Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AP II Test 2 > Peripheral Nerve Blocks > Flashcards

Peripheral Nerve Blocks Flashcards

1
Q

What determines our choice of anesthetic? (5)

A

time to onset
duration of action
degree of sensory block to motor block
risk of cardiac toxicity
how many areas need to be blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the dose and duration of bupivacaine?

A

3mg/kg

1.5 - 8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the dose and duration of lidocaine?

A
  1. 5 mg/kg, 7 with epi
  2. 75 - 2 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the dose and duration of mepivicaine?

A

4.5 mg/kg, 7 with epi

1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the dose and duration of ropivacaine?

A

3 mg/kg

1.5-8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the amides: (5)

A

bupivacaine

lidocaine

mepivacaine

prilocaine (used for dental, PNB)

ropivacaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name the esters: (5)

A

benzocaine

chloroprocaine

cocaine

procaine

tetracaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the concentrations of bupivicaine?

A
  1. 25%
  2. 5%
  3. 75%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the concentrations of lidocaine?

A

0.5-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the concentrations of mepivacaine?

A

1-3.5% in 0.5% increments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the concentrations of ropivacaine?

A

0.2, 0.5, 0.75, 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the max dose and duration of chloroprocaine?

A

12 mg/kg

All esters are 0.5 - 1 hr except tetracaine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the max dose and duration of cocaine?

A

3mg/kg

All esters are 0.5 - 1 hr except tetracaine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the max dose and duration of tetracaine?

A

3mg/kg

1.5-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the max dose and duration of procaine?

A

12 mg/kg

0.5-1 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do we use epinephrine? (4)

A

Intravascular marker: increase HR by 20%

Improves quality of block: increased neuronal uptake, and alpha2- adrenergic receptors

Decreases absorption: prolong action

Vasoconstriction on surgical field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What amount of epinephrine do we add to LA?

A

5 mcg/ml (1:200,000)
2.5 mcg/ml (1:400,000)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the major risks of nerve blocks?

A

Systemic toxicity, rare but fatal

Infection

Peripheral nerve damage

Note: Use B bevel needles (short bevel) to reduce risk of nerve damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What vascular areas are most to least prone to systemic toxicity? (8)

A

Tracheal
Intercostal
Caudal
Paracervical
Epidural
Brachial plexus
Sciatic
subcutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the signs and symptoms of CNS excitation toxicity? (6)

A

Dizziness
Tinnitis
Circumoral numbness
Muscle twitches
Slurred speech
Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the cardiovascular signs of toxicity? (5)

A

Depress myocardial conduction and contractility

Produce arterial vasodilatation, except cocaine

Hypotension

Bradycardia, PVCs, PACs

VT or VF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you prevent systemic toxicity?

A

Incremental injection
Frequent aspiration
Adding a marker
Limiting LA dose and concentration
Continual communication with patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In a nerve block, proceed with caution in what patients?

A

Patients with cardiac conduction abnormalities

Kidney or liver disease

Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you treat seizures from systemic toxicity?

A

midazolam, propofol, thiopental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you treat cardiac toxicity/respiratory depression during systemic toxicity?

A

Airway management
ACLS/BLS: avoid calcium channel blockes, B-blockers and lidocaine
IV lipid infusion
Cardiopulmonary bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you provide LAST lipid treatment?

A

20% Intralipid

  1. 5 mL/kg as an initial bolus, followed by
  2. 25 mL/kg/min for 30-60 minutes

Bolus could be repeated 1-2 times for persistent cardiac collapse
Infusion rate could be increased if the BP declines.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the methods to place nerve blocks?

A

Ultrasound technique: direct visualization

Peripheral nerve stimulator: motor response

Paresthesia technique: sensory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What nerves are included within the brachial plexus?

A

C5-C8, T1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What nerves can accidentally be blocked when blocking the brachial plexus?

A

Superficial cervical plexus: C3-C4

Phrenic nerve: C3, C4, C5

Intercostobrachial nerve: T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Name the brachial plexus blocks: (4)

A

Interscalene

Supraclavicular

Infraclavicular

Axillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Name the block performed with the ultrasound positions indicated in the image:

A
  1. Interscalene (roots/trunks)
  2. Supraclavicular(divisions)
  3. Infraclavicular(cords)
  4. Axillary(branches)
  5. Mid-humeral(branches)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the most commonly performed blocks for regional anesthesia?

A

Interscalene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What block provides anesthesia and analgesia for shoulder, humerus, and clavicle?

A

Interscalene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What block is performed at the level of the roots/trunks of BP, between the anterior & middle scalene muscle?

A

Interscalene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What block is traditionally unsuccessful for forearm and hand surgery because the ulnar nerve is often missed?

A

Interscalene

36
Q

What are the adverse effects and possible complications of brachial plexus blocks?

A
  • phrenic nerve palsy
  • Horner’s syndrome (stellate ganglion block)
  • Cervical plexus block (small pupil, drooped eyelid)
  • Recurrently laryngeal nerve palsy
  • Possible vertebral artery injection
  • Pneumothorax (PTX)
  • Epidural, subarachnoid injection
37
Q

What anesthetic is often used for humeral fractures or shoulder surgery?

A

Ropivacaine 0.75%

38
Q

What is also known as the spinal of the arm?

A

Supraclavicular block

39
Q

What block is performed at the DIVISIONS of the brachial plexus and is used to perform surgery for the entire arm, below the shoulder?

A

Supraclavicular block

40
Q

What are the risks of supraclavicular blocks?

