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Anesthesia > Pain/Regional > Flashcards

Pain/Regional Flashcards

1
Q

A-delta

A

myelinated, sharp, well localized pain, temp, touch (somatic)

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2
Q

C fibers

A

unmyelinated, poorly localized mechanical, thermal, chemical (visceral)

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3
Q

pain course

A

a-delta/c fibers send signal to doral horn (near substantia gelatinosa), travel up spinal cord to the thalamus via ipsilateral spinoreticulothalamic tract or contralateral spinothalamic tract, some travel to somatosensory cortex and some to anterior cingulated gyrus (limbic forebrain) for emotional processing

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4
Q

allodynia

A

pain due to non painful stim

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5
Q

hyperalgesia

A

increased response to pain

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6
Q

hyperesthesia

A

exaggerated pain to noxious stimuli

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7
Q

hypoalgesia

A

decreased pain to painful stimuli

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8
Q

dyesthesia

A

unpleasant, abnormal sensation (spon/evoked)

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9
Q

how many nodes of ranvier need to be blocked

A

3

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10
Q

CRPS 1 vs CRPS 2

A

no known insult, gradual onset vs known major nerve damage and distal to central spread, both don’t follow dermatomes

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11
Q

CRPS acute

A

(first stage) 1-4 weeks; red, hot, dry skin

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12
Q

CRPS dystrophic

A

(second stage) 4 weeks - 4 months; cold, clammy, white

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13
Q

CRPS atrophic

A

(third stage) after 4 months; muscle wasting, joint destruction, bone demineralization, hair loss, nail changes, thinning of skin

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14
Q

CRPS triad

A
  1. sensory (pain, allodynia, hyoeralgesia) 2. autonomic (edema, skin color, skin temp) 3. motor (muscle weakness, spasm, decreased ROM)
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15
Q

phantom limb pain

A

all amputees get over time, no difference traumatic or not, worse with more proximal amputation, can reactivate with spinal/epidural

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16
Q

phantom treatment

A

carbamazepine or calcitonin, TENS, narcotics (epidural/PO), peripheral/central neurolysis or nerve blocks, trigger point injections

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17
Q

TENS

A

transcutaneous electrical nerve stimulation - low intensity electrical stim releases endogenous endorphins that are inhibitory at spinal cord

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18
Q

spinal cord stim placement technique

A

needle into epidural space via paramedian using fluoro

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19
Q

myofascial pain syndrome

A

widespread aching, stiffness, erythema, fluctuations in pain intensity, 3rd/4th decade of life, can have trigger points

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20
Q

myofascial treatment

A

exercise, PT, massage, LA injections

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21
Q

Post herpetic neuralgia treatment

A

4-6 weeks post outbreak; TCAs, anticonvulsants, oral analgesics, sympathetic nerve blocks, topical LA, capsaician

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22
Q

ethyl alcohol

A

painful, immediate and profound neurolysis, hypobaric, long duration, high incidence of post neurolysis neuralgia, pure - somatic blocks, diluted - sympathetic

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23
Q

phenol

A

painless, delayed and less intense neurolysis, hyperbaric, short duration, LA properties, used for peripheral nerve blocks

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24
Q

methgb susceptible

A

benzocaine, prilocaine (build up o-toluidine), NO, G6P deficiency, methbg reductase deficiency (<4 months have this), nitrites/nitrates, anti-malaria meds, phenytoin

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25
Q

methgb treatment

A

methylene blue 1-2 mg/kg over 5-10 min to avoid toxicity (restlessness, tremor, precordial pain), reduction in 30-60 min or ascorbic acid 2mg/kg

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26
Q

Methgb percentage

A

70% death

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27
Q

signs of total spinal in infant

A

apnea –> hypoxemia –> bradycardia

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28
Q

cervical plexus superficial block

A

C1-4, posterior lateral border of SCM from inferior surface of mandible to clavicle

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29
Q

cervical plexus deep block

A

C1-4, 10 ml at level of C4 transverse process or 3 injections at levels C2, 3, 4 transverse processes

