Regional Quiz #4 Flashcards
What are the indications for Intravenous Regional Anesthesia(Bier Blocks)?
surgeries and manipulations of the extremities requiring anesthesia for up to an hour’s duration. Many times done in the ER.
What procedures are IVRA(Bier Blocks) most suited for?
peripheral soft-tissue ganglionectomies, carpal tunnel releases, Dupuytren’s contractors or reduction of fractures
What are some adjuvants to LA in Bier Blocks?
ketorolac clonidine fentanyl pancuronium rocuronium sodium bicarbanate
What equipment is used for a Bier Block?
Local Anesthesia 7/8" rubber tourniquet 18, 20, 22 g IV catheter and hep lock standard monitors and resuscitation equipment double-bladder pnuematic tourniquet 4,5, or 6" Esmarch bandage 60 ml syringe
What is the technique for performing a Bier Block?
- Place double tourniquet on brachium of arm with padding(soft roll)
- Cuff A placed in Axilla or “Above”
- Cuff B placed “Below” - Place angiocath as far distal as possible
- Elevate arm and wrap Esmarch tightly up to B cuff
- Inflate distal(B) cuff 100 torr above patients SBP. Then, inflate A cuff to same pressure
- Remove Esmarch and check for presence of a radial artery pulse
- wrap 7/8” tourniquet around distal forearm and inject chosen volume of LA and remove angiocatheter
- prep, drape, cut
What are some complications associated with a Bier Block?
- Drug related(LA and Adjuvants)—>LAST or Sedation related(opioids)
- Equipment related—>inadvertent deflation of cuff, cuff failure sudden increase in venous pressure
What are Patrick Moss’ clinical pearls regarding a Bier Block?
- attempt to administer at least 4 mg of Versed prior to deflation of cuffs
- deflate cuffs in a tiered fashion(down 10 sec and up 10 sec then repeat a few times) This allows time to question patient for CNS symptoms of toxicity.
- Never deflate tourniquet if time is under 20, 25 or 30 minutes(depending on the text)—>20 was in Bold
- The solution he uses:30 ml of 1.5% mepivacaine + 20 ml of sterile water or saline yielding a final concentration of 0.9% Mepivacaine and total volume of 50ml
What are digital blocks used for?
Used as to provide anesthesia to the digits of the fingers and toes
Where are digital blocks utilized?
mostly used in ER, Primary Care Clinics and occasionally in the operating theater
What equipment is used to perform a digital block?
- sterile towels with 4X4
- 10 ml syringe with desired LA
- 25g 1.5” needle
What is the technique utilized when performing a digital block?
- 26g needle inserted at a point on the dorsolateral aspect of the base of the finger and a small skin wheal is raised.
- then redirect needle anteriorly toward the base of the phalanx.
- 2-3 ml of solution is injected along phalanx with an additional 1 ml as the needle is being withdrawn.
- Repeat on the other side
What are Pat’s Pearls of wisdom concerning Digital Nerve Blocks?
- NO EPI!!!
- Max volume 4-5ml per digit(roughly 2ml/side)
- NO digital tourniquets(this means rubber bands too)
- Caution if patient has Raynaud’s or Sickle Cell Disease when using tourniquets
- Do no use tourniquet if patient has peripheral vascular disease
What are three types of Ocular Regional Blocks?
- Topical
- Peribulbar
- Retrobulbar
What is the Opthalmic Anatomy?
- 6 extraocular muscles
- 2 eyelid muscles(Levator and Orbicular)
- Cranial Nerves of Eye Function(II-optic, III-oculomotor, IV–trochlear, V-TRIGEMINAL, VI-abducen, VII-FACIAL, X-VAGUS
What are the possible complications of Ocular Regional Blocks?
- retrobulbar hemorrhage
- bleeding into the eye
- temporary loss of vision
- lens occluded by blood
- increases intraocular pressure
- intrarterial injection(MOST COMMON COMPLICATION)
- injection into optic nerve sheath
- OCULOCARDIAC REFLEX(5 AND DIME)
