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Nerve Block Presentations > Nerve Block Presnetations > Flashcards

Nerve Block Presnetations Flashcards

1
Q

Where is the adductor canal found and what 3 muscles are formed by it?

A

Medial-mid thigh

Sartorius, vastus medialis, and adductor longus

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2
Q

The adductor canal block is a modified what?

A

Femoral nerve block that is performed most distally

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3
Q

What does the adductor canal block?

A

Saphenous nerve (branch of femoral nerve) at the mid-thigh level, distal to the motor branches of the quad.

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4
Q

What 3 things does the adductor canal NOT block?

A
  1. Femoral nerve
  2. Lateral femoral cutaneous
  3. Obturator nerves
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5
Q

What is the advantage of the adductor canal block?

A

Preserves all motor function

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6
Q

What is the disadvantage to the adductor canal block?

A

Only blocks the medial portion of the knee (good for partial knee replacement) and medial lower leg

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7
Q

Is the adductor canal block motor sparing?

A

Supposed to be motor sparing BUT more cephalad the block is the more likely a motor block

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8
Q

Where is the ultra sound probe place for an adductor canal block and what are the 5 landmarks?

A

Above the knee of the medial side

Anatomical landmarks: sartorius, adductor longus, vastus medialis, femoral artery, femoral vein

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9
Q

Where is the nerve most likely found in an adductor canal block and where is local injected?

A

Between sartorius and vastus medialis muscles

LATERAL to the femoral artery

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10
Q

Used to block the recurrent laryngeal nerve (larynx and trachea; BELOW the cords)

A

Transtrachael

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11
Q

What is contraindicated in ALL patients?

A

Direct recurrent laryngeal nerve blocks because risk of bilateral vocal cord paralysis and airway obstruction

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12
Q

What 3 blocks are used for an awake fiber optic intubation?

A
  1. Transtrachael
  2. Superior laryngeal
  3. Glossopharyngeal
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13
Q

Potential complication for transtrachael block?

A

Posterior laryngeal wall puncture if needle advanced too far

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14
Q

Used to block the larynx above the cords (glottis closure reflex)?

A

Superior laryngeal

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15
Q

Common dose for superior laryngeal block?

A

2ml of 2% lidocaine through 25ga needle

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16
Q

4 potential complications for superior laryngeal?

A
  1. Sore throat
  2. Cough
  3. Hoarseness
  4. Injection into the nearby superior laryngeal artery
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17
Q

Which block is useful in blocking the gag reflex/oropharynx?

A

Glossopharyngeal block

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18
Q

What 2 ways can the glossopharyngeal be accomplished?

A
  1. Applying gauze soaked in LA directly over the nerve

2. Direct injection of LA around the nerve

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19
Q

3 potential complications with glossopharyngeal block?

A
  1. Dysphagia
  2. Loss of taste
  3. Throat hoarseness
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20
Q

The ankle block anesthetize the foot by blocking what 5 different nerves?

A
  1. Deep peroneal
  2. Superficial peroneal
  3. Saphenous
  4. Posterior tibial
  5. Sural nerves
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21
Q

4 of the nerves of the ankle block are branches of the sciatic nerve?

A
  1. Deep peroneal
  2. Superficial peroneal
  3. Tibial
  4. Sural
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22
Q

What are the 2 deep injection and 3 superficial injections for the ankle block?

A

Deep: deep peroneal and posterior tibial
Superficial: Superficial peroneal, Saphenous, Sural

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23
Q

Ankle bock is effect and in effect at anesthetizing what?

A

Effect: foot
Ineffective: ankle

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24
Q

What are the 3 contraindications for an ankle block?

A
  1. Infection
  2. Compromised circulation to the foot
  3. Use of epi in the LA
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25
Q

The ankle block requires how much LA?

A

15-20/foot for a complete block
-5ml for deep peroneal nerve
-5ml for posterior tibial nerve
-3-5ml for saphenous, superficial peroneal, and sural nerves
3-5 LA per nerve is sufficient for an effective block

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26
Q

Landmark and insertion technique: insert needle lateral to the anterior tibial pulse. Advance till it hits bone and inject.

A

Deep peroneal nerve

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27
Q

Landmark and insertion technique: insert needle lateral to the anterior tibial pulse. Advance superficially towards superior aspect of lateral malleolus.

A

Superficial peroneal nerve

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28
Q

Landmark and insertion technique: insert needle lateral to the Achilles’ tendon and advance towards the lateral malleolus.

A

Sural nerve

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29
Q

Landmark and insertion technique: insert needle lateral to the anterior tibial pulse. Advance superficially towards superior aspect of medial malleolus.

