Regional Flashcards
Highest point of iliac crests?
L4
Level of umbilicus
T10
level of posterior iliac spines?
S2
Inferior edge of scapula?
T7
First palpable spinous process
C2
Cord ends at what level in adult? Subarachnoid space?
Cord - L2, Subarachnoid space - S2
Most common site for spinal anesthesia?
L3-L4
What causes the physiological response of spinal anesthetic?
preganglionic sympathetic blockade
Spread of local (spinal)?
specific gravity & position, as well as dose, site of injection, etc
PDPH incidence?
2%, headache is postural with relief in the supine position
PDPH treatment?
conservative - hydration, caffeine, analgesics, abdominal binder, sumatriptan (imatrex)
Epidural level determined by what?
How to estimate?
Have T 12- but want T10? How much to give?
VOLUME!!
T12 to T10… 3-4 ccs
Hyperbaric solutions typically contain what?
- Tetracaine, bupivacaine, lidocaine, procaine
Dextrose
Isobaric solutions typically contain what?
-tetracaine, bupivicaine, lidocaine
saline
Hypobaric solutions typically contain what?
-tetracaine, bupivacaine
water (h2o)
Epidural placement midline approach?
Skin-SQ-supra-inter-liga flavum- epidural space!
Epidural paramedian approach
skin-SQ-liga flavum - epidural space!
TAP block’s hit what?
Advantages?
Disadvantages?
plane between the transversus abdominis and internal oblique muscles!
intercostal nerves T7-T12 - hits iliohypogastric nerves through here
Advantages: no hemodynamic changes, no motor blockade of LE.
Disadvantages: no analgesia of visceral peritoneum or abd contents. (is an adjunct to pain management, not primary.
IS block where?
covers what area?
between Anterior and middle scalene muscles
C5-C7
(spares some of C8-T1, which is why this works for shoulder, not hand.)
What is stellate ganglion?
indications?
Complications?
most easily felt at C6
indications: regional circulatory insufficiency, complex regional pain syndrome.
complications: hematoma, intravascular injection, dural puncture, pleural puncture.
Axillary block.. what is missed?
Musculocutaneous
Assessment of UE blockade?
4 P's Push = radial Pull = musculocutaneous pinch index = median pinch pinky = ulnar
Bier block
How long does it last?
Tourniquet up for how long? Why?
Can last 45-60 minutes (use dilute lidocaine - 0.5%)
15-20 mins minimum, allows time for tissues to bind with local, limit systemic effects upon deflation.
what nerves do wrist blocks hit?
radial, median, and ulnar
if you can palpate the ulnar artery you can palpate the ?? nerve?
ulnar
FNB
Remember what acronym?
NAVEL: Nerve Artery Vein Empty space Lacunar ligament
Above knee?
Femoral nerve
Below the knee
Sciatic
+ Saphenous (only FN present this far down) - most medial of FNB
Largest nerve in the body?
Largest nerve trunk is the Sciatic nerve
Popliteal block
part of Sciatic nerve
cephalad 7-10 cm (hot spot!)
Where do you put needle? NOT IN POPLITEAL FOSSA!!!! move it up 7 to 10 cm up the leg above pop crease.
ankle block .. what are nerves?
deep peroneal, superficial peroneal, posterior tibial, sural, and saphenous.
Horner’s Syndrome?
Blocks sympathetic stimulation to the face! * a guarentee of block of arm”
Droopy eyelid - ptosis DROOPY!! P = Ptosis pupil constriction - myosis facial anhydrosis (no sweat)
What is the substantia gelatinosa?
Lamina of Rexed II (in the dorsal horn of gray matter)
Branches of Facial Nerve? (5)
Mandibular, Zygomatic, Temporal, Buccal, and cervical!
To Zanzibar by motor car
Cervical Plexus block? Where is it, why? Common problems?
Level of T12ish, (pt. in prone position) common for tx of abdominal visceral cancer type pains, pancreatic. Common problems are inadvertant AORTA puncture,
CRPS Type I pain block in RUE assessed how?
Although Horners syndrome is common sign, this indicates SNS of the face, not necessarily the extremity itself. Look for temperature change in R limb.
SLN? What is its function? How is it blocked?
The superior laryngeal nerve is comprised of two branches: the external branch which provides motor innervation to the cricothyroid muscle, and the internal branch which provides sensory innervation to the laryngeal mucosa above the level of the vocal cords. SLN block is performed between the lateral aspect of the hyoid bone and the thyroid cartilage at the thyrohyoid membrane.
