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AP: Cumulative > Peripheral Nerve Blocks > Flashcards

Peripheral Nerve Blocks Flashcards

1
Q

What class of drug includes bupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine?

A

Amides

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2
Q

What is the maximum dose and duration for bupivacaine?

A

Max dose = 3 mg/kg

duration = 1.5 to 8 hours

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3
Q

What is the maximum dose and duration for lidocaine?

A

Max dose = 4.5 mg/kg (7 w epi)

duration = 0.75 to 2 hours

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4
Q

What is the maximum dose and duration for mepivacaine?

A

Max dose = 4.5 mg/kg ( 7 w epi)

duration = 1 to 2 hours

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5
Q

What is the maximum dose and duration for ropivacaine?

A

Max dose = 3 mg/kg

duration = 1.5 to 8 hours

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6
Q

What drug can be added to lidocaine in mepivacaine to prolong their action?

A

Epinephrine

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7
Q

Benzocaine, chloroprocaine, cocaine, procaine, and tetracaine all fall into what category of drugs?

A

Esters

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8
Q

It is more common to have an allergic reaction to amides or esters? why?

A

Esters

PABA

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9
Q

A toxic dose of benzocaine can cause what?

A

Met hemoglobinemia

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10
Q

How is met hemoglobinemia treated?

A

Methyline blue

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11
Q

Why is epinephrine added to local anesthetics?

A

Intravascular marker
improves quality of block
decreases absorption (prolong action)
vasoconstriction on surgical field

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12
Q

What are the three major risks of nerve blocks?

A

Systemic toxicity
infection
peripheral nerve damage

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13
Q

What is LAST?

A

Local anesthetic systemic toxicity

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14
Q

Which CNS symptoms come first C&S excitation or CNS depression?

A

CNS excitation

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15
Q

What are the cardiovascular effects of LAST?

A

Depression of myocardial conduction and contractility

production of arterial vasodilatation

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16
Q

How can LAST be prevented?

A 
Incremental injection
Frequent aspiration
Adding a marker
Limiting local anesthetic dose and concentration
Communication with the patient
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17
Q

How is LAST treated?

A 
Seizures: Versed, propofol, thiopental
Cardio/pulmonary symptoms: airway management
ACLS/BLS
Intralipid infusion
CP Bypass
18
Q

How is Intralipid administered?

A

1.5 mL/kg as an initial bolus followed by .25 mL/kg/min for 30 to 60 minutes

19
Q

Name three techniques for placement of blocks

A

Ultrasound technique
Peripheral nerve stimulator
Paresthesia technique

20
Q

The brachial plexus stems from what roots?

A

C5-8, T1

21
Q

Name the five main branches of the brachial plexus?

A 
Musculocutaneous 
axillary 
Radial 
 median 
Ulnar
22
Q

Name the three main nerves or groups of nerves that are in Close proximity to the brachial plexus

A

Superficial cervical plexus
Phrenic nerve
Intercostal brachial nerve

23
Q

What are the main approaches to the brachial plexus?

A

Interscalene
Supraclavicular
Infraclavicular
Axillary

24
Q

What type of block is most commonly done for shoulder, humorous and clavicle procedures?

A

Interscalene block

25
Q

What area is commonly missed by an interscalene block?

A

C8-T1 ulnar nerve

26
Q

In what patients would you be most concerned with the possibility of phrenic nerve palsy?

A 
Ascites
Pregnant
COPD
Respiratory depression
Oxygen dependent
Obese
27
Q

What type of block would you perform for surgeries for the entire arm below the level of the shoulder?

A

Supraclavicular block

28
Q

Supraclavicular blocks are performed at what level of the brachial plexus?

A

At the level of the divisions

29
Q

What type of block is performed at the level of the cords and is indicated for elbow forearm and hand surgery?

A

Infraclavicular

30
Q

What type of block is performed at the level of the terminal branches for elbow forearm and hand surgery?

A

Axillary

31
Q

How is a bier block performed?

A

By inserting IV catheter distally, inflating a double pneumatic tourniquet, wrapping the arm in eschmark elastic bandages and injecting 50mL of 0.5% lidocaine

32
Q

What type of block would be performed for surgery on the hip anterior thigh and knee?

A

Lumbar plexus block

33
Q

What nerves does the lumbar plexus block cover?

A

Femoral nerve
Lateral femoral cutaneous nerve
Obturator nerve

34
Q

The femoral nerve is medial or lateral to the artery?

A

Lateral

35
Q

Femoral nerve blocks are performed for what types of surgeries?

A

Knee surgeries
Femoral ORIF
Surgery involving the medial aspect of the leg

36
Q

What is the largest sensory branch of the femoral nerve?

A

Saphenous nerve

37
Q

What is the largest nerve of the leg?

A

Sciatic nerve

38
Q

The sciatic nerve is composed of what 2 nerves?

A

Tibial nerve and common peroneal nerve

39
Q

What are the two common approaches to a sciatic nerve block?

A

Popliteal fossa and subgluteal

40
Q

What type of block is performed for foot and toe surgeries?

A

Ankle block

41
Q

Which nerves are blocked in the ankle block?

A 
Deep peroneal
Superficial peroneal
Posterior tibial
Sural
Saphenous

AP: Cumulative (40 decks)

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