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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
Q

3 main terminal branches that branch to the hand

A

radial
median
ulnar

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26
Q

the interscalene block is best suited to what surgeries

A
  • SHOULDER AND UPPER ARM
  • SURGERY(proximal to elbow)
  • shoulder
  • clavicle
  • proximal humerus
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27
Q

which part of the anatomy has the greatest variability?

A

terminal nerves (branches)

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28
Q

most reliable block to produce cervical plexus anesthesia (shoulder)

A

supraclavicular

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29
Q

nickname: the spinal of the arm (which block)

A

supraclavicular

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30
Q

best block for ambulatory settings

A

axillary block

typically serves as an anesthetic block

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31
Q

block best suited for hand surgeries

A

axillary

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32
Q

which block usually requires multiple injections because of greater separation of the terminal nerves

A

axillary

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33
Q

interscalene blocks performed at what level of the anatomy?

A

roots

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34
Q

At what level of the anatomy are infraclavicular blocks performed

A

the cords

  • the lateral cord
  • medial cord
  • posterior cord
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35
Q

medial nerve combines

A

the lateral and medial cord

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36
Q

the medial nerve becomes the

A

ulnar nerve

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37
Q

at what level of the anatomy are axillary blocks performed?

A

terminal nerves AKA the BRANCHES

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38
Q

where is the greatest variability in the anatomy

A

terminal nerves

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39
Q

what are the 3 main nerves that branch to the hand?

A

radial-posterior to axillary artery

median-superior to the axillary artery

ulnar-inferior to the axillary artery

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40
Q

direction for peripheral nerve stimulator approach for interscalene block

A

ALWAYS posterior and lateral

NEVER cephalad or medial (vertebral artery or dura puncture risk)

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41
Q

nerves always lie ______ to the lung

A

superior

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42
Q

perivascular injection is the easiest technique and is used for which block?

A

axillary
the needle is advanced as close as possible to the AA while aspirating
LA injected to opposite sides of the artery.

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43
Q

COPD is a relative contraindication for which block? why?

A

interscalene

possibility of phrenic nerve paralysis (rare)

44
Q

which LA takes longest for the onset

A

-0.5% ropivacaine 15-20min

instead of 5-15 min of 1.5% mepivacaine and 2% lidocaine

45
Q

what volume of LA is needed for an axillary block?

A

35-40cc, upper limit is 50cc

10mL/branch

46
Q

how long does 0.5% ropivacaine last ANESTHESIA

A

6-8 hours

47
Q

how long does 2% lido last ANESTHESIA

A

3-6 hours

48
Q

how long does 1.5% mepivacaine last? ANESTHESIA

A

2.5-4 hours

49
Q

how long does 0.5% ropivacaine last? ANALGESIA

A

8-12 hours

50
Q

how long does 2% lido last? ANALGESIA

A

5-8 hours

51
Q

how long does 1.5% mepivacaine last? ANALGESIA

A

3-6 hours

52
Q

what does clonidine 150mcg do in a block

A

prolongs anesthesia

when added to mepivicaine an additional 4 hours can be provided

53
Q

what does adding bicarb to a block do?

A

quickens onset by raising onset closer to the pka of the LA

54
Q

which LAs is bicarb added to?

A

lido and mepivicaine

1ml 8.4% for every 10 ml

55
Q

what are the 3 types of regional anesthesia?

A
  • field blocks
  • peripheral nerve blocks
  • central neuraxial nerve blocks
56
Q

what is potency determined by?

A

lipid solubility

how fast it will soak through

57
Q

what is duration determined by?

A

protein binding

58
Q

what is LA onset determined by

A

pKa

higher the pKa, the slower the onset (more ionized)

59
Q

onset order of fibers

A

c, b, a-delta, a-gamma, a-beta, a-alpha

60
Q

A-alpha
modality?
diameter?
myelinated?

A

motor/proprioception
12-20mm
yes

61
Q

A-Beta
modality?
diameter?
myelinated?

A

touch/psi
5-12mm
yes

62
Q

A-Gamma
modality?
diameter?
myelinated?

A

motor
3-6mm
yes

63
Q

A-Delta
modality?
diameter?
myelinated?

A

pain(sharp)/temp/touch
2-5mm
yes

64
Q

B fiber
modality?
diameter?
myelinated?

A

autonomics
<3mm
some

65
Q

C fiber
modality?
diameter?
myelinated?

A

pain(dull/psi) temp
0.4-1.2mm
no

66
Q

rheobase

A

minimal current needed to stimulate a nerve

67
Q

chronaxie

A

the duration of current required to achieve twice the stimulation that the rheobase produces

68
Q

an appropriate muscle twitch for a given nerve at

A

0.2-0.5mA

69
Q

<0.2mA may indicate what

A

intraneural needle placement

70
Q

how long can a perineural catheter be left in?

