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Priniclpes Of Anesthesia > Nerve blocks (exam 4) > Flashcards

Nerve blocks (exam 4) Flashcards

1
Q

Brachial plexus components

A

Roots
Trunks
Divisions
Cords
Branches

(Reach to Drink Cold Beverages)

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1
Q

Brachial plexus roots (and how many)

A

5 roots:
C5
C6
C7
C8
T1

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2
Q

Brachial plexus trunks (and how many)

A

3 trunks:
Superior
Middle
Inferior

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3
Q

Brachial pelxus divisions #

A

6

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4
Q

Brachial plexus cords (and how many)

A

3 Cords
Lateral
Posterior
Medial

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5
Q

Brachial plexus branches (and how many)

A

5 branches
Musculocutaneous n
Axillary n
Radial n
Median n
Ulnar n

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6
Q

Musculocutaneous n is innervated at

A

C5-7

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7
Q

Axillary n is innervated at

A

C5-6

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8
Q

Radial n is inervatted at

A

C5-T1

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9
Q

Median n is innervated at

A

C5-T1

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10
Q

Ulnar N is innervated

A

C8-T1

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11
Q

Brachial plexus flow

A
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12
Q

Medial nerve pre op neuro exam

A

Touch thumb and pinky

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13
Q

Ulnar nerve pre op nuero exam

A

spread hands/fingers
“OK” pinch thumb and index

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14
Q

Radial pre op neuro exam

A

“stop” flex hand up
thumbs up

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15
Q

Radial nerve pre op STRENGTH neuro exam

A

Push’eR
elbow extension against resistance (triceps contraction)

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16
Q

Musculocutaneous preop STRENGTH neuro exam

A

Pull’eM
elbox flexion against resistance (biceps contracation)

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17
Q

median n. preop STRENGTH neuro exam

A

Pinch Me: pinch patients index finger

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18
Q

Ulnar n preop STRENGTH neuro exam

A

Pinch U: pinch patients pinky finger (5th digit)

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19
Q

Pre block neuro exam for lower extremities

A
  1. ankle dorsifelxion (flex to head)
  2. Great toe dorsiflexion
  3. ankle plantar flexion (point ball of foot)
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20
Q

Interscalene block indications

A

Shoulder surgery (includes rotator cuff)
Upper arm surgery (proximal humerus)
Distal clavicle

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21
Q

Interscalene block roots

A

C5-C7

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22
Q

Inerscalene landmarks

A

It is lateral to the subclavian artery

Landmarks:
Sternocleidomastoid (inferior to)
Middle scalene muscle
Anterior scalene muscle

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23
Q

Block contraindications (7)

A
  1. patient refusal
  2. contralateral diaphragmatic paralysis
  3. injection
  4. LA allergy
  5. Severe resp disease
  6. COPD
  7. Anticoagulation
  8. Preexisting neurodeficits
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24
Q

For goal of post operative pain management (i.e. in infusion), you should use

A

0.25% marcaine or ropiviacaine

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25
Q

For goal of surgical anesthesia, you should use

A

0.375-0.5% marcaine or ropivicaine
(denser)

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26
Q

Phrenic nerve is innervated at

A

C3-C5

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27
Q

Supraclavicular nerve is innervated at

A

C3-C4

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28
Q

Supraclavicular indications

A

Upper arm
Elbow
Wirst
Hand

29
Q

Supraclavicular landmark

A

Lateral to subclavian artery
Superior to first rib

30
Q

Supraclavicular: what do you aim for and what is it

A

“corner pocket”
Where 1st rib meets subclavian arter

31
Q

Nerve stimulator use in blocks

A

to ensure you are not intranueronal, especially above shoulders

32
Q

What will proglong a single shot block

A

concentration (density) of LA and adjuncts

NOT volume
(volume can affect spread)

