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6903 - Special Populations > PNB > Flashcards

PNB Flashcards

1
Q

Randy Travis Drinks Cold Beer

A 
roots 5
trunks 3
divisions 6, 
cords  3
terminal nerves/(branches)
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2
Q

supraclavicular block is performed where?

A

where the trunks and divisions are close together in the fascia before branching occurs

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3
Q

where does the supraclavicular block provide sensory anesthesia?

A

the hand and entire forearm

most practitioners use it for the mid humerus level

if enough LA is used, it can be used for the shoulder

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4
Q

major landmarks in an infraclavicular block

A

C6 tubercle and the coracoid process

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5
Q

axillary blocks are best suited for _____ surgeries

A

hand

with supplementation can provide anesthesia to the forearm

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6
Q

axillary blocks provide anesthesia to the ….

A

3 terminal nerves of the hand.

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7
Q

intravascular injection is most concerning with which block?

A

interscalene bc of the proximity of the verterbral artery to the cervical roots

a molecule of LA in the vertebral artery will produce a seizure

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8
Q

pneumo highest risk

A

with supraclavicular technique <1%

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9
Q

horner’s syndrome

what is it?

A

with interscalene block: inadvertent anesthetizing of sympathetic trunk feeding the head

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10
Q

epi 1:400,000

A

helps detect intravascular injection

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11
Q

epi 1:200,000

A

prolongs the duration of the block especially with lido and mepivicaine

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12
Q

epi in block increases the risk of neuropathy

A

in those who have neuropathies

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13
Q

sodium bicarbonate in a block

A

quickens onset by raising pH of the soln closer to pKa of the LA (unionized drug crosses more freely)

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14
Q

how much bicarb is added to a block?

A

for lido and mepivicaine, 1ml 8.4% is added to every 10ml of LA

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15
Q

evaluating the radial nerve after a block

A

push-extension of the forearm

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16
Q

evaluating the musculocutaneous nerve after a block

A

pull-flexion of the forearm

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17
Q

evaluating the median nerve after a block

A

pinch-sensory to index and middle fingers, motor flexion of fingers and wrist

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18
Q

evaluating the ulnar nerve after a block

A

pinch-sensory to pinky finger and ring finger, motor abduction of thumb and pinky

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19
Q

roots (location)

A

C5-T1 (known as brachial plexus)