A

Saphenous nerve

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30
Q

Landmark and insertion technique: insert needle posterior (and deep) to the posterior tibial pulse (dorsal to the medial malleolus). Advance until the tibia is encountered.

A

Posterior tibial nerve

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31
Q

Area of body anesthetized: space between the first two toes

A

Deep peroneal nerve

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32
Q

Area of body anesthetized: for sum of the foot and toes (except between first 2 toes)

A

Superficial peroneal nerve

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33
Q

Area of body anesthetized: medial ankle and foot, medial sole

A

Saphenous nerve

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34
Q

Area of body anesthetized: lateral portion of the foot and heel, lateral/posterior sole

A

Sural nerve

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35
Q

Area of body anesthetized: 1. Most of the heel 2. Most of the sole 3. Tips of the toes

A

Posterior tibial nerve

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36
Q

Alternative to the inter scalene block that minimizing anesthetizing the phrenic nerve?

A

Anterior suprascapular block

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37
Q

What is an excellent choice for pts with pulmonary dysfunction?

A

Anterior suprascapular block

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38
Q

Branch of brachial plexus nerves C5-6

A

Anterior suprascapular

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39
Q

How can you locate anterior suprascapular on the ultrasound?

A

Ultrasound in the supraclavicular fossa, deep to the omohyoid muscle and lateral to the plexus and subclavian artery

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40
Q

The anterior suprascapular block primarily covers what?

A

C5-6, so there is less motor block (bc axillary nerve is spared)

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41
Q

3 advantages to anterior suprascapular?

A
  1. Minimizes diaphragm paralysis and better preserves pulmonary function
  2. Less motor blockade (due to auxiliary nerve sparing)
  3. Horner syndrome is less likely
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42
Q

2 disadvantages to anterior suprascapular?

A
  1. Closer proximity to the pleura (higher risk of pneumothorax)
  2. Lesser blockade at C7-8 and less complete analgesia than interscalene approach
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43
Q

What level is the axillary block performed at?

A

Branches (median, radial, ulnar) but it misses the musculocutaneous nerve and axillary nerve

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44
Q

What part of the body does the musculocutaneous nerve cover?

A

Lateral forearm and biceps brachii

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45
Q

The axillary block anesthetize what (3)?

A

Elbow, forearm and hand

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46
Q

Of the axillary block, where never is the deepest?

A

Radial

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47
Q

What makes up the neurovascular bundle?

A

Median, radial and ulnar

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48
Q

What 2 scenarios should a supplementary musculocutaneous block should be considered?

A
  1. Pt needs lateral forearm coverage

2. Surgeon is using tourniquet on the forearm for hand surgery

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49
Q

2 advantages to axillary block?

A

Reduce risk of

  1. Pneumothorax
  2. Phrenic nerve paralysis
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50
Q

Where can the musculocutaneous nerve be found?

A

Between the coracobrachialis muscle and biceps brachii

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51
Q

Dosing amount for transarterial technique for axillary block?

A

30-40ml of LA

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52
Q

Dosing amount for ultrasound technique with axillary block?

A

At least 20 ml of LA (5-7ml/nerve)

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53
Q

2 contraindications to the axillary block?

A
  1. Axillary lymphadenopathy

2. Preexisting neurologic disease of the upper extremity

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54
Q

The anterior/ventral side of the hand/digits are innervated by what 2 nerves?

A

Median and ulnar

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55
Q

The posterior/dorsal side of the hand/digits are innervated by what 2 nerves?

A

Ulnar and radial nerves

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56
Q

Each digit has how many nerves and arteries?

A

4 nerves, each accompanied by an artery

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57
Q

All digital blocks carry what risk?

A

Compartment syndrome if too high a volume of LA is administered

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58
Q

How much volume should be given for finger blocks and small toe blocks?

A

<4ml

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59
Q

How much volume should be given for great toe blocks?

A

<6ml

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60
Q

Digit blocks should be avoided when?

A

If there is evidence of compromised circulation

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61
Q

Should epi be added to LA with digital blocks?

A

NO

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62
Q

Most painful to least painful digital blocks? (3)

A

Most: transthecal approach
Ring block
Least: subcutaneous volar injection

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63
Q

Local is injected above and on both sides of the digit (2 injections)

A

Ring block

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64
Q

Ring block injection dosage?

A

Max volume of 2ml on each side of the finger, for total max volume of 4ml per finger

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65
Q

Needle is inserted at the distal palmar crease (single injection)

A

Transthecal volar block

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66
Q

If there is pressure during injection with the transthecal volar block where are you?

A

In the flexor tendon, so withdraw the needle until no pressure is felt

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67
Q

Transthecal volar block dosing?

A

2-3ml per digit

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68
Q

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

A

Subcutaneous volar block

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69
Q

Subcutaneous volar block the local is injected at what depth and how much dosing?

A

Depth: subcutaneous
Dose: 2-3ml per digit

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70
Q

The fascia iliaca compartment contains what 3 nerves?

A
  1. Femoral nerve
  2. Lateral femoral cutaneous nerve
  3. Obturator nerve
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71
Q

How many injections is the fascia iliaca block?

A

Single

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72
Q

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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73
Q

The fascia iliaca block anesthetize what 4 things?

A
  1. Hip and knee joints
  2. Anterior knee and medial posterior knee
  3. Femur, anterior thigh, and lateral thigh
  4. Medial lower leg and medial foot
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74
Q

Compared with the femoral nerve block, the fascia iliaca block provides better coverage to what 2 areas?

A
  1. Lateral femoral cutaneous

2. Obturator nerves

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75
Q

Needle insertion directions for the fascia iliaca block (3)

A
  1. Draw a line b/n anterior superior iliac spine and ipsilateral pubic tubercle
  2. Mark point 1/3 the distance from the anterior superior iliac spine, and insert needle 1cm caudad to the point
  3. Advance needle until 2 distinct pops are felt perforating the fascia lata and fascia iliaca
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76
Q

Dosing for fascia iliaca block and inserted b/n what 2 muscles?

A

30-40ml of LA b/n fascia iliaca and iliacus muscle

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77
Q

The femoral block aims to block what 3 nerves?

A
  1. Femoral nerve
  2. Lateral femoral cutaneous
  3. Obturator nerve
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78
Q

The femoral nerve anesthetizes what following areas? (4)

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

If a continuous nerve block catheter is used for a femoral block, the catheter should be removed within how long due to infection?

A

48 hours

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80
Q

Commonly used LA for a femoral block?

A

15-20ml of LA with 1:200,000 epi

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81
Q

What twitches are you looking for with a femoral block?

A

Patellar and quad twitch. If sartorius muscle twitch is observed, redirect needle laterally (closer to femoral nerve) until patellar twitch is observed.

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82
Q

Landmarks and needle insertion for the femoral block?

A

Landmark: NAVEL and inguinal ligament

Need insertion: laterally to the femoral artery during palpation

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83
Q

Ilioinguinal/iliogypogastric blocks what 2 nerves?

A
  1. Iliohypogastric nerve

2. Ilioinguinal nerve

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84
Q

Ilioinguinal/iliogypogastric block anesthetizes what 3 areas of the body?

A
  1. Hypogastric region
  2. Inguinal crease
  3. Upper medial thigh
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85
Q

Ilioinguinal/iliogypogastric block is indicated for what types of surgeries?

A

Inguinal hernia repair and other inguinal surgeries (orchiopexy, hydrocele repair, varicocele repair)

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86
Q

Correct placement for the Ilioinguinal/iliogypogastric block?

A

B/n transversus abdominis and internal oblique muscle planes around the ilioinguinal and iliogypogastric nerves

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87
Q

Where is the ultrasound probe placed for the Ilioinguinal/iliogypogastric block?

A

Anterior-superior iliac spine

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88
Q

2 potential complications for the Ilioinguinal/iliogypogastric block?

A
  1. Transient femoral nerve palsy

2. Deep circumflex iliac artery puncture

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89
Q

Intercostal nerve block anesthetizes areas of the chest wall by blocking what nerve?

A

Anterior and lateral cutaneous branches of the intercostal nerve

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90
Q

Good block for thoracotomy or mastectomy?

A

Intercostal block

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91
Q

Intercostal blockade should include what for the surgical incision site?

A

2 dermatomes above and below surgical incision site

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92
Q

Needle insertion for the intercostal block?

A

Very shallow (1cm until you hit bone), and inserted in cephalad position

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93
Q

The intercostal block is commonly performed where on the body?

A

6-8 cm lateral to the spinous processes (angle of the rib)

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94
Q

Behind the rib, what is the order from superior to inferior?

A

VAN,
Vein
Artery
Nerve

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95
Q

Out of all the peripheral nerve blocks, the intercostal block results in what?

A

Highest blood level of LA per volume and highest toxicity risk

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96
Q

Why does intercostal block have a risk of pneumothorax?

A

Distance to the pleura is 8m deep to the rib

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97
Q

Intercostal nerves expand from what dermatomes?

A

T1-T12

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98
Q

Intercostal block becomes more complicated where and why?

A

Above T7 bc scapula prevents access to the ribs

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99
Q

Alternative approach t the intercostal block for anesthetizing the intercostal nerves?

A

Paravertebral

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100
Q

Where does the paravertebral block?

A

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

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101
Q

Steps to inserting the needle for paravertebral block? (2)

A
  1. Insert needle until it hits the transverse process

2. “Walked off” the transverse process in a cephalad direction and advance 1cm placing tip in paravertebral space

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102
Q

Where does the interscalene block target?