33
Q

axillary nerve block indications

A

Forearm, hand, wrist

34
Q

Axillary block positioning

A

arm up at 90 degrees

35
Q

Axillary block landmarks

A

-musculocutaneous nerve
-axillary artery
-nerves: median, ulnar, radial

36
Q

Axillary block landmarks

A

-musculocutaneous nerve
-axillary artery
-nerves: median, ulnar, radial

37
Q

Femoral block indications

A

-hip (fracture pain control and surgery)
-Femur
-Quad
-Knee

for surgery, often used in conjunction with sciatic block for full coverage

38
Q

Femoral landmarks

A

“triangle” fascia lata
-Femoral artery
-Fascia lata
-ilioposoas muscle

39
Q

Femoral depth

A

3-5 cm

40
Q

Fascia lata

A

Femoral nerve branches within

41
Q

Adductor canal block indication

A

Knee surgery (anterior/medial aspects)
Ankle
ACL
Medial portion of leg, foot, angle

*must block with vastus medialis nerve to achieve full anterior knee analgesia

42
Q

Adductor canal block blocks the

A

saphenous nerve

43
Q

Adductor canal/saphenous triangle landmarks

A

Sartorius muscle anteriorly
Vastus medialis laterally
Adductor longus medially

44
Q

adductor canal landmarks (beyond triangle)

A

Superficial femoral artery
Femoral vein
Saphenous nerve

45
Q

adductor canal landmarks

A
46
Q

adductor canal block position

A

frog leg
(use blankets to prob leg up if necessary)

47
Q

PENG block stands for

A

perricapsular nerve group block

48
Q

PENG block indication

A

Fracture of femoral neck
Hip arthroscopy/plasty
Pain management

49
Q

PENG is a ____ block

A

Sensory only
(no motor)

50
Q

What nerves does the PENG block cover

A

obturator
Femoral
accessory obturator (50%)

51
Q

PENG block landmarks

A

Anterior superior illiac spine (ASIS)
AIIS
Pubis ligament
inguinal ligament

52
Q

PENG block reasons for failure

A

Failure to injuct under psoas muscle/tendon

Poor local spread alone ilium
(where nerves are located)

Technique

Failure to cabture lateral femoral cutaneou

53
Q

Popliteal sciatic known complications

A

foot drop
intraneural injection high risk
*use nerve stimulater and hydrodissect

54
Q

Popliteal Sciatic indications

A

Podiatry, below knee, calf, ankle
-Post operative pain management
-Surgeon preference
-Primary anesthetic

55
Q

Popliteal sciatic anatomy

A

Sciatic nerve slightly above the knee, sciatic branches into tibial and common peroneal

56
Q

Popliteal sciatic landmarks

A

Popliteal artery

Biceps femoris, semitendenous, semimembranous muscles

Bifurcation of sciatic nerve into common tibial and common peroneal nerve

57
Q

Popliteal sciatic position

A

-supine, operative leg elevated

58
Q

Popliteal sciatic transducer type and placement

A

linear array placed in popliteal crease

short axis image

59
Q

Where do you block in popliteal sciatic

A

where tibial nerve and common peroneal nerve share a sheath but are not touching

“kissing”

60
Q

For popliteal sciatic block, there is a high risk for ____ so you should ____

A

nueral injection. No adjunts, 5 mL increments, use a nerve stimulator

61
Q

a TAP (transversus abdominal planus) block is a

A

somatic block only

62
Q

TAP block indication

A

-hernia repair
-appendectomy open
-laparoscopic abdominal

63
Q

TAP block provides analgesia to

A

skin
muscle
parietal peritoneum

64
Q

Subcostal/midaxillary TAP block landmarks

A

Rectus abdominus
External oblique
Internal oblique
Transverse abdominis

65
Q

Mid axillary aka

A

lateral approach

66
Q

Mid exillary/lateral approach landmarks

A

mid axillary line superior and parallel to iliac crest

EO
IO
TA

67
Q

What type of spread do you want in TAP block?

A

lateral

68
Q

Mid axillary TAPS approach

A

through external oblique and internal oblique

block between internal oblique and transversus abdominus

69
Q

Ilioinguinal-iliohypogastric / posterior TAP block indication

A

hernias

70
Q
A

Priniclpes Of Anesthesia (19 decks)

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