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30
Q

cervical plexus block complications

A

horner’s, RLN block, epidural/intrathecal injection, phrenic or SLN block, intravascular injection

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31
Q

interscalene block

A

C6 between anterior and middle scalene, blocks roots, spares lower trunk (supplemental block for ulnar)

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32
Q

supraclavicular block

A

lateral SCM and clavicle, block trunks

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33
Q

infraclavicular block

A

blocks at cords

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34
Q

axillary block

A

blocks at branches (distal to elbow), need sup for musculocutaneous at coracobrachialis, intercostobrachial (posterior medial arm) and medial cutaneous nerve (medial forearm) by arm cuff

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35
Q

push, pull, pinch, pinch

A

push radial, pull musculocutaneous, pinch (thumb to pinky) median, pinch (pinky to thumb) ulnar

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36
Q

radial injury

A

wrist drop

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37
Q

ulnar injury

A

can’t adduct thumb or abduct pinky

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38
Q

median injury

A

can’t oppose thumb and pinky

39
Q

radial wrist block

A

anatomic snuff box (btw extensor pollicus longus & brevis)

40
Q

ulnar wrist block

A

medial to ulnar artery(btw flexor carpi ulnaris & ulnar art)

41
Q

median wrist block

A

btw palmaris longus & flexor carpi radialus tendons (injured at AC fossa with drug extravasation or needle injury

42
Q

Intercostal nerve blocks

A

8-10 cm from back midline

43
Q

TAP block location

A

between internal oblique and transverse abdominus fascia

44
Q

femoral nerve block

A

L2-4, sensory to ant thigh & knee, medial aspect of leg

45
Q

saphenous nerve block

A

only branch of femoral that innervates below the knee, block near saphenous vein at level of tibial tuberosity

46
Q

ilioinguinal/iliohypogastric block

A

T12/L1, 2 cm medial and 2 cm superior to ASIS

47
Q

lateral femoral cutaneous block

A

2 cm medial and 2 cm inferior to ASIS

48
Q

obturator block

A

1-2cm distal and lateral to pubic tubercle, hit pubic bone then redirect cephalad to obturator canal

49
Q

sciatic nerve injury

A

(innervateds hamstrings and muscles of leg and foot, sensory to outer leg and whole foot except instep and medial malleolus) weakness to all muscles below knee, L4-S3

50
Q

tourniquet contraindications

A

sickle cell, infection, ischemic vascular disease

51
Q

which LA associated with thrombophlebitis and bier block

A

chloroprocaine

52
Q

bier block doses

A

prilocaine 3-4, lidocaine 1.5-3, ropivicaine 1.2-1.8

53
Q

tourniquet inflation guidelines

A

250-275 of 100 mm Hg > SBP

54
Q

tourniquet times

A

minimum of 25 minutes before deflation, if before –> deflate then re-inflate immediately, wait 1 minute then deflate

55
Q

physio changes after tourniquet deflation

A

1-8 mm HG CO2 increase, 10-15% increase in HR, 5-10% potassium increase, ass with cerebral embolism

56
Q

describe symptoms from nerve impingement in vertebral foramina and treatment

A

unilateral numbness/parethesias, in UE with movement (extension); treat with NSAIDs, steroids, surgery

57
Q

common peroneal damage

A

no dorsal flexion of toes, no eversion of foot

58
Q

lumbar sympathetic block

A

7cm lateral and 2 cm inferior to L2 vertebral body, success leads to vasodilation of LE, elevated skin temp, decreased skin resistance

59
Q

lumbar/celiac sympathetic block complications

A

aorta/IVC puncture, perforation of renal pelvis/other organs, subarachnoid injection, somatic spread,bretroperitoneal hemorrhage, pneumo (celiac)

60
Q

celiac plexus block and success

A

T5-12 in retroperitoneal space anterior to L1, posterior to aorta and IVC; hypotension, diarrhea

