal approach to the sciatic nerve block:
In the popliteal fossa, the sciatic nerve bifurcates into the ____ and _____nerves
tibial
| common peroneal
225
Posterior popliteal approach (with the patient prone) for the sciatic nerve block:
The needle is inserted between the ____(laterally) and _____ and _____ muscles (medially)
biceps femoris
| semitendinosus; semimembranosus
226
Lateral approach (with the patient supine) for the sciatic nerve block:
The needle is inserted between the ______ muscle and the _______ muscle
biceps femoris
| vastus lateralis
227
In either approach for the sciatic nerve block:
| local anesthetic is injected near the ______ of the sciatic nerve
bifurcation
in between the tibial and common peroneal nerves
228
What advantage does the popliteal approach to the sciatic nerve block have that the transgluteal approach does not offer?
knee flexion
229
Which approach to the sciatic nerve block can a continuous catheter infusion be used?
popliteal approach
230
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
5
| caudad
231
What 3 nerves does the Serratus plane block anesthetize?
1. thoracodorsal
2. long thoracic
3. lateral intercostal
232
What surgeries does the serratus plane block provide pain relief for?
1. breast surgery
2. thoracotomy
3. rib fractures
233
Where is the ultrasound probe placed for the serratus plane block?
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
Between what 2 structures is the local anesthetic injected for the serratus plane block?
Local anesthetic is injected between the latissimus dorsi and serratus muscles (approx. 1-2cm deep)
235
The serratus plane block is a more superficial block, so it carries a lower risk of ______
pneumothorax
236
Both PECS blocks provide analgesia for the _______
anterior chest wall
237
PECS 1 anesthetizes which 2 nerves?
| What muscle do these nerves innervate?
medial and lateral pectoral nerves
| pectoralis muscles
238
In the PECS 1 block:
| Local anesthetic and needle is injected in the fascial plane between the _____ and_____ muscles
pectoralis major and minor
239
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
serratus anterior
| upper intercostal
240
For the PECS II block:
| The needle insertion site is between the______ ribs, just medial to where the arm attaches
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
Which 2 blocks are both found to give better and longer lasting analgesia than intercostal blocks for post-thoracotomy pain?
Serratus plane and PECS block
242
Between the serratus plane and the PECS block: which one requires 1 injection, and may offer better pain management
serratus plane
243
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
PECS block
244
The SPEDI block is indicated for anesthesia and analgesia of the ______
entire lower leg
245
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)
Saphenous
| sciatic
246
Which block is a faster version of the traditional popliteal-sciatic/ saphenous combination block?
SPEDI block
247
For the SPEDI block, where is the ultrasound probe and needle placed?
How many injections are made?
over the proximal thigh, and 2 injections are made at different depths (to cover both the sciatic and saphenous nerves)
248
What are the 2 landmarks that help guide insertion for the SPEDI block?
inguinal ligament and the lesser trochanter
249
For the SPEDI block: ___mL of 0.75% Ropivacaine is injected near the sciatic nerve, and____mL near the saphenous nerve.
15
| 5
250
What is the risk associated with the SPEDI block?
increased risk of femoral artery puncture
251
Which block has a higher risk of pneumothorax?
| supraclavicular infraclavicular
supraclavicular (cautioned in outpatient surgery)
252
Which block has a higher risk of phrenic nerve palsy?
| supraclavicular or infraclavicular
supraclavicular
253
Which block has a better use with an indwelling catheter?
| supraclaviuclar or infraclavicular
infraclavicular (because of the stabilization from the pectoralis muscles)
254
Why is the supraclavicular block difficult in obese patients?
due to the presence of supraclavicular fat pads
255
Why is the infraclavicular block difficult in obese patients?
because the brachial plexus is deeper with the infraclavicular approach
256
Which block is acceptable for use in COPD patients?
| supraclavicular or infraclavicular
infraclavicular
257
Which block has a faster onset?
| supraclavicular or infraclavicular
infraclavicular
258
Which block has better visualization?
| supraclavicular or infraclavicular
supraclavicular (more superficial)
infraclavicular is worse (deeper), but decreased risk of complications with ultrasound
259
Which block has a higher incidence of hematoma with accidental vascular puncture?
supraclavicular or infraclavicular
infraclavicular (due to difficulty of applying pressure)
260
What area and dermatomes does the TAP block anesthetize?
sub-umbilical abdomen; T10-L1
261
What surgeries is the TAP block indicated for?
LOWER abdominal surgeries
| appendectomy, hernia repair, caesarean section, abdominal hysterectomy, prostatectomy, etc
262
TAP blockade is limited to (visceral/somatic) anesthesia & provides no (visceral/somatic) anesthesia
somatic
visceral
* Somatic pain comes from the skin, muscles, and soft tissues
* Visceral pain comes from internal organs
263
Is the TAP block bilateral or unilateral?
usually performed on both sides (and bilateral blocks are required for midline incisions).
264
If doing a bilateral TAP block, how should it be dosed?
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
When performing a blind TAP block, what landmark should be identified for needle entry/ injection site?
Triangle of Petit
266
What 3 structures does the Triangle of Petit include?
iliac crest, external oblique, and latissimus dorsi
267
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
internal oblique
transverse abdominus
268
The two pops that are felt in the TAP block are the needle passing through what two muscle layers?
external oblique and internal oblique
269
What are the 4 approaches to the TAP block?
1. Subcostal
2. Lateral
3. Posterior
4. Oblique Subcostal
270
What 2 of the 4 approaches to the TAP block are the most common?
subcostal and lateral
271
What are 2 potential complications of the TAP block?
visceral organ damage and intraperitoneal injection if the needle is inserted too far
272
What 2 areas does the wrist block provide analgesia for?
entire hand and digits
273
What are the 2 nerves anesthetized in a wrist block?
1. radial
2. ulnar
3. median
274
wrist block:
this nerve lies between the Flexor Carpi Radialis and the Flexor Palmaris Longus
median nerve
275
wrist block:
this nerve lies medially and deep to the Flexor Carpi Ulnaris tendon
It’s branches are both palmar and dorsal.
ulnar nerve
276
wrist block:
this nerve is between the ulnar artery and flexor carpi ulnaris (which is just superficial to the ulnar nerve)
radial nerve
It is anesthetized proximal to the radial styloid in both medial and lateral directions.
277
wrist block:
The ______ side of the hand/digits are innervated by the median and ulnar nerves
anterior/ventral
278
wrist block:
The ______ side of the hand/digits are innervated by the ulnar and radial nerve
posterior/dorsal
279
wrist block:
____mL’s of local anesthetic are injected at each site
5
280
what drug should not be used in a wrist block?
epinephrine
281
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)
wrist
| brachial plexus
282
brachial plexus block VS wrist block:
The ____ block is primarily a sensory block and thus better preserves motor function
wrist
283
brachial plexus block VS wrist block:
Because of the superficial location of the nerves, the _____ block is a relatively easy block to perform
wrist
284
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
wrist
285
brachial plexus block VS wrist block:
A ____ block requires more needle sticks
wrist