A

Brachial plexus at the level of the ROOTS; C5-C7, but not C8-T1

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103
Q

What sparing block is the interscalene block?

A

Ulnar

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104
Q

Interscalene block anesthetizes what (4) and does not what (3)?

A

Anesthetizes: shoulder, upper arm, lateral arm, and lateral hand
Does not: medial arm, hand, or elbow

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105
Q

Landmarks for interscalene block?

A

Interscalene groove (b/n anterior and middle scalene muscles); lateral to the clavicular head of the sternocleidomastoid and at the level of the cricoid cartilage (C6)

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106
Q

Where is the scalene groove normal palpated?

A

Just in front or behind the external jugular vein

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107
Q

6 complications with interscalene block:

A
  1. Ipsilateral phrenic paralysis
  2. Horner’s syndrome (miosis, ptosis, anhidrosis)
  3. Possible pneumothorax
  4. Possible hoarseness bc bloated of recurrent laryngeal nerve
  5. Possible accidental epidural or subarachnoid injection
  6. Vertebral artery injection, leading to immediate seizure
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108
Q

Interscalene block should be avoided in what type of patients?

A

Pts with any degree of pulmonary disease

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109
Q

As little as how much of LA into vertebral artery can induce a seizure?

A

1ml

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110
Q

One advantage to interscalene block over supraclavicular block?

A

Blocks part of the cervical plexus

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111
Q

IPACK block provides what?

A

Sensory block to the posterior aspect of the knee while PRESERVING MOTOR FUNCTION

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112
Q

What is IPACK block typically used in combo with?

A

Adductor canal block for total knee replacement because both are motor sparing

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113
Q

IPACK block targets what nerves? (4)

A
  1. Branches of the superior and medial genicular nerves
  2. Obturator nerve
  3. Common peroneal nerve
  4. Articular branch of tibial nerve
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114
Q

4 relevant landmarks for the IPACK block?

A
  1. Vastus medialis
  2. Femoral shaft
  3. Popliteal artery
  4. Semimembranosus muscle
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115
Q

IPACK spares what 2 nerves?

A
  1. Tibial nerve

2. Peroneal nerve

116
Q

Which 2 nerves does NOT preserve motor function?

A
  1. Tibial nerve

2. Peroneal nerve

117
Q

Where is the needle inserted and dosage for the IPACK block?

A

Needle: through vastus medialis b/n popliteal artery and lateral femoral condyle
Dosage: ~15ml LA

118
Q

Brachial plexus block is formed from where?

A

C5-T1 nerve roots

119
Q

Brachial plexus covers where?

A

Should, all of upper limb except for upper medial arm which is covered by T2

120
Q

From proximal to distal, the brachial plexus is divided into what? (5)

A
  1. Roots
  2. Trunks
  3. Divisions
  4. Cords
  5. Branches/terminal nerves
121
Q

5 main branches/terminal nerves of the brachial plexus?

A
  1. Axillary
  2. Radial
  3. Ulnar
  4. Median
  5. Musculocutaneous
122
Q

What are the 3 supplemental blocks to the brachial plexus blocks?

A
  1. Intercostobrachial (T2)
  2. Medial cutaneous nerve
  3. Musculocutaneous nerve
123
Q

What are the 3 reasons for intercostobrachial (T2) nerve block?

A
  1. Medial arm surgery
  2. Medial elbow surgery
  3. Help out wit tourniquet pain (in combo with supraclavicular, infraclaviuclar, or axillary block) for forearm and hand surgery
124
Q

What block can provide medial (C8-T1) coverage to the arm when an interscalene block is used?

A

Medial cutaneous nerve block

125
Q

Which block can provide coverage to the lateral forearm when an axillary block is used?

A

Musculocutaneous nerve block

126
Q

Should and lateral arm dermatome?

A

C5-C7

127
Q

Medial arm and hand dermatome?

A

C8-T1

128
Q

Forearm dermatome (3)

A
  1. Medial cutaneous nerve (C8-T1) ; medial forearm
  2. Msuculocutaneous nerve (C5-C7) ; lateral forearm
  3. Radial nerve (C5-C6) ; posterior medial forearm
129
Q

Elbow dermatome (3)

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
130
Q

Medial hand dermatome

A

Ulnar nerve (C8-T1)

131
Q

Posterior lateral hand dermatome

A

Radial nerve (C5-C6)

132
Q

Anterior lateral hand and fingertips of first 3 digits and half of the fourth digit dermatome

A

Median nerve (C6-C8)

133
Q

Block option for shoulder/proximal humerus

A

Interscalene

134
Q

Block option for mid humerus (2)