61
Q

intraspinal narcotic symptoms

A

pruritis>n/v>urinary retention

62
Q

spinal additions

A

alpha agonists and neostigmine have some analgesic properties

63
Q

block succession

A

sensory then sympathetic then motor

64
Q

block lag spinal

A

sensory lags 2 dermatomal segments behind sympathetic

65
Q

spinal segment anesthetic requirements

A

1-2 ml per spinal segment in 20-40 yo, 2/3 blocked above, 1/3 blocked below (increase in age 0.75-1.5 ml)

66
Q

large dose of intrathecal LA

A

pupil dilation

67
Q

caudal landmarks

A

PSIS and sacral hiatus (between sacral cornua)

68
Q

spinal/subarachnoid space block factors

A

baricity and patient position most important for sensory level

69
Q

epidural block factors

A

increased dose (mass) more effective at faster onset and longer duration

70
Q

Taylor approach

A

L5-S1 interspace epidural injection, find PSIS and use paramedian approach

71
Q

neuraxial contraindications

A

coagulopathy, increased ICP, local/systemic infection, hypovolemic, R-L cardiac shunt, fixed cardiac lesions (AS, MS, IHSS), multiple sclerosis, spina bifida occulta

72
Q

cutting needles

A

quinke, pitkin

73
Q

conical needles

A

whitacre, sprotte, greene

74
Q

epidural hematoma

A

rapid onset of backache, b/l muscle weakness, sensory deficit, urinary retention, paraplegia, treatment within 8 hours

75
Q

epidural abscess

A

slow (5 days) onset of backache and loss of function, stage1: back pain→stage 2: radicular pain→stage 3: motor/sensory deficits→stage 4: paraplegia, dx w/MRI

76
Q

anterior spinal artery thrombosis

A

rapid, painless, flaccid paralysis 2/2 to arteria radicularis magna damage

77
Q

spinal cord blood supply

A

1 anterior spinal artery (vertebral aa at base of skull) supplies anterior 2/3, 2 posterior spinal aa (cerebellar aa) supplies posterior 1/3

78
Q

spinal cord blood supply feeders

A

intercostal arteries T9-12 (75%), lumbar arteries L1-2 (10%), artery of adamkiewitz arises from aorta on left (T9-L2/T5) –> major blood supply for anterior spinal a and lower 2/3 of spinal cord

79
Q

cauda equine syndrome

A

low back pain, BLE weakness, saddle anesthesia, loss of blowel/bladder control, assoc w/large micro catheters for cont spinal

80
Q

transient neurologic syndrome

A

pain/dyesthesia in back, buttock & LE w/IT LA esp lido (w/o sensory/motor loss or bowel/bladder dysfunction), ↑risk w/lithotomy, ambulatory, obesity, onset of sx 12-24 hours, resolves in 3 days, tx: NSAIDs

81
Q

total spinal

A

LOC 2/2 ischemic paralysis of medullary ventilatory centers b/c profound ↓BP or penetration of local thru foramen magnum, Pupilary dilation & loss of light reflex

82
Q

neuraxial pruritits treatment

A

opioid ant, mixed opioid ag-ant, diphenhydramine and hydroxyzine, propofol

83
Q

intralipid therapy

A

20% lipid emulsion, 1mk/kg bolus (can repeat), then followed by 0.25ml/kg/min after stable

84
Q

LMWH catheter placement

A

12 hours after prophylaxis, 24 hours after treatment

85
Q

Heparin catheter placement

A

4 hours after dose

86
Q

clopidogrel neuraxial

A

7 days

87
Q

ticlid neuraxial

A

14 days

88
Q

abciximab neuraxial

A

2 days

89
Q

tirofiban neuraxial

A

8 hours

90
Q

eptifibatide neuraxial

A

8 hours

91
Q

streptokinase/urokinase neuraxial

A

avoid

92
Q

transdermal fentanyl mechanism of action

A

fentanyl depot in the upper layer of skin, takes about 1 hour before seen in serum and continues to circulate for about 24 hours after patch removed

93
Q

lumbar plexus

A

ventral rami L1-4, variable contribution from T12 and L5

Anesthesia (16 decks)

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