POCUS - Nerve Blocks Flashcards
The fascia lata is ________ to the fascia iliaca.
superficial
The FICNB should be injected ______ the fascia iliaca.
below/deep to
The three nerves that need to be blocked in the FICNB are what?
Lateral femoral cutaneous neve
Obturator nerve
Femoral nerve
What side effect do you need to keep in mind with FICNBs?
LAST (local anesthetic, systemic toxicity)
The antidote for LAST is ___________.
intralipids
Before you do an extremity nerve block, always check ________________ beforehand.
neuro vascular exam
What dose of buivacaine do you use for FICNB?
20-30 mL of 0.25% bupivicaine
2 mg/kg max
What are contraindications for femoral nerve block?
Coagulopathy, overlying cellulitis, and multisystem trauma
The multisystem trauma is because people may develop compartment syndrome and if they are numb they cannot report symptom change.
The FICNB is injected _________ to the femoral nerve block.
about two inches lateral
The landmark is 1/3 of the way from the ASIS to the pubic symphysis.
What does the superficial cervical plexus block?
Th anterolateral neck, submandibular area, earlobe/posterior pinna, and supraclavicular area. It can provide anesthesia for IJ CVCs and clavicle fractures.
The superficial cervical block hits nerves that are between which two muscles?
SCM and LSM (levator scapulae muscle)
Linear probe goes transverse at the level of the superior border of the thyroid cartilage with the dot pointed anterior/medial. Slide posterior until you see the LSM and hit the nerves between there.
True or false: the interscalene block numbs the whole arm.
False
It numbs shoulder to elbow. The supraclavicular brachial plexus blocks the forearm.
Where do you find the interscalene block?
Have the patient look contralateral. With the probe transverse at the level of the cricoid cartilage (so inferior to the superficial cervical block) look for the SCM. The AS is deep to the SCM and posterior to the IJ. The brachial blexus is between the AS and the MS.
Alternatively, you can also start at the clavicle and fan up. First find the supraclavicular brachial plexus (next to the subclavian) and fan back.
The interscalene block needs to be deep to the ______________ fascia.
prevertebral
True or false: the SCM is deep to the prevertebral fascia.
False
In a view of the interscalene block, how are the nerve roots organized?
Top = C5
Bottom = C8
For subclavian brachial plexus blocks, the subclavian artery passes through which of the two scalene muscles?
Anterior and middle
In doing a subclavian brachial plexus block, the brachial plexus is ____________ to the subclavian artery. The subclavian artery is ___________ to the first rib.
lateral; superficial
The supraclavicular nerve block anesthetizes what?
The whole arm – shoulder to hand
What is RAPTIR?
Retroclavicular APproach To the Infraclavicular Region
The RAPTIR block provides the same anesthesia as the ________________.
supraclavicular block
Where should your probe be in the RAPTIR block?
Linear probe
Sagittal orientation
Distal clavicle
Indicator to the head
Pointing
In the RAPTIR block, the axillary vein is __________ to the axillary artery.
anterior
The RAPTIR block is injected just posterior to ____________.
the axillary artery
How is the RAPTIR different than the traditional infraclavicular block?
The RAPTIR goes under the clavicle to get to the axilla, whereas the traditional infraclavicular block goes over.
In doing the axillary nerve block, the axillary nerve will be seen superior to the ___________ artery.
posterior circumflex
In doing the axillary block, the teres minor is _________ to the teres major.
superior
What position do you get in for the axillary nerve block?
Patient is prone
Linear probe
Sagittal with dot cephalad
Inject needle from cephalad to caudad
What position do you get in for the axillary nerve block?
Patient is prone
Linear probe
Sagittal with dot cephalad
Inject needle from cephalad to caudad
The musculocutaneous nerve runs between which two muscles?
Biceps and coracobrachialis
The musculocutaneous block innervates which region?
Anterior forearm
The musculocutaneous block is done how?
Arm abducted and externally rotated
Probe transverse on the medial upper arm/distal axilla
Find the nerve beween the biceps and coracobrachialis
How do you find the ulnar nerve?
Locate it next to the ulnar artery and ulnar styloid and then scroll proximally until you find the split into the superficial and deep branches.
What muscle runs just anterior and ulnar to the ulnar nerve?
Flexor carpi ulnaris
The median nerve lies between which two muscles?
Flexor digitorum superficialis and profundis
Proximal to the elbow, the median nerve runs parallel to which artery?
Brachial
The radial nerve is always ____________ to the radial artery.
radial
In the erector spinae block, you can see what muscles?
Superficial to deep:
- Trapezius
- Rhomboid
- Erector spinae
- Intercostal
On US, how can you tell the difference between rib and transverse process?
Ribs are round, TP is flat
The erector spinae block goes between what two landmarks?
Transverse process and erector spinae muscle
What region is anesthetized by the erector spinae block?
Hemithorax region, 3 levels above and 4 levels below the injection
What region is anesthetized by the posterior tibial nerve block?
Most of the sole of the foot
Where do you find the posterior tibial nerve?
Posterior to the posterior tibial artery
Where do you have the probe for the posterior tibial block?
Leg is externally rotated
Probe is a couple cm proximal to the medial malleolus with the dot anterior
What is the PENG block?
Pericapsular nerve group
What does the PENG block anesthetize?
Acetabulum and pubic rami
Between what two landmarks does the PENG block go?
Psoas and ilac crest between ASIS and pubic eminence
In doing the suprainguinal nerve block, where does the probe go and what do you see?
It goes perpendicular to the ilium.
You see the “bowtie” with the sartorius inferior and the internal oblique superior and the iliacus in the middle.