A
  1. Interscalene

2. Supraclavicular

135
Q

Block option for elbow (4)

A
  1. Supraclavicular (+musculocutaneous)
  2. Infraclavicular (+musculocutaneous)
  3. Axillary (+musculocutaneous)
  4. May consider intercostobrachial (T2) block for medial elbow surgery since T2 extends to the elbow joint in 1/3 of pts
136
Q

Block option for forearm (3)

A
  1. Supraclavicular (+musculocutaneous)
  2. Infraclavicular (+musculocutaneous)
  3. Axillary (+musculocutaneous)
137
Q

Block option for wrist (3)

A
  1. Supraclavicular
  2. Infraclavicular
  3. Axillary
138
Q

Block option for hand (4)

A
  1. Supraclavicular
  2. Infraclavicular
  3. Axillary
  4. Wrist block
139
Q

Block option for fingers (5)

A
  1. Supraclavicular
  2. Infraclavicular
  3. Axillary
  4. Wrist block
  5. Digital block
140
Q

Targets the brachial plexus at the level of the ROOTS; reliably blocks C5-T1, but not C8-T1, so it is an ulnar sparing block

A

Interscalene

141
Q

Targets the TRUNKS and DIVISIONS of the brachial plexus; the SUBCLAVIAN artery is identified

A

Supraclavicular

142
Q

Targets the CORDS of the brachial plexus; axillary artery is identified

A

Infraclavicular

143
Q

Targets the BRANCHES of the brachial plexus (gets median, radial, ulnar, but misses the axillary and musculocutaneous nerves)

A

Axillary

144
Q

Shoulder, lateral 2/3 of clavicle, and the lateral arm/hand. DOESN’T block the medial arm, hand, or elbow.

A

Interscalene

145
Q

Entire arm/hand except the upper medial portion (which is covered by T2); it can be considered for should surgery, even though it may not be as good as an interscalene block

A

Supraclavicular

146
Q

Same coverage as supraclavicular, except that it isn’t considered for a shoulder block

A

Infraclavicular

147
Q

Get the hand, medial arm, and most of the elbow; Doesn’t get the upper arm (due to axillary sparing) or lateral forearm (due to musculocutaneous sparing)

A

Axillary

148
Q

Of brachial plexus approaches: which can cause ipsilateral phrenic nerve palsy (2)

A
  1. Interscalene

2. Supraclavicular

149
Q

Of brachial plexus approaches: which is the best for COPD pts?

A

Infraclavicular

150
Q

Of brachial plexus approaches: which causes recurrent laryngeal nerve palsy & subsequent hoarseness (2)

A
  1. Interscalene

2. Supraclavicular

151
Q

Of brachial plexus approaches: which causes horner’s syndrome (miosis, ptosis, anhidrosis) (3)

A
  1. Interscalene
  2. Supraclavicular
  3. Infraclavicular
152
Q

Of brachial plexus approaches: which can cause epidural/subarachnoid injection (1)

A
  1. Interscalene
153
Q

Of brachial plexus approaches: which can cause a pneumothorax (3)

A
  1. Interscalene
  2. Supraclavicular
  3. Infraclavicular
154
Q

Of brachial plexus approaches: which has the highest incidence of pneumothorax

A

Supraclavicular

155
Q

Of brachial plexus approaches: which can have a subclavian artery puncture

A

Supraclavicular

156
Q

Of brachial plexus approaches: which can cause a vertebral artery puncture?

A

Interscalene

157
Q

Of brachial plexus approaches: which can cause an axillary artery puncture (2)

A
  1. Infraclavicular

2. Axillary

158
Q

Of brachial plexus approaches: which spares the musculocutaneous nerve (1)

A

Axillary

159
Q

Of brachial plexus approaches: which spares the ulnar nerve (3)

A
  1. Interscalene
  2. Supraclavicular (less likely, but possible)
  3. Infraclavicular (less likely, but possible)
160
Q

Of brachial plexus approaches: which can be used for upper arm tourniquet pain

A
  1. Interscalene (from T1&T2)
  2. Supraclavicular (from T2)
  3. Infraclavicular (from T2)
  4. Axillary (from T2)
161
Q

Of brachial plexus approaches: contraindicated for respiratory disease/COPD (2)

A
  1. Interscalene

2. Supraclavicular

162
Q

Of brachial plexus approaches: contraindicated for contralateral phrenic nerve dysfunction (2)

A
  1. Interscalene

2. Supraclavicular

163
Q

Of brachial plexus approaches: contraindicated for ipsilateral central line or pacemaker (1)

A

Infraclavicular

164
Q

Coverage:

  1. Anterior knee and anteromedial thigh
  2. Medial lower leg, ankle, and foot
A

Femoral nerve

165
Q

Coverage:

