Regional

Question 1

Structure

Answer 1

Oh TLC Should Work

Orientation
Target
Landmark (BVM)
Complication
Surface anat
Work?

Question 2

Block selection

Answer 2

I believe ”block X” will provide clinically useful analgesia, will be safe in this patient, and will avoid the risks associated with “block Y

BRAN
Benefit
Risk
Alternative
Nothing

Question 3

Doing the block / prepartion

Answer 3

CIMPLES

Consent
IV
Monitor
Position
LA
Equipment
SBYB

Question 4

Risk of RA

Answer 4

Sig/perm complication = extremely low

1. Needle risk
   - PNB
2. PDPH:
   Epi 1:100 (1%)
   Spinal: 1:800

LAST - 8.7/1000

Question 5

REGIONAL / ANATOMY – Factors influencing spread of IT LA

[18A11] Outline the factors influencing spread of intrathecal local anaesthetic.

Answer 5

1. Level of injection
2. Baricity
3. Dose (conc + vol)
   4 . Position

Question 6

REGIONAL / ANATOMY – Ankle block

[17A06] Describe the innervation of the foot relevant to an ankle block.

Answer 6

5 nerves

Medial:
Saph + PT

Lat
Sup+Deep Peroneal
Sural (post)

DP
b/w 1st and 2nd toe

PT
ventral foot - sural (lateral) and saphenous (medial)

sural
- posterolateral
O - lat mall and achilles gma
Saphenous - medial calc

SP
dorsal foot minus DPN

Question 7

REGIONAL / ANATOMY – Femoral triangle (femoral vs FI block)

[20B15] Describe the cross-sectional anatomy of the femoral triangle and identify where local anaesthetic would be placed for a

a. femoral nerve block
b. fascia iliaca block

Describe the strengths and weaknesses of these two blocks for the provision of analgesia during surgery for repair of a fractured neck of femur.

Answer 7

PR: 33% !!!

Femoral triangle

Border: IL-S-AL
ing lig
sarto
add long

Floor: IPsPecA
iliacus
ps oas
pectineus
adductor longus

Lat NAVELLL
n. a. v. empty LN/loose CT

FNB
pros: high conc, easy US
Cons: art punc, no LFCN

FIB
pros: cover LFCN, less art, eaasy landmark, *safe if anticoag
cons: larger volume

Question 8

REGIONAL / ANATOMY – Axillary block

[09A04]

Draw a cross section of the arm at the level of the axilla illustrating the anatomy relevant to performing a brachial plexus block for surgery on the forearm (50%).

List the advantages and disadvantages of a block at this level compared to a supraclavicular block (50%).

Answer 8

(40.1%) Lengthy comment. See report.

MUR b/w AA/ AV

McN b/w Biceps and CBM

Pros:
1. No PTX/horner/phrenic
2. Easy US
3. Exc anaes mid forearm
4. Compress if punc

Cons
1. Miss McN
2. Not for prox/mid forarm
3. Less hygienic
4. X tourniquet pain

Question 9

REGIONAL / ANATOMY – TAP block

[12B12] Describe the anatomy of the Transversus Abdominis Plane (TAP) relevant to regional analgesia. (70%) List the complications associated with TAP block. (30%)