A

pneumothorax

50% chance of phrenic nerve block

recurrent laryngeal nerve block

vascular puncture

41
Q

What block is indicated for elbow, forearm, and hand surgery?

A

infraclavicular, aka axillary block

least preferred

42
Q

What block is performed at the level of the terminal branches: median, ulnar, radial, and musculocutaneous nerves?

A

axillary

43
Q

Axillary block has a low complication rate and low rate of infection/hematoma. True or false?

A

false

low complication

high infection rate/hematoma

44
Q

What position must the arm be in for an axillary block?

A

abducted

45
Q

What nerve often gets overlooked in brachial plexus blocks?

A

musculocutaneous nerve

46
Q

What block provides surgical anesthesia for short procedures (<45-60 minutes) in the forearm, hand, or leg?

A

Bier block

47
Q

What items do you need to perform a bier block?

A

IV inserted on the hand

double pneumatic tourniquet

eschmark elastic bandage

0.5% lidocaine (50ml)

48
Q

What are the benefits of continuous peripheral nerve blocks?

A

Decreased sleep disturbances
Increased patient satisfaction
Possible improved early rehabilitation
Decreased narcotic side effects:

  • Nausea/vomiting
  • Pruritis
  • Sedation
49
Q

The lumbar plexus is comprised of the ventral rami of what nerves?

Name them:

A

T12, L1-L4

Iliohypogastric/ilioinguinal
Femoral
Obturator
Lateral femoral cutaneous

50
Q

The sacral plexus is comprised of the ventral rami of what nerves?

Name them:

A

L4-S4

Sciatic nerve

Tibial

Common peroneal

51
Q

What are the most commonly blocked nerves in the lumbar plexus?

A

femoral

sciatic

obdurator

52
Q

What type of block is good for providing analgesia for the hip, anterior thigh, and knee?

A

lumbar plexus block

53
Q

What nerves does the lumbar plexus block cover?

A

LFCN

femoral

obturator

54
Q

What is a lumbar plexus deep block’s distance from skin to lumbar plexus?

A

5-10 cm

55
Q

What are the complications of a lumbar plexus block?

A

renal puncture

spinal or epidural injection

hematoma

LAST

56
Q

What is the largest branch block of the lumbar plexus that arises from L2, L3, and L4?

A

femoral nerve block

57
Q

What nerve emerges from the psoas muscle and gives off articulating branches to the hip?

A

femoral nerve

58
Q

What nerve enters the leg under the inguinal ligament and then quickly divides?

A

femoral nerve

59
Q

Is the femoral nerve located more medially or laterally?

A

laterally

60
Q

What muscle is on the anterior division of the femoral nerve?

A

sartorius

61
Q

What muscle is located on the posterior division of the femoral nerve?

A

Saphenous nerve (most medial)
Muscular (quadriceps muscle)
Articular branches ( knee)
Femur

62
Q

Where do we place the transducer for a femoral nerve block?

A

Over the femoral artery at the level of inguinal ligament

63
Q

What is the needle approach to a femoral nerve block?

A

lateral to medial

64
Q

What type of block do we use for:

knee surgery: TKA, ACL reconstruction, patellar surgery

femoral ORIF, skin grafting, muscle biopsy?

A

femoral

65
Q

What block do we use for surgery involving the medial aspect of the leg?

A

femoral nerve block

66
Q

What nerve tends to be overlooked in a femoral nerve block and may need to be blocked also?

A

saphenous nerve

67
Q

What is the onset time for a femoral block using ultrasound with 20ml of buivacaine 0.5%?

A

about 15 minutes vs. about 30 minutes for an unguided block

68
Q

For any surgery involving the medial aspect of the foot/ankle or a popliteal/sciatic nerve block. you must also have what nerve blocked?

A

saphenous nerve

69
Q

What is the largest sensory branch of the femoral nerve?

A

saphenous nerve

70
Q

What are the 4 main locations we can block the saphenous nerve?

A

femoral nerve

adductor canal

below the knee

medial malleolus

71
Q

What is the largest nerve in the human body?

A

sacral plexus, sciatic nerve

L4-S3

72
Q

What are the imaging areas for the sciatic nerve?

A

popliteal

mid-thigh

subgluteal

transgluteal

73
Q

What is the sensory nerve to the posterior hip and knee?

A

sciatic nerve

74
Q

The sciatic nerve innervates what muscles? (motor function)

A

hamstrings and lower leg below the knee

75
Q

When do we use a sciatic nerve block?

A

Knee surgery(TKA), foot and ankle surgery

76
Q

What are the complications of a sciatic nerve block?

A

partial block, nerve injury

77
Q

What are complications of popliteal fossa sciatic nerve blocks?

A

incomplete blocks due to anatomical variations

sciatic nerve divides into the tibial nerve and common peroneal nerve at varying locations above the popliteal fossa

78
Q

What is the main obstacle of subgluteal sciatic nerve blocks?

A

depth of nerve, especially in large pts

79
Q

Sciatic nerve blockade in the subgluteal region is convenient and easily accessible. True or false?

A

true

80
Q

Where do you insert for sciatic nerve block?

A

groove just lateral to the upper portion of the biceps femoris muscle

81
Q

What are the indications for an ankle block?

A

foot and toe surgery

good if no tourniquet is used above the calf

82
Q

What nerves are blocked in an ankle block?

A

Deep peroneal
Superficial peroneal
Posterior tibial
Sural
saphenous

83
Q
A
84
Q

What is the concentration of benzocaine?

A

20% topical only

85
Q

For lumbar plexus block, what type of probe do you need?

A

low frequency

AP II Test 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions