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N931 Advanced Principles of Anesthesia I > Truncal Blocks > Flashcards

Truncal Blocks Flashcards

1
Q

What kind of coverage is accomplished with truncal blocks?

A

somatic/sensory

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2
Q

truncal blocks focus on ____ over nerves

A

fascia planes

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3
Q

rectus sheath block indications

A

umbilical surgery - hernia repair (pediatrics)

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4
Q

rectus sheath block placement of local anesthetic

A

close proximity to the epigastric arteries and peritoneum

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5
Q

where do you place the transducer for rectus sheath block

A

transverse orientation over the rectus abdominus muscle where it meets the internal oblique where the intercostal and costal nerves run

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6
Q

potential complication with a rectus sheath block

A

puncture of the peritoneum

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7
Q

rectus sheath block technique

A

supine position
high frequency transducer lateral to the umbilicus (T10) in transverse orientation
needle inserted in plane lateral to medial approach

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8
Q

what lies below the posterior fascia

A

the peritoneum

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9
Q

injections along the lateral wall have been shown

A

to be more efficacious

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10
Q

indications for TAP block

A

alternative for low to mid abdominal wall surgery when an epidural and/or intrathecal opioids are contraindicated or refused

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11
Q

TAP block success depends on

A

the correct identification of the transversus abdominis plane

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12
Q

TAP blocks provide somatic anesthesia to the abdominal wall from ____ to ____

A

T7 - L1

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13
Q

TAP block to abdominal wall is highly dependent on

A

interfascial spread

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14
Q

is a subcostal TAP block for c-section helpful?

A

no because the block only goes to T9

do a lateral approach to get further coverage

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15
Q

to get full abdominal coverage what do you need to cover?

A

T6-L1

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16
Q

TAP block approach

A

start midline at xiphoid process where rectus sheath is, identify the muscles and slide laterally

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17
Q

what is something that won’t change person to person on TAP block scan?

A

peritoneum (we know that is the deepest structure)

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18
Q

transversus abdominis plane anatomy on US

A

external oblique, internal oblique, transversus abdominus, bowel

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19
Q

transversus abdominis technique

A

supine position
high frequency transducer between the costal margin and iliac crest midaxillary line in transverse orientation
slide medially and laterally under all 3 muscles are identified
needle inserted in plane to fascia between the internal oblique and transversus abdominis

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20
Q

transversus abdominis plane blocks are not benign procedures because

A

could have injected too much volume or since the plane is very tight the LA gets absorbed faster and there have been documented LAST events in obstetric patients

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21
Q

erector spinae block is a fascial plane block

A

deep to the spinae muscle group

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22
Q

erector spinae block primarily targets the

A

dorsal rami and potentially the ventral rami

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23
Q

risk with erector spinae block

A

risk for puncture of retroperitoneum, pleura, and kidney

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24
Q

erector spinae is a group of 3 muscles that provides support to the spinal column… what are the 3 muscles?

A

spinalis, longisimus, iliocostalis

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25
Q

erector spinae block technique

A

use curvilinear transducer, parasagittal plane and find desired level, slide transducer laterally to identify transverse process, insert needle cephalad to caudal (do bilaterally)
can be done in supine or lateral decubitus position

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26
Q

erector spinae block is dependent on

A

volume

4 dermatomal level of distribution (2 above and 2 below)

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27
Q

superior attachment

A

T12

28
Q

inferior attachment

A

iliac crest

29
Q

medial attachment

A

transverse process

30
Q

erector spinae block complications

A

hematoma, infection at site, tissue trauma, pneumothorax, hemodynamic instability, LAST, lumbar plexus block, block failure

31
Q

quadratus lumborum block indications

A

large bowel resections, appendectomy, cholecystectomy, c section, total abdominal hysterectomy, prostatectomy, renal transplant surgery, nephrectomy, abdominoplasty, iliac crest bone graft, ex lap

32
Q

quadratus lumborum block targets

A

iliohypogastric, ilioinguinal, and subcostal nerves that cross the psoas muscle and transversalis fascia
get more lateral wall coverage

33
Q

truncal blocks are more for

A

postoperative pain management

34
Q

quadratus lumborum block technique

A

lateral decubitus position with hips and knees flexed
use curvilinear transducer on midaxillary line cephald to iliac crest
slide posteriorly and tilt caudad until see “shamrock sign”

35
Q

shamrock sign

A

L4 transverse process is the stem

trefoil - erector spinae, QL, and psoas

36
Q

what type of block shows the shamrock sign?

