POCUS - Nerve Blocks

Question 1

The fascia lata is ________ to the fascia iliaca.

Answer 1

superficial

Question 2

The FICNB should be injected ______ the fascia iliaca.

Answer 2

below/deep to

Question 3

The three nerves that need to be blocked in the FICNB are what?

Answer 3

Lateral femoral cutaneous neve
Obturator nerve
Femoral nerve

Question 4

What side effect do you need to keep in mind with FICNBs?

Answer 4

LAST (local anesthetic, systemic toxicity)

Question 5

The antidote for LAST is ___________.

Answer 5

intralipids

Question 6

Before you do an extremity nerve block, always check ________________ beforehand.

Answer 6

neuro vascular exam

Question 7

What dose of buivacaine do you use for FICNB?

Answer 7

20-30 mL of 0.25% bupivicaine

2 mg/kg max

Question 8

What are contraindications for femoral nerve block?

Answer 8

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.

Question 9

The FICNB is injected _________ to the femoral nerve block.

Answer 9

about two inches lateral

The landmark is 1/3 of the way from the ASIS to the pubic symphysis.

Question 10

What does the superficial cervical plexus block?

Answer 10

Th anterolateral neck, submandibular area, earlobe/posterior pinna, and supraclavicular area. It can provide anesthesia for IJ CVCs and clavicle fractures.

Question 11

The superficial cervical block hits nerves that are between which two muscles?

Answer 11

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.

Question 12

True or false: the interscalene block numbs the whole arm.

Answer 12

False

It numbs shoulder to elbow. The supraclavicular brachial plexus blocks the forearm.

Question 13

Where do you find the interscalene block?

Answer 13

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.

Question 14

The interscalene block needs to be deep to the ______________ fascia.

Answer 14

prevertebral

Question 15

True or false: the SCM is deep to the prevertebral fascia.

Answer 15

False

Question 16

In a view of the interscalene block, how are the nerve roots organized?

Answer 16

Top = C5
Bottom = C8

Question 17

For subclavian brachial plexus blocks, the subclavian artery passes through which of the two scalene muscles?

Answer 17

Anterior and middle

Question 18

In doing a subclavian brachial plexus block, the brachial plexus is ____________ to the subclavian artery. The subclavian artery is ___________ to the first rib.

Answer 18

lateral; superficial

Question 19

The supraclavicular nerve block anesthetizes what?

Answer 19

The whole arm – shoulder to hand

Question 20

What is RAPTIR?

Answer 20

Retroclavicular APproach To the Infraclavicular Region

Question 21

The RAPTIR block provides the same anesthesia as the ________________.

Answer 21

supraclavicular block

Question 22

Where should your probe be in the RAPTIR block?

Answer 22

Linear probe
Sagittal orientation
Distal clavicle
Indicator to the head
Pointing

Question 23

In the RAPTIR block, the axillary vein is __________ to the axillary artery.

Answer 23

anterior

Question 24

The RAPTIR block is injected just posterior to ____________.

Answer 24

the axillary artery

Question 25

How is the RAPTIR different than the traditional infraclavicular block?

Answer 25

The RAPTIR goes under the clavicle to get to the axilla, whereas the traditional infraclavicular block goes over.

Question 26

In doing the axillary nerve block, the axillary nerve will be seen superior to the ___________ artery.

Answer 26

posterior circumflex

Question 27

In doing the axillary block, the teres minor is _________ to the teres major.

Answer 27

superior

Question 28

What position do you get in for the axillary nerve block?

Answer 28

Patient is prone Linear probe Sagittal with dot cephalad Inject needle from cephalad to caudad

Question 29

What position do you get in for the axillary nerve block?

Answer 29

Patient is prone Linear probe Sagittal with dot cephalad Inject needle from cephalad to caudad

Question 30

The musculocutaneous nerve runs between which two muscles?

Answer 30

Biceps and coracobrachialis

Question 31

The musculocutaneous block innervates which region?

Answer 31

Anterior forearm

Question 32

The musculocutaneous block is done how?

Answer 32

Arm abducted and externally rotated Probe transverse on the medial upper arm/distal axilla Find the nerve beween the biceps and coracobrachialis

Question 33

How do you find the ulnar nerve?

Answer 33

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.

Question 34

What muscle runs just anterior and ulnar to the ulnar nerve?

Answer 34

Flexor carpi ulnaris

Question 35

The median nerve lies between which two muscles?

Answer 35

Flexor digitorum superficialis and profundis

Question 36

Proximal to the elbow, the median nerve runs parallel to which artery?

Answer 36

Brachial

Question 37

The radial nerve is always ____________ to the radial artery.

Answer 37

radial

Question 38

In the erector spinae block, you can see what muscles?

Answer 38

Superficial to deep: - Trapezius - Rhomboid - Erector spinae - Intercostal

Question 39

On US, how can you tell the difference between rib and transverse process?

Answer 39

Ribs are round, TP is flat

Question 40

The erector spinae block goes between what two landmarks?

Answer 40

Transverse process and erector spinae muscle

Question 41

What region is anesthetized by the erector spinae block?

Answer 41

Hemithorax region, 3 levels above and 4 levels below the injection

Question 42

What region is anesthetized by the posterior tibial nerve block?

Answer 42

Most of the sole of the foot

Question 43

Where do you find the posterior tibial nerve?

Answer 43

Posterior to the posterior tibial artery

Question 44

Where do you have the probe for the posterior tibial block?

Answer 44

Leg is externally rotated Probe is a couple cm proximal to the medial malleolus with the dot anterior

Question 45

What is the PENG block?

Answer 45

Pericapsular nerve group

Question 46

What does the PENG block anesthetize?

Answer 46

Acetabulum and pubic rami

Question 47

Between what two landmarks does the PENG block go?

Answer 47

Psoas and ilac crest between ASIS and pubic eminence

Question 48

In doing the suprainguinal nerve block, where does the probe go and what do you see?

Answer 48

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.