  1. Hip joint
  2. Lateral thigh
A

Lateral femoral cutaneous nerve

166
Q

Coverage:

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

Obturator nerve

167
Q

Coverage:

  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)
A

Sciatic nerve

168
Q

Notes:

  1. Motor component (quad; leg/knee extension)
  2. Saphenous nerve is a SENSORY branch
A

Femoral nerve

169
Q

Notes:

Reliably blocked with a femoral nerve block and fascia iliaca block

A

Lateral femoral cutaneous nerve

170
Q

Notes:

Is NOT reliably blocked with a femoral nerve block or fascia iliaca block

A

Obturator nerve

171
Q

Notes:

  1. Branches into 4 nerves: deep peroneal, superficial peroneal, tibial, sural
  2. Provides MOTOR innervation to the posterior thigh muscles and lateral muscles distal to the knee
A

Sciatic nerve

172
Q

Area of the body anesthetized:

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

Femoral, “3 in 1”, and fascia iliaca

173
Q

Area of the body anesthetized:

  1. Medial knee
  2. Medial lower leg
  3. Medial foot
A

Saphenous nerve block

174
Q

Area of the body anesthetized:

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

Sciatic block (transgluteal approach)

175
Q

Area of the body anesthetized:

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

A

Sciatic block (popliteal approach)

176
Q

Does the femoral, “3 in 1”, and fascia iliaca block provide motor block?

A

Yes (quad); leg/knee extension is limited

177
Q

Does the saphenous nerve block provide motor block?

A

NO

178
Q

Does the sciatic block (transgluteal approach) provide motor block?

A

Yes (posterior thigh muscles and lateral muscle distal to the knee)

179
Q

Dose the sciatic block (popliteal approach) provide motor block?

A

Yes (lateral muscles distal to the knee)

180
Q

Femoral block uses how much dosing?

A

Smaller amount (~20ml)

181
Q

The femoral block infrequently anesthetizes the what nerve?

A

Obturator

182
Q

“3 in 1” block is at the same location of what block but uses how much dosing?

A 
Femoral block 
Larger volume (25-30ml) and distal pressure (2-4cm below injection site)
183
Q

The “3 in 1” block drifts in what location to better involve what 2 nerves?

A

Cranial to better involve lateral femoral cutaneous and obturator nerves

184
Q

Fascia iliaca block is what location compared to femoral block and uses how much dosing?

A

More lateral than femoral, but uses larger volume (30-40ml)

185
Q

Which block has the best at anesthetizing the lateral femoral cutaneous AND obturator nerves

A

Fascia iliaca

186
Q

The obturator block covers what location on the body?

A

Medial thigh

187
Q

The obturator block can be used to abolish what reflex during what surgery?

A

Obturator reflex during TURBT surgery

188
Q

Complete anesthesia of the lower limb is possible with what 2 nerve blocks?

A

Femoral and sciatic

189
Q

What are the 2 approaches to the sciatic nerve block?

A
  1. Transgluteal

2. Popliteal

190
Q

Transgluteal sciatic block is used for what surgery?

A

Posterior thigh

191
Q

Popliteal sciatic block is used for what surgery and covers what area of body?

A

Lower leg surgery and covered entire lower leg and foot EXCEPT medial portion

192
Q

Which block is most popular for ankle surgery?

A

Popliteal block

193
Q

Block choice for hip surgery?

A

Fascia iliaca, 3in1, or femoral ; +/- sciatic

194
Q

Block choice for anterior thigh surgery?

A

Fascia iliaca, 3in1, or femoral

195
Q

Block choice for knee surgery?

A

Fascia iliaca, 3in1, or femoral ; +/- sciatic

196
Q

Block choice for tibia surgery?

A

Popliteal

197
Q

Block choice for ankle surgery?

A

Popliteal ; +/- saphenous

198
Q

Block choice for foot surgery?

A

Ankle or popliteal

199
Q

Quadratus lumborum anesthetizes what part of the body?

A

Abdominal region; somatically and in part viscerally

200
Q

Quadratus lumborum covers what dermatomes and how does it compare to TAP block?

A

T7-L1; provides broader, longer block as TAP only covers T10-T12

201
Q

What are the 4 approaches to the Quadratus lumborum?

A

Lateral
Posterior
Anterior/transmuscular
Intramuscular

202
Q

Type 1 Quadratus lumborum

A

Lateral

203
Q

Type 2 Quadratus lumborum

A

Posterior

204
Q

Type 3 Quadratus lumborum

A

Anterior/transmuscular

205
Q

Type 4 Quadratus lumborum

A

Intramuscular ; NOT COMMON

206
Q

Pt positioning for Quadratus lumborum 1, 2, 4?

