Neuraxial blocks Flashcards

1
Q

Vertebral column is formed by __ vertebrae?

A

33

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2
Q

Describe how many cervical, thoracic, lumbar, sacral, & coccygeal vertebrae there are.

A
Cervical= 7
Thoracic= 12
Lumbar= 5
Sacral= 5-fused
Coccygeal= 4-fused
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3
Q

Describe the types of curves that exist in the spine.

A

Cervical & lumbar= lordosis

Thoracic & sacral= kyphosis

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4
Q

_____ & _______ join the anterior and posterior segments of the vertebra to form the vertebral foramen

A

Lamina & pedicles

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5
Q

The vertebral foramen contains the

A

spinal cord, nerve roots, and epidural space

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6
Q

Cervical and thoracic spinous processes angle in a ______ direction which requires more _________ approach with the needle

A

caudal; cephalad

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7
Q

The lumbar spinous processes project in a posterior direction which is beneficial because

A

it increases ease of access for placement of neuraxial anesthesia

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8
Q

The intervertebral disc separate ______ and act

A

each vertebra and act as shock absorbers

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9
Q

Spinal nerves exit the vertebral column through

A

the intervertebral foramina

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10
Q

_________ reduces the size of the intervertebral foramina

A

disc degeneration

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11
Q

Disc degeneration can lead to

A

nerve compression and manifest as pain, parathesias, and/or motor deficits

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12
Q

Surface landmark: vertebra prominens

A

C7

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13
Q

Surface landmarks: spine of scapula

A

T3

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14
Q

Surface landmarks: inferior angle of scapula

A

T7

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15
Q

Surface landmarks: rib margin 10 cm from midline

A

L1

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16
Q

Surface landmarks: superior aspect of iliac crest

A

L4

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17
Q

Surface landmarks: posterior superior iliac spine

A

S2

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18
Q

Tuffier’s line correlates with

A

L4

in infants up to 1 year it is L5-S1 interspace

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19
Q

The facet joints are responsible for

A

guiding and restricting the movement of the vertebral column

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20
Q

Injury to facet joint can

A

compress nerves leading to pain and muscle spasms

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21
Q

What spinal level coincides with the conus medullaris in adults?

A

L1-L2

22
Q

What spinal level coincides to the conus medullaris in the infant?

A

L3

23
Q

What spinal level coincides with the dural sac in the adult?

A

S2

24
Q

What spinal level coincides with the dural sac in the infant?

A

S3

25
Q

What is the bundle of spinal nerves that extend from the conus medullaris to the dural sac?

A

cauda equina

26
Q

The filum terminale is fixated at which two points?

A

conus medullaris

coccyx

27
Q

Describe the significance of the sacral hiatus

A

provides an entry point to the epidural space- useful in pediatrics

28
Q

The sacral hiatus coincides with

A

S5

29
Q

The sacral hiatus is covered by the

A

sacroccocygeal ligament

30
Q

Bony nodules that flank the sacral hiatus are known as

A

sacral cornua

they are used as landmarks for caudal anesthesia

31
Q

Order the spinal ligaments from superficial to deep: anterior longitudinal ligament, posterior longitudinal ligament, interspinous ligament, ligamentum flavum, supraspinous ligament

A
  1. supraspinous ligament
  2. interspinous ligament
  3. ligamentum flavum
  4. posterior longitudinal ligament
  5. anterior longitudinal ligament
32
Q

With either the midline or paramedian approach, the needle should NEVER pass through

A

the anterior longitudinal ligament and the posterior longitudinal ligament

33
Q

Ligaments transversed in the midline approach:

A

supraspinous ligament
interspinous ligament
ligamentum flavum

34
Q

Ligaments transversed in the paramedian or Taylor approach

A

ligamentum flavum

35
Q

The cranial border of the epidural space is

A

the foramen magnum

36
Q

The caudal border of the epidural space is the

A

sacrococcxygeal ligament

37
Q

The anterior border of the epidural space is the

A

posterior longitudinal ligament

38
Q

The lateral border of the epidural space is the

A

vertebral pedicles

39
Q

The posterior borders of the epidural space is the

A

ligamentum flavum and vertebral lamina

40
Q

The epidural space communicates with the _____ space by way of the

A

paravertebral space by way of the intervertebral foramina

41
Q

The epidural space contains

A

nerve roots, fat pads, and blood vessels

42
Q

Epidural fact acts as a sink for

A

liphophilic drugs, reducing their bioavailability

bupivacaine> lidocaine & fentanyl> morphine

43
Q

Epidural veins or Batson’s plexus work to drain

A

venous blood from the spinal cord

44
Q

Obesity & pregnancy increase intraabdominal pressure leading to

A

engorgement of the plexus

associated with increased risk of needle injury or cannulation during neuraxial anesthesia

45
Q

Describe the 3 meningeal layers from outside to inside

A
dura mater
subdural space
arachnoid mater
subarachnoid space
pia mater
46
Q

This mater should never be punctured during spinal anesthesia

A

Pia mater

47
Q

The pia mater is the external covering of

A

the spinal cord

48
Q

The subarachnoid space contains

A

CSF, nerve roots, rootlets, and the spinal cord

49
Q

The target of spinal anesthesia is the

A

subarachnoid space

50
Q

Inadvertent local anesthetic injection into the subdural space will cause

A

a high spinal (if using epidural dosing) or a failed spinal (if using spinal dosing)