Peripheral Nerve Block Scenarios Flashcards
25 yo 200 pound male with a right proximal humeral fracture and a left clavicle fracture. Pain level is 10/10. No PMH, no medications, and no allergies. Scheduled for ORIF of humerus today.
What type of block and what nerve distribution will you miss?
interscalene
will miss ulnar
25 yo 200 pound male with a right proximal humeral fracture and a left clavicle fracture. Pain level is 10/10. No PMH, no medications, and no allergies. Scheduled for ORIF of humerus today.
Which local anesthetic?
Bupivicaine
0.5%
After ORIF of proximal humerus, patient is in PACU. The nurse sees you walking by, grabs you because the patient cant take a deep breath, Sao2 are 93%. And family is wondering if patient has had a stroke. He has a right droopy eye. How do you explain the most likely cause?
Phrenic nerve accidentally blocked
Horner’s syndrome, accidentally blocked stellate ganglion
90 yo 85 pound lady comes in for ORIF of distal radius. PMH of LBBB and HTN. Axillary nerve block was done with bupivacaine 0.5% 40 mls. She tolerated block fine and went to OR. When the pneumatic tourniquet is in inflated to 250mmHg the patient complains of pain. At incision, she starts to feel ‘funny’. You notice some PVCs on her cardiac monitor.
What nerves are not blocked with an axillary nerve block that need to be covered when using a tourniquet?
Intercostal brachial nerve T2
90 yo 85 pound lady comes in for ORIF of distal radius. PMH of LBBB and HTN. Axillary nerve block was done with bupivacaine 0.5% 40 mls. She tolerated block fine and went to OR. When the pneumatic tourniquet is in inflated to 250mmHg the patient complains of pain. At incision, she starts to feel ‘funny’. You notice some PVCs on her cardiac monitor
In what order do you see CNS signs?
tinnitus, numbness, PVCs
90 yo 85 pound lady comes in for ORIF of distal radius. PMH of LBBB and HTN. Axillary nerve block was done with bupivacaine 0.5% 40 mls. She tolerated block fine and went to OR. When the pneumatic tourniquet is in inflated to 250mmHg the patient complains of pain. At incision, she starts to feel ‘funny’. You notice some PVCs on her cardiac monitor
How do you treat her issue?
Versed
What might the patient be complaining of when you see PVCs on the EKG?
tinnitus
numbness around mouth
What would you do if your patient goes into v-tach?
give lipids!
get code cart!
40 yo female presents for total elbow. She has a supraclavicular block with Lidocaine 1% with epi 20 mls.
In PACU she is SOB and restless.
Why add epinephrine? Give 2 reason?
Add epi to lengthen duration of block for lidocaine and mupivicaine only.
It is also an intravascular marker.
How much epinephrine is added as a marker?
15 mcg minimum b/c 5mcg/ml
What does an increase in concentration of local anesthetic do?
It increases the motor blockade.
40 yo female presents for total elbow. She has a supraclavicular block with Lidocaine 1% with epi 20 mls.
In PACU she is SOB and restless.
Would this be enough for anesthesia?
No (hard question to answer)
Would want .5% bupivicaine or 2% lidocaine to induce motor block b/c most would want motor blockade for surgery.
40 yo female presents for total elbow. She has a supraclavicular block with Lidocaine 1% with epi 20 mls.
In PACU she is SOB and restless.
What would cause SOB?
phrenic nerve block
pneumothorax
40 yo female presents for total elbow. She has a supraclavicular block with Lidocaine 1% with epi 20 mls.
In PACU she is SOB and restless.
How long do we expect the block to last?
1.5 - 2 hours
44 yo healthy male has torn his achilles tendon playing basketball. He presents for an achilles tendon reconstruction. You decide to do a popliteal block and sedation. He goes to the OR is placed in the prone position, and when surgery starts, he states, “I can feel that”
What nerve(s) did you miss?