A

5 days

71
Q

high frequency probe___-____MHz

A

5-13MHz
shallow penetration-but higher resolution
appropriate for 4cm and shallower
nerves, blood vessels, arteries

72
Q

low frequency probe ____-____MHz

A

2-5MHz
penetrate deeper-lower resolution
appropriate for 4-30cm

73
Q

in plane

needle is ____ w US beam

A

parallel

74
Q

out of plane

needle is ______ w US beam

A

perpendicular

75
Q

gain

A

increase or decrease the contrast of the image

how light or dark the image is

76
Q

trunks are housed within what

A

fascial sheath

77
Q

lateral cord***

A

musculocutaneous nerve and median nerve (lateral root)

78
Q

medial cord splits to become…

A

ulnar nerve and median nerve (medial root)

79
Q

posterior cord

A

divides into the axillary and radial nerve

80
Q

radial nerve (C5-T1)

A

dorsal extensor muscles(triceps)

sensory-extensor region of the arm, forearm and hand

81
Q

musculocutaneous nerve (C5-7)

A 
flexor muscles(biceps)
sensory-lateral aspect of the forearm
82
Q

median and ulnar nerves

A

pass through arm and provide motor and sensory innervation to the forearm and hand

83
Q

horner’s syndrome

what are the signs?

A

-ptosis
-miosis
-anhydrosis
all on ipsilateral side(same side)

84
Q

lumbar plexus

provide:
* *********

A

sensory and motor to the anterior thigh and sensory to the medial leg

85
Q

3 major nerves in the lumbar plexus

A

1) femoral (L2-4)
lateral femoral
2) cutaneous (L1-3)
3) Obturator-(L2-4)

86
Q

nerves of the sacral plexus

A

L4/5-S1-4

87
Q

what does the sacral plexus innervate

******

A

the posterior thigh and most of the leg and foot

88
Q

what does the posterior femoral cutaneous nerve of the sacral plexus innervate?

A

S1-3

the posterior thigh

89
Q

what are the lower extremity nerve blocks of lumbar plexus?

A

lumbar plexus

  • femoral nerve block
  • saphenous/adductor canal nerve block
  • fascia illiac
90
Q

in which nerve block will the quad function be impacted (falling)

A

femoral nerve block

91
Q

what is a femoral nerve block utilized for what surgeries?

A

hip, thigh, knee, and ankle surgery

typically analgesic

92
Q

an ankle block is 5 nerve blocks. what are they?

A 
deep peroneal
superficial peroneal
saphenous
posterior tibial
sural
93
Q

TAP block does not cover what

A

visceral pain
they feel like they were kicked in the gut.
only covers incisional pain

94
Q

Bier block volumes****

A

50mL 0.5% PF Lidocaine

95
Q

anatomically, where are interscalene blocks performed?

A

The roots pass bw the posterior fascia of the anterior scalene and the anterior fascia of the middle scalene muscle.

96
Q

the trunks are housed within a

A

fascial sheath

97
Q

nerve blocks of the sacral plexus

A

sacral plexus

  • sciatic nerve block(major nerve of this plexus)
  • popliteal nerve block (tibial and common peroneal nerve block)
98
Q

what is a saphenous/adductor canal block used for?

A

analgesic block
used for TKA and ankle surgery
quad sparing-ONLY SENSORY BLOCKED NOT MOTOR

99
Q

sciatic nerve block

A

pt unable to bear weight

for hip, thigh, knee, leg, or foot

100
Q

Where is the target in a TAP block?

A

IN the fascial plane between the internal oblique and transverse abdominis

external oblique
internal oblique
transversus abdominal

bw the 2nd and 3rd layer

101
Q

the adductor canal block, blocks which nerve

A

saphenous nerve

saphenous nerve runs under the sartorius muscle in the adductor canal

102
Q

bier block

how long does the tourniquet have to be up to prevent LAST?

A

20 min

103
Q

sciatic nerve branches to the ______ and _____ nerves in the leg

A

common peroneal and tibial nerve

104
Q

in a regional block, what do you lose from 1st to last?

A

pain, temp, touch, proprioception, motor

105
Q

adding 50mcg of precedex prolongs the block how long?

A

4-8h

106
Q

adding 4-8 of decadron prolongs the block how long?

A

2-4h

107
Q

what is the pulse width?

A

100m/sec which will stimulate A-alpha (motor neurons) but will not cause pain

6903 - Special Populations (16 decks)

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