A

QL 3

37
Q

QL 1 block

A

find TAP anatomy where come together at the thoracolumbar fascia between the QL and psoas muscle

38
Q

on a QL 3 block the transverse process will show up medially or laterally on the US image?

A

medially

39
Q

on a QL 3 block the erector spinae muscle will show up anteriorly or posteriorly on the US image?

A

posteriorly

40
Q

on a QL 3 block the psoas muscle will show up anteriorly or posteriorly on the US image?

A

anteriorly

41
Q

on a QL 3 block the QL muscle will show up medially or laterally on US image?

A

laterally

42
Q

the lower pole of the kidney lies ____ to the QL muscle and can reach ___ with deep inspiration

A

anterior ; L4

43
Q

indications for PEC blocks

A

analgesia following breast surgery, flap, biopsy

alternative to paravertebral block or thoracic epidural

44
Q

what kind of nerves are PEC blocks blocking?

A

small branches of brachial plexus

45
Q

PEC 1 blocks are designed to anesthetize the (nerves)

A

medial and lateral pectoral nerves

46
Q

PEC 2 blocks are an extension of ____ and provide additional blockade of the ____

A

PEC 1; upper intercostal nerves

47
Q

pec 1 block technique

A

supine with arm abducted
high frequency transducer cephalad medial and cuadad lateral orientation at level of coracoid process
needle inserted in plane cephalad to caudad

48
Q

what is identified in pec 1 US image

A

costal margins, pect major, pect minor, serratus muscles

49
Q

which fascia plane is the needle going between in pec 1 block

A

between pec major and pec minor

50
Q

pec 2 technique

A

is a pec 1 block + lateral and deeper to get the long thoracic nerve
transducer slid caudad to level of 2nd rib and angled inferolaterally until the pec minor and serratus anterior muscles are identified
move laterally and find 3rd and 4th rib

51
Q

where is local injected in a pec 2 block

A

between the pec major and pec minor

between the pec minor and serratus anterior muscles

52
Q

what can subsequently be blocked in pec blocks

A

phrenic nerve

53
Q

what is the implication with intercostal thoracic blocks

A

can only block one level!

no spread

54
Q

what is a consideration for a paravertebral thoracic block

A

right at the epidural space

55
Q

indications for a paravertebral block

A

periop analgesia for thoracic, chest wall, or breast surgery, pain management for rib fractures

56
Q

what does the paravertebral block target

A

the paravertebral space which contains the spinal nerves and their branches and sympathetic trunk

57
Q

the paravertebral space is

A

a wedge shaped formed medially by the vertebral body, inferiorly by the parietal pleura and anteriorly by the costotransverse ligament

58
Q

goal with transverse paravertebral block

A

want to get the pleura pushed down

59
Q

transverse paravertebral in plane technique

A

lateral decubitus position
high frequency transducer in transverse orientation just lateral to the spinous process
identify the transverse process and ribs and slide caudad into intercostal space

60
Q

downward displacement of the pleural in a paravertebral block indicates

A

correct spread of LA

61
Q

what is essential when performing a paravertebral block

A

visualize the needle at all times

62
Q

intercostal nerve block indications

A

analgesia following breast, thoracic, and upper abdominal surgery, pain management for rib fractures

63
Q

intercostal nerve block targets

A

intercostal nerves resulting in ipsilateral anesthesia

64
Q

what could you run into with a intercostal block?

A

scapula at T7

65
Q

intercostal nerve block technique

A

sitting, lateral decubitus, