Truncal Apex Flashcards
Types of truncal blocks
PECS 1 & 2
Serratus anterior plane
Intercostal
Paravertebral
Errector Spinae
Transverse abdominus plane
Rectus sheath
Quadratus lumborum
PECS 1 and 2, SAP indications
PECS 1- breast implantation, cardiac device implantation
PECS 2- all from pec 1, and mestectomy, biopsy, tumors
SAP- breast reconstruction with latissimus dorsi flap
Complications of PECS1,2,SAP
Failure to appreciate the thoracoacromial artery can lead to puncture, hematoma, LAST
PTX from close proximity
Indication for intercostal blocks
Rib fx
Herpes zoster
Chest surgery
Chest tubes placement when epidural analgesia is not possible
MUST be done at each level bc it only provides analgesia at one dermatome at a time
Intercostal block complications
LAST from high vascularity
Failure to visualize needle on US can lead to PTX
Respiratory compromise in severe COPD patients
Indications of paravertebral block
Surgical procedures- thoracic, breast, chole, appendix
Pain management- rib fx, flail chest, blunt ab trauma, hepes zoster
Benefits of paravertebral block
Less epidural spread when done slowly
Less hemodynamic instability than neuraxial anesthesia
Complications of paravertebral block
LAST
PTX
Spinal injection
PDPH
3 muscles of the erector spinae
I like standing
Illiocostalis
Longissimus
Spinalis
Indications for erector spinae block
Neuropathic pain
Rib fx
Surgery of; spine, cardiac, breast, bariatric, abdomen
Complications of erector spinae block
Typically safe bc landmarks are easily identified
Failed block
PTX if lost sight of needle on US
Transversus abdominis plan block (TAP) indications
Hernia repair
Appenedix
Gyneco
C section
Prostate
Complications of TAP
LAST
Injury to ab organs
Rectus sheath block indications
Midline incision (hernia repair in pedis, c section, postpartum tubal ligation)
Rectus sheath complications
LAST low risk
Failure
Entry into peritoneum