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20
Q

anesthesia of the roots includes

A

dermatomes C4-C7

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21
Q

upper trunk

A

C5-C6

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22
Q

middle trunk

A

C7

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23
Q

lower trunk

A

C8-T1

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24
Q

what block is performed at the trunks

A

supraclavicular

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25
3 main terminal branches that branch to the hand
radial median ulnar
26
the interscalene block is best suited to what surgeries
- SHOULDER AND UPPER ARM - SURGERY(proximal to elbow) - shoulder - clavicle - proximal humerus
27
which part of the anatomy has the greatest variability?
terminal nerves (branches)
28
most reliable block to produce cervical plexus anesthesia (shoulder)
supraclavicular
29
nickname: the spinal of the arm (which block)
supraclavicular
30
best block for ambulatory settings
axillary block | typically serves as an anesthetic block
31
block best suited for hand surgeries
axillary
32
which block usually requires multiple injections because of greater separation of the terminal nerves
axillary
33
interscalene blocks performed at what level of the anatomy?
roots
34
At what level of the anatomy are infraclavicular blocks performed
the cords - the lateral cord - medial cord - posterior cord
35
medial nerve combines
the lateral and medial cord
36
the medial nerve becomes the
ulnar nerve
37
at what level of the anatomy are axillary blocks performed?
terminal nerves AKA the BRANCHES
38
where is the greatest variability in the anatomy
terminal nerves
39
what are the 3 main nerves that branch to the hand?
radial-posterior to axillary artery median-superior to the axillary artery ulnar-inferior to the axillary artery
40
direction for peripheral nerve stimulator approach for interscalene block
ALWAYS posterior and lateral NEVER cephalad or medial (vertebral artery or dura puncture risk)
41
nerves always lie ______ to the lung
superior
42
perivascular injection is the easiest technique and is used for which block?
axillary the needle is advanced as close as possible to the AA while aspirating LA injected to opposite sides of the artery.
43
COPD is a relative contraindication for which block? why?
interscalene | possibility of phrenic nerve paralysis (rare)
44
which LA takes longest for the onset
-0.5% ropivacaine 15-20min instead of 5-15 min of 1.5% mepivacaine and 2% lidocaine
45
what volume of LA is needed for an axillary block?
35-40cc, upper limit is 50cc 10mL/branch
46
how long does 0.5% ropivacaine last ANESTHESIA
6-8 hours
47
how long does 2% lido last ANESTHESIA
3-6 hours
48
how long does 1.5% mepivacaine last? ANESTHESIA
2.5-4 hours
49
how long does 0.5% ropivacaine last? ANALGESIA
8-12 hours
50
how long does 2% lido last? ANALGESIA
5-8 hours
51
how long does 1.5% mepivacaine last? ANALGESIA
3-6 hours
52
what does clonidine 150mcg do in a block
prolongs anesthesia when added to mepivicaine an additional 4 hours can be provided
53
what does adding bicarb to a block do?
quickens onset by raising onset closer to the pka of the LA
54
which LAs is bicarb added to?
lido and mepivicaine | 1ml 8.4% for every 10 ml
55
what are the 3 types of regional anesthesia?
- field blocks - peripheral nerve blocks - central neuraxial nerve blocks
56
what is potency determined by?
lipid solubility | how fast it will soak through
57
what is duration determined by?
protein binding
58
what is LA onset determined by
pKa | higher the pKa, the slower the onset (more ionized)
59
onset order of fibers
c, b, a-delta, a-gamma, a-beta, a-alpha
60
A-alpha modality? diameter? myelinated?
motor/proprioception 12-20mm yes
61
A-Beta modality? diameter? myelinated?
touch/psi 5-12mm yes
62
A-Gamma modality? diameter? myelinated?
motor 3-6mm yes
63
A-Delta modality? diameter? myelinated?
pain(sharp)/temp/touch 2-5mm yes
64
B fiber modality? diameter? myelinated?
autonomics <3mm some
65
C fiber modality? diameter? myelinated?
pain(dull/psi) temp 0.4-1.2mm no
66
rheobase
minimal current needed to stimulate a nerve
67
chronaxie
the duration of current required to achieve twice the stimulation that the rheobase produces
68
an appropriate muscle twitch for a given nerve at
0.2-0.5mA
69
<0.2mA may indicate what
intraneural needle placement
70
how long can a perineural catheter be left in?
5 days
71
high frequency probe___-____MHz
5-13MHz shallow penetration-but higher resolution appropriate for 4cm and shallower nerves, blood vessels, arteries
72
low frequency probe ____-____MHz
2-5MHz penetrate deeper-lower resolution appropriate for 4-30cm
73
in plane | needle is ____ w US beam
parallel
74
out of plane | needle is ______ w US beam
perpendicular
75
gain
increase or decrease the contrast of the image how light or dark the image is
76
trunks are housed within what
fascial sheath
77
lateral cord*******
musculocutaneous nerve and median nerve (lateral root)
78
medial cord splits to become...
ulnar nerve and median nerve (medial root)
79
posterior cord
divides into the axillary and radial nerve
80
radial nerve (C5-T1)
dorsal extensor muscles(triceps) | sensory-extensor region of the arm, forearm and hand
81
musculocutaneous nerve (C5-7)
``` flexor muscles(biceps) sensory-lateral aspect of the forearm ```
82
median and ulnar nerves
pass through arm and provide motor and sensory innervation to the forearm and hand
83
horner's syndrome | what are the signs?
-ptosis -miosis -anhydrosis all on ipsilateral side(same side)
84
lumbar plexus provide: * *************************
sensory and motor to the anterior thigh and sensory to the medial leg
85
3 major nerves in the lumbar plexus
1) femoral (L2-4) lateral femoral 2) cutaneous (L1-3) 3) Obturator-(L2-4)
86
nerves of the sacral plexus
L4/5-S1-4
87
what does the sacral plexus innervate | ****************
the posterior thigh and most of the leg and foot
88
what does the posterior femoral cutaneous nerve of the sacral plexus innervate?
S1-3 | the posterior thigh
89
what are the lower extremity nerve blocks of lumbar plexus?
lumbar plexus - femoral nerve block - saphenous/adductor canal nerve block - fascia illiac
90
in which nerve block will the quad function be impacted (falling)
femoral nerve block
91
what is a femoral nerve block utilized for what surgeries?
hip, thigh, knee, and ankle surgery | typically analgesic
92
an ankle block is 5 nerve blocks. what are they?
``` deep peroneal superficial peroneal saphenous posterior tibial sural ```
93
TAP block does not cover what
visceral pain they feel like they were kicked in the gut. only covers incisional pain
94
Bier block volumes**************
50mL 0.5% PF Lidocaine
95
anatomically, where are interscalene blocks performed?
The roots pass bw the posterior fascia of the anterior scalene and the anterior fascia of the middle scalene muscle.
96
the trunks are housed within a
fascial sheath
97
nerve blocks of the sacral plexus
sacral plexus - sciatic nerve block(major nerve of this plexus) - popliteal nerve block (tibial and common peroneal nerve block)
98
what is a saphenous/adductor canal block used for?
analgesic block used for TKA and ankle surgery quad sparing-ONLY SENSORY BLOCKED NOT MOTOR
99
sciatic nerve block
pt unable to bear weight | for hip, thigh, knee, leg, or foot
100
Where is the target in a TAP block?
IN the fascial plane between the internal oblique and transverse abdominis external oblique internal oblique transversus abdominal bw the 2nd and 3rd layer
101
the adductor canal block, blocks which nerve
saphenous nerve | saphenous nerve runs under the sartorius muscle in the adductor canal
102
bier block | how long does the tourniquet have to be up to prevent LAST?
20 min
103
sciatic nerve branches to the ______ and _____ nerves in the leg
common peroneal and tibial nerve
104
in a regional block, what do you lose from 1st to last?
pain, temp, touch, proprioception, motor
105
adding 50mcg of precedex prolongs the block how long?
4-8h
106
adding 4-8 of decadron prolongs the block how long?
2-4h
107
what is the pulse width?
100m/sec which will stimulate A-alpha (motor neurons) but will not cause pain

6903 - Special Populations (16 decks)

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