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APEX > Regional Anesthesia > Flashcards

Regional Anesthesia Flashcards

1
Q

What are the 5 components of brachial plexus?

A

5/3/6/3/5

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2
Q

What are the five terminal branches of the brachial plexus

A

Musculocutaneous (C5 - C7)
Axillary (C5 - C6)
Median (C5 - T1)
Radial (C5 - T1)
Ulnar (C8 - T1)

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3
Q

Where do the roots turn into trunks?

A

Just beyond the lateral border of the scalene muscles

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4
Q

Where do trunks turn into divisons

A

Under the clavicle and over the first rib

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5
Q

Where do divisions turn into cords

A

Pectoralis minor muscle

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6
Q

Where do cords turn into terminal branches

A

Axilla

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7
Q

Describe the sensory innervation of the upper extremity

A

The ventral portion is supplied by median, ulnar, musculocutaneous nerves = lateral and median cords

The dorsal portion is supplied by the radial and axillary nerves = posterior cord

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8
Q

How do you assess each branch of the brachial plexus?

A

PushER = radial nerve, triceps
PushEM= musculocutaneous, biceps
Pinch Em = median nerve, middle finger
Pinch U = ulnar nerve, pinky

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9
Q

What types of surgical procedures are well suited for a supraclavicular block?

A

upper arm, elbow, wrist, hand

not ideal for shoulder procedures b/c it does not reliably anesthetize the suprascapular nerve which arises from the proximal upper trunk

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10
Q

Describe the relationship between the terminal branches relative to the axillary artery

A

Musculocutaneous - anterior & lateral
Median - anterior & medial
Radial - posterior & lateral
Ulnar - posterior & medial

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11
Q

How do you block the radial nerve in the forearm?

A

LA btw biceps tendon and brachioradialis (3 - 4 mL)

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12
Q

How do you block the ulnar nerve at the elbow?

A

Flex elbow 90 degrees
Inject LA btw olecranon and medial epicondyle of the humerus (3 - 5 mL)

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13
Q

How do you block the median nerve at the forearm?

A

In the AC, inject LA mediaal to brachial artery. Brachial artery is medial to biceps tendon.

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14
Q

How do you block the ulnar nerve at the wrist

A

inject 3 - 5 mL medial to and below flexor carpi ulnaris tendon.

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15
Q

How do you block median nerve at wrist

A

5 mL btw flexor carpi radialis and flexor palmaris longuss

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16
Q

Bier block how much LA?

A

50 mL of 0.5% lidocaine

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17
Q

How long before tourniquet pain w/Bier Block?

A

25 mins (some texts say 45 - 60 mins)

2 hours max inflation time

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18
Q

When can you deflate the tourniquet?

A

20 mins

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19
Q

Name the 6 terminal branches of the lumbar plexus

A

Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral Femoral Cutaneous
Obturator
Femoral
i invariably get lazy on fridays

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20
Q

Which nerve roots give rise to each nerve of lumbar plexus

A

2 from 1 - I, I, both L1
2 from 2 - G = L1, L2, L = L2, L3
2 from 3 = O & F L2 - L4

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21
Q

What nerves are covered with the psoas compartment block?

A

AKA lumbar plexus block
LFC, obturator, and femoral are covered

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22
Q

Describe the femoral triangle

A

SAIL
Sartorius
Adductor Longus
Inguinal Ligament

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23
Q

thoracic intercostal n.

A

ventral rami of spinal n T1 - T6
-innervates breast, chest, IC muscles

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24
Q

lateral pectoral n

A

C5 - C7
pec major

25
Q

medial pectoral n.

A

C8 - T1
pec minor

26
Q

LTN

A

c5 - c7
chest wall superficial to the serratus anterior

27
Q

thoracodorsal n.

A

c6 - c8
latissimus dorsi

28
Q

what artery may you seen when doing a PECS block

A

axillary artery at the upper border of the pec minor muscle

29
Q

PECS 1 block.. where? nerves?

A

btw pec major and pec minor
Medial pec, lateral pec

30
Q

PECS 2 block. where? nerves?

A

PECS1 + btw minor & serratus anterior

-medial & lateral pec, thoracic intercostals, LTN

31
Q

procedures for PECS 2?

A

mastectomy, sentinel biopsy, tumor resection

+ PECS 1 coverage (breast implant, AICD)

32
Q

serratus anterior block

A

btw latissimus dorsi and serratus anterior

nerves: thoracic intercostals (more than PECS2), LTN, thoracodorsal

33
Q

what ribs do you see on u/s w/PECS1 vs PECS2

A

PECS 1 = 2nd/3rd rib
PECS 2 = 3rd/4th rib
SAP = 4th/5th

34
Q

intercostal n. block indications

A

rib fractures, herpes, chest/abd procedures, CT placement

35
Q

name the layers of a IC n. block

A

SubQ
Trapezius
Erector Spinae Muscle Group
3-5 mL at inferior border of upper rib.

36
Q

boundaries of the paravertebral space

A

anterior > parietal pleura
medial > vertebral body
posterior > T/P + superior costotransverse ligament

37
Q

which aspect of the paravertebral space is a continuation of the epidural space

A

medial aspect

i.e., why sympathetic ganglia are anesthetized by a paravertebral block.

38
Q

what are some surgeries that a paravertebral block would be useful for

A

cholecystectomy
appy
thoracic/breast obvi

39
Q

name the levels of a paravertebral block

A

subq
trapeziius
laatissimus dorsi
internal intercostal membrane
PVS space :))

40
Q

ESB targets

A

ventral and dorsal rami of the thoracolumbar nerves at the level of the injection

41
Q

name the levels of the ESB

A

trapezius
ESGroup
**LA here
TP
RIB

42
Q

ESB thoracic level coverage

A

8 - 11 dermatomes

43
Q

ESB lumbar level coverage

A

3- 4 dermatomes

44
Q

complications with ESB

A

failed block - mistake facet joint for TP. pneumo shouldn’t be a risk b/c pleura is far away ..

45
Q

triangle of petit

A

aka: inferior lumbar triangle

posterior border = lat
anterior border = EOM
inferior border = iliac crest

46
Q

TAP block targets

A

T6-L1 nerves

47
Q

subcostal vs lateral & posterior approach

A

subcostal = procedures above umbilicus

lateral & posterior approach = procedures below the umbilicus

48
Q

levels of subcostal TAP

A

EOM
IOM (aponeurosis) Rectus abd.
TAP

49
Q

Lateral approach levels

A

EOM
IOM
Transversus abdominus

50
Q

posterior approach

A

Latissimus dorsi
Quadratus Lumborum
(LEFT SIDE/aka posterior)

EOM
IOM
TA
(Right side) aka anterior

51
Q

landmark technique for TAP

A

-go to ASIS
-follow ASIS until it moves inward
-one pop

52
Q

what block should you use for a midline incision

A

rectus sheaath

53
Q

layers of rectus sheath block

A

SQ
EOM
IOM _ Rectus Abdominus
TA _ Posterior rectus sheath

54
Q

where does LA go with a rectus sheath block

A

btw rectus abdominis and posterior rectus sheath

55
Q

QL 1

A

LA lateral to QLM
abdominal surgery below the umbilicus

56
Q

QL2

A

LA posterior to QLM
abdominal surgery below or above umbilicus (up to T6)

57
Q

QL3

A

LA anterior to QLM
low frequency curvilinear!

58
Q

which QL block has the clover sign

A

QL3

transverse process
ESB
QL muscle

APEX (18 decks)

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