Regional Anesthesia

Question 1

How is CSF volume related to extent of spinal anesthesia?

Answer 1

CSF volume is inversely related to the height of the block

Question 2

What are the indications for a stellate ganglion block?

Answer 2

CRPS 1 and 2 of the upper extremity

phantom limb pain of the upper extremity

refractory angina or VT

vascular insufficiency

Question 3

What is the relationship of the stellate ganglion to the cervical vertebrae?

Answer 3

• located at C7
• can be blocked at the transverse process of C6 (tubercle of Chassiagnac)

Question 4

What indicates a sucessful stellate ganlgion block? Other side effects?

Answer 4

** increased temperature of the upper extremity **

also: Horner’s syndrome (sympathetic palsy), hoarseness (recurrent laryngeal palsy, elevated hemidiphragm (phrenic nerve palsy)

Question 5

What are the compliacations of a stellate ganlgion block?

Answer 5

intrathecal injection

vertebral artery injection

pneumothorax

hematoma

esophageal injury

Question 6

Why is neuraxial anesthesia difficult in patients with ankylosing spondylitis?

Answer 6

osseous ligaments and smaller intervertebral space

Question 7

What is the most frequent complication of an interscalene block?

Answer 7

Ipsilateral diaphragmatic paralysis

Question 8

What forms the intercostobrachial nerve? What does it supply?

Answer 8

T2

sensory fibers to the medial upper arm

Question 9

What is the order of blockade (sympathetic, sensory, motor) for upper extremity, lower extremity, and spinal blocks?

Answer 9

• upper extremity: sympathetic then motor then sensory
• lower extremity: sympathetic then sensory then motor
• spinal: sympathetic then sensory then motor

Question 10

Which nerve is most often missed with an axillary nerve block? What does it supply?

Answer 10

musculocutaneous

lateral aspect of the forearm

Question 11

How can a supplementary block of the musculocutaneous nerve be done?

Answer 11

Injection into the body of the choracobrachialis muscle

Question 12

What is the nerve supply to the hand?

Answer 12

Question 13

Where can the superficial cervical plexus be blocked?

Answer 13

midpoint of the posterior border of the sternocleidomastoid

Question 14

Where can a deep cervical plexus block be performed?

Answer 14

transverse processes of C2-C4

Question 15

What are the indications for cervical plexus block?

Answer 15

carotid endarterectomy

superficial neck surgery

Question 16

Where is the celiac plexus located?

Answer 16

L1

Question 17

What sensory information is transmitted through the celiac plexus?

Answer 17

visceral pain from the mid-stomach to the mid-transverse colon

Question 18

What are the most common side effects of a celiac plexus block?

Answer 18

1. orthostatic hypotension (splanchnic vasodilatation)
2. diarrhea (splanchnic vasodilatation)
3. paraplegia (injury to the artery of Adamkiewicz)

Question 19

How does epidural anesthesia affect bowel function?

Answer 19

increases gut motility and decreases the chance of ileus

Question 20

How is a subdural block differentiated from a subarachnoid block?

Answer 20

• slower onset
• extensive sensory block with minimal motor block
• less hypotension (but more than epidural)

Question 21

What indicates complete resolution of a spinal block?

Answer 21

ability to urinate

Question 22

Which fascial planes are traversed during a femoral nerve block?

Answer 22

fascia lata then fascia iliaca

Question 23

What factors determine degree of hypothermia during spinal anesthesia?

Answer 23

• height of block
• patient age

Question 24

What are the indications for a sphenopalatine ganglion block?

Answer 24

analgesia following endoscopic sinus surgery

Question 25

What is the dermatome map?

Answer 25

Question 26

When can prophylactic Lovenox be resumed after removal of an epidural catheter?

Answer 26

4 hours after

Question 27

What is the upper limit of PTT to administer neuraxial anesthesia according to ASRA guidelines?

Answer 27

1.5 x normal (40)

Question 28

How long should Plavix, dabigatran, Eliquis, Xarelto, and eptipibatide be held prior to neuraxial anesthesia?

Answer 28

Plavix: 5 days

Eliquis and Xarelto: 3-5 day

dabigatran: 3 days
eptifibatide: 8 hours

Question 29

How high will a neuraxial block typically rise with hyperbaric local ansethetic in a supine patient?

Answer 29

about T6

(due to normal kyphosis of the thoracic spine)

Question 30

Which patient factors are assoiated with high spinal block due to decreased CSF volume?

Answer 30

pregnancy

ascites

severe kyphoscoliosis

advanced age

Question 31

When are the two peaks of respiratory depression following intrathecal morphine administration? Peak analgesia?

Answer 31

peak respiratory depression: after injection and 6 hours later

peak analgesia: 6-12 hours after injection

Question 32

Is pruritis worse with neuraxial or IV opioid administration?

Answer 32

neuraxial administration

Question 33

Which epidural local anesthetic may (unlikely) interfere with the efficacy of epidural opioids?

Answer 33

chloroprocaine

Question 34

What areas are most commonly spared by an interscalene block?

Answer 34

ulnar nerve (C8-T1)

proximal cutaneous shoulder (covered by superficial cervical plexus block)

Question 35

Which left sided upper extremity block has the highest risk of chylothorax?

Answer 35

infraclavicular

Question 36

Which nerves mediate wrist extension? Flexion? Pinch?

Answer 36

Extension: raidal

Flexion: median

Pinch: ulnar

Question 37

What are the max doses of commonly used local anesthetics for regional anesthesia?

Answer 37

bupivacaine: 2.5 mg/kg (3 mg/kg w/ epi)
ropivacaine: 2-3 mg/kg
mepivacaine: 5 mg/kg (7 mg/kg w/ epi)
lidocaine: 4.5 mg/kg (7 mg/kg w/ epi)

Question 38

Branches of which nerve predominantly carry sensation to the plantar surface of the foot? Dorsal surface?

Answer 38

plantar surface: tibial nerve

dorsal surface: common peroneal nerve

Question 39

What innervates the web space between the great and second toes?

Answer 39

deep peroneal nerve