A

Supine

207
Q

Pt positioning for Quadratus lumborum 3?

A

Lateral

208
Q

Which Quadratus lumborum is most common?

A

1 and 2

209
Q

Which Quadratus lumborum provides more coverage?

A

3

210
Q

Where is ultrasound placed in Quadratus lumborum block?

A

Superior to the iliac crest

211
Q

The Quadratus lumborum represents what leaf when looking at landmarks?

A

Shamrock

212
Q

For the Quadratus lumborum:

Stem, posterior, anterior, and lateral leaf represent what on the body?

A

Stem: transverse process (T4)
Posterior: erector spinae
Anterior: psoas
Lateral: Quadratus lumborum

213
Q

Goal of Quadratus lumborum is to anesthetize what nerves?

A

Thoracolumbar

214
Q

Complications of Quadratus lumborum?

A

Puncture of the liver, kidney, spleen

215
Q

The rectus sheath blocks what on the body and dermatomes?

A

Middle abdomen (T7-T12); from xyphoid process to symphysis pubis

216
Q

rectus sheath is indicated for what surgery?

A

Umbilical surgery and midline laparotomy

217
Q

The goal of rectus sheath block is to inject local where?

A

Between rectus abdominis muscle and posterior rectus sheath

218
Q

How much dosing is placed in rectus sheath block?

A

~10ml on both sides of umbilicus

219
Q

Where does the sciatic/popliteal block anesthetize?

A

Posterior thigh and lower leg and foot, EXCEPT medial leg

220
Q

What are the 4 branches of the sciatic nerve?

A

Tibial, superficial and deep peroneal, sural

221
Q

Which is the largest spinal nerve in the body and what is the cause of that?

A

Sciatic; longest onset and duration

222
Q

What are the 2 approaches for the sciatic block?

A

Transgluteal and popliteal

223
Q

Both approaches to the sciatic block provide what type of block?

A

Motor and sensory block

224
Q

Transgluteal approach of the sciatic block anesthetizes what on the body?

A

Posterior thigh, knee and everything below the knee except medial portion of lower leg

225
Q

Popliteal approach of sciatic block anesthetizes what?

A

Everything below the knee except medial portion of the lower leg

226
Q

The sciatic nerve bifurcates into what nerves?

A

Tibial and common peroneal nerves

227
Q

For the popliteal approach of sciatic nerve, the needle can be inserted in what 2 positions?

A
  1. Posteriorly (pt prone)

2. Lateral (pt supine)

228
Q

Posterior popliteal approach of sciatic block has the needle inserted between what 2 muscles?

A

Biceps femoris (lateral) and semiteninosus/semimembranosus (medial)

229
Q

Lateral popliteal approach of sciatic block has the needle inserted between what 2 muscles?

A

Biceps femoris and vastus lateralis

230
Q

Can a continuous block with a catheter be used for the popliteal approach of the sciatic block?

A

YES

231
Q

What does the popliteal approach allow over the transgluteal approach for the sciatic block?

A

Knee flexion

232
Q

Transgluteal approach for needle insertion?

A

~5cm caudad to midline point b/n greater trochanter and posterior superior iliac spine

233
Q

The serratus plane bocks what 3 nerves to provide pain relief for what 3 things?

A

Thoracodorsal, long thoracic, and lateral intercostal

Breast surgery, thoracotomy, or rib fractures

234
Q

Where is ultrasound prob and needle placed for serratus plane block?

A

Superior to 5th rib (level of nipple) on mid axillary line

235
Q

Where is local injected for serratus plane block?

A

B/n latissimus Dorsi and serratus (~1-2cm deep)

236
Q

serratus plane block carries a lower risk of what and why?

A

Pneumothorax bc it is more superficial

237
Q

PECS block provides analgesia for what location on body?

A

Anterior chest wall

238
Q

PECS 1 anesthetizes what nerves that innervate what muscle?

A

Medial and lateral pectoral nerves, which innervate the pectoralis muscle

239
Q

PECS 1 local is injected b/n what muscles?

A

Pectoralis major and minor

240
Q

PECS 2 local is injected b/n what 2 muscles and goal is to blockade what nerve?

A

Pectoralis minor and serratus anterior muscles which block upper intercostal nerves

241
Q

PECS 2 includes what other block?

A

PECS 1

242
Q

For the PECS block, the needle is inserted b/n what ribs?

A

3rd and 4th ribs; just medial to where the arm attaches

243
Q

Of the PECS block, which is done first and second?

A

PECS 2 then PECS 1

244
Q

Which 2 blocks give a better and longer lasting analgesia then intercostal block?

A

Serratus plane and PECS

245
Q

Serratus plane requires how many injections?

