Regional Blocks

Question 1

Lidocaine

Answer 1

-Duration 1-2 hours (2-6 w/ epi)
-CNS toxicity, seizures
-rapid onset

Question 2

Bupivacaine

Answer 2

-Duration 2-4 hours (3-7 w/ epi)
-slow onset
-CV toxicity (heart blocks, hypotension, dysrhythmias)

Question 3

Ropivacaine

Answer 3

-Rapid onset
-Duration 4-6 hours
-Less motor block

Question 4

T4 Dermatone

Answer 4

Nipple

Question 5

T6 dermatone

Answer 5

Xiphoid process

Question 6

T10 dermatone

Answer 6

Umbilicus

Question 7

L4 dermatone

Answer 7

Knees

Question 8

S2-5 dermatones

Answer 8

Genitalia -buttocks

Question 9

Motor Assessment

Answer 9

0/5 No movement
1/5 flick
2/5 unable to overcome gravity
3/5 overcome gravity, no resistance
4/5 some resistance
5/5 normal strength

Question 10

Cervical plexus block

Answer 10

-C2-4
-anterolateral neck & ear, and skin inferior to clavicle on chest wall
-procedures: carotid endartectomy, thyroidectomy, proximal clavicle fractures

Question 11

Interscalene nerve block

Answer 11

-C5-7
-part of clavicle, scapula, whole shoulder. Numbness extends to digits 1-3
-weakness of deltoid muscle and some hand muscles
-surgeries: shoulder, ORIF of clavicle/scapula, mid numeral shaft fracture
-Complications: diaphragmatic paralysis on blocked side from phrenic nerve block (25% dec in plum function); pneumothorax; Horner Syndrome; Bezold-Jalisco reflex (hypotension & Bradycardia); LAST
-Use Arm Sling

Question 12

Horner Syndrome

Answer 12

-hoarse voice, constricted pupil (myosin), drooping eyelid (ptosis), nasal congestion, dec sweating (anhidrosis)
-Risk for blocks: Interscalene, supraclavicular
-self-limiting… reassure pt

Question 13

Supraclavicular Block

Answer 13

-Affects arm below mid-humerus
-Motor and sensory loss entire arm below elbow
-surgeries: mid shaft humerus, biceps tendon repair, ORIF elbow, surgery of hand/foreman/digits
-**complications: phrenic nerve paralysis, Horner syndrome, hemothorax, pneumothorax
-*Use Sling

Question 14

PECs block

Answer 14

-LA injected into the fasical plane between PECs major and minor muscles; C5-T1
-SENSORY block
-surgeries: after breast surgery, after thoracotomy, rib fx, axilla
-possible need for sling

Question 15

Serratus Plane Block

Answer 15

-LA injecjected in the fasical plane of serratus anterior muscles to block upper intercostal nerves T3-T9
-SENSORY
-surgeries: after breast, after thoracotomy, rib fix, axiilla
-possible need for sling

Question 16

Paravertebral Block

Answer 16

-LA injected alonside thoracic or lumbar vertebrae T1-T6
-*complications: High epidural/block block can occur, pneumothorax, LAST
-surgeries: breast, thoracotomy, non-invasive heart, rib fx, abd procedures

Question 17

Erector Spinae Plane Block

Answer 17

-LA injected deep into vertical back muscles. Spreads vertically and wraps around front of chest and upper abd
-SENSORY T3-T9
-Place block in upright position
-surgeries: rib fx, thoracic surgery (VATS), breast, bariatric, cardiac

Question 18

Quadratus Lumborum Block

Answer 18

-fascial plane block of the posterior wall of the abd and affects the back muscles
-SENSORY block to abd and hip regions T4-L1
-surgeries: upper/lower abd surgeries; some hip; cesarean, hysterectomy, renal transplant, nephrectomy, iliac crest bone graft

Question 19

Fascia Iliaca Block

Answer 19

-LA injected under the inguinal ligament and above the iliopsoas muscle; fasical plane
-affects the upper leg and inside of lower leg
-*FALL RISK: limb/leg brace: weakness of Quads. Numbness felt in anterior thigh, medial leg and big toe
-surgeries: total posterior/lateral hip replacements; hip/femoral fx; knee; AKA/BKA

Question 20

Femoral Block

Answer 20

-MOTOR and SENSORY loss to anterior thigh, anterior knee. ONLY SENSORY to medial calf/ankle
-posterior thigh and knee will have full sensation
-pt positioned supine
-*FALL RISK: motor block to quads
-surgeries: total knee replacement, ACL, knee arthroscopy, ORIF patella

Question 21

Anterior Sciatic Block

Answer 21

MOTOR & SENSORY to posterior knee, hamstring, and entire lateral lower leg (not medial)
*FALL RISK, foot drop

Question 22

IPACK block

Answer 22

SENSORY block to posterior knee

Question 23

Popliteal/Sciatic Block

Answer 23

MOTOR & SENSORY block to lateral leg below and behind knee (medial not blocked)
-FALL RISK
-contraindicated with neuropathies and DM

Question 24

Adductor Canal Block

Answer 24

-SENSORY to anterior and medial lower leg

Question 25

Lipid bolus tx for LAST

Answer 25

1.5 ml/kg bolus then 0.25-0.5 ml/g/min gtt

Question 26

Regional Anesthesia loss and return of sensation/movement

Answer 26

Loss:
-autonomic (bladder, Vado motor)
-temp
-pain
-touch
-movement
-proprioception

RECOVERY BACKWARDS