Regional

Question 1

What areas are commonly missed in the axillary brachial plexus block?

Answer 1

Musculocutaneous nerve (supplying the lateral aspect of the forearm) as it sits outside the fascial plane
Intercostobrachial nerve (supplying medial aspect of the upper arm) as it isn’t a branch of the brachial plexus

Question 2

What is the procedure for a lumbar plexus block?

Answer 2

Preop + consent + CAMDEN
Position laterally, operative side up
Find insertion point, 4-5cm laterally from midline at L3
Enter perpendicular to the skin
Aim cephalad over the transverse process
Maximum depth 8-12 cm
Inject 20-30 mL
Observe for twitch of patella

Question 3

What are the complications of a lumbar plexus block?

Answer 3

As for any regional + intra/retroperitoneal bleeding/haematoma
Damage to intra/retroperitoneal organs
Epidural/intrathecal injection

Question 4

What are the indications for a femoral nerve block (3-in-1 block)? (3)

Answer 4

Surgery on:
The anteromedial thigh
Quadriceps surgery
Knee (obturator/lateral cutaneous nerve of the thigh are frequently missed, so may need topping up)

Question 5

What are the components of “Stop before you block”? (3)

Answer 5

Immediately prior to needle insertion, stop and check:
The surgical site marking
The site and side of the block

Question 6

What areas are commonly missed in the supraclavicular brachial plexus block?

Answer 6

Ulnar nerve distribution often missed

Question 7

What are the branches of the brachial plexus at the level of theroots? (4)

Answer 7

Dorsal scapular (C5) - rhomboids
Nerve to subclavius (C5, C6)
Long thoracic (C5, C6, C7) - serratus anterior
Nerve to scalene muscles