A

1 injection and may offer better pain management

246
Q

PECS require how many injections for full block

A

2 injections and may take more expertise to obtain view on ultrasound

247
Q

Supraclavicual or infraclavicular block: risk of pneumothorax?

A

Supraclavicular

248
Q

Supraclavicual or infraclavicular block: incidence of phrenic nerve palsy?

A

Supraclavicular

249
Q

Supraclavicual or infraclavicular block: use of in dwelling catheter

A

Supraclavicular: worse (higher dislodgment)
Infraclavicular: better (stabilization from pectoralis muscle)

250
Q

Supraclavicual or infraclavicular block: use in obese pts?

A

Both difficult
Supraclavicular: presence of supraclavicular fat pads
infraclavicular: brachial plexus is deeper with this approach

251
Q

Supraclavicual or infraclavicular block: use in COPD pts?

A

Infraclavicular

252
Q

Supraclavicual or infraclavicular block: onset?

A

Supraclavicual: slower
infraclavicular: faster

253
Q

Supraclavicual or infraclavicular block: better visualization?

A

Supraclavicular because more superficial

254
Q

Supraclavicual or infraclavicular block: incidence of hematoma with accidental vascular puncture?

A

Infraclavicular bc difficulty of applying pressure

255
Q

Supraclavicual approach is performed at what levels and dermatomes?

A

TRUNKS and DIVISIONS; C8-T1

256
Q

Supraclavicual approach anesthetizes what part of the body?

A

Entire arm except upper medial arm (T2)

257
Q

Does the Supraclavicual approach cover the entire shoulder?

A

No bc the needle insertion site is too distal

258
Q

Infraclavicular approach is performed at what level?

A

CORDS

259
Q

What are the 3 cords (superficial to deep)?

A

Lateral, posterior, medial

260
Q

What is the difference to the supraclavicular and Infraclavicular approach?

A

Essentially provides same coverage, just different needle location

261
Q

supraclavicular and Infraclavicular approach anesthetizes what areas on the body?

A

Elbow, forearm, hand and fingers

262
Q

The supraclavicular approach has what landmark?

A

Subclavian artery

263
Q

The infraclavicular approach uses what landmark?

A

Axillary artery

264
Q

Supraclavicular and infraclavicular approach risks what syndrome?

A

Horner’s syndrome but less common than interscalene approach

265
Q

TAP block anesthetizes what area on body and what dermatomes?

A

Sub-umbilical abdomen (T10-L1)

266
Q

TAP block is used for what surgery?

A

Lower abdominal (appendectomy, hernia repair, C/section, abdominal hysterectomy, prostatectomy)

267
Q

TAP block provides what anesthesia via somatic and visceral

A

Provides somatic but NO visceral

268
Q

TAP block uses how much dosing?

A

10-20ml per side and performed on both sides

269
Q

When performing the blind TAP block, you must identify what?

A

Triangle of petit (iliac crest, external oblique, and latissimus dorsi)

270
Q

The TAP block local is injected b/n what 2 muscles?

A

Internal oblique and transverse abdominus

271
Q

What are the pops you encounter with the TAP block?

A

2 as it passes through external and internal oblique muscles

272
Q

What are the 4 approaches to the TAP block?

A

Subcostal, lateral, posterior, and oblique subcostal

273
Q

Which TAP block is the most common/traditional approach?

A

Lateral

274
Q

What are the 2 potential complications with the TAP block?

A

Visceral organ damage

Intraperitoneal injection if inserted too far

275
Q

The wrist block provides analgesia for what on the body?

A

Hand and digits

276
Q

What 3 nerves are anesthetized for a wrist block?

A

Radial, ulnar, and median

277
Q

Median nerve lies b/n what?

A

Flexor carpi radialis and flexor palmaris longus

278
Q

Ulnar nerve lies b/n what?

A

Medially and deep to flexor carpi ulnaris tendon

279
Q

Radial nerve lies b/n what?

A

Ulnar artery and flexor carpi ulnaris

280
Q

Anterior/ventral side of hand is innervated by what 2 nerves?

A

Median and ulnar

281
Q

Posterior/dorsal side is innervated by what 2 nerves?

A

Ulnar and radial

282
Q

How much LA is injected at each site for wrist block?

A

~5ml

283
Q

Should epi be used for wrist block?

A

NO

284
Q

4 advantages to wrist block over brachial plexus block

A
  1. Only anesthetizes the hand and leaves brachial plexus out (preserve up limb mobility)
  2. Primarily sensory and preserves motor function
  3. Easy because superficial location
  4. Small amount of LA so less risk of toxicity
285
Q

2 disadvantages to wrist block compared to brachial plexus block?

A
  1. Don’t block area of tourniquet

2. More needle sticks

Nerve Block Presentations (1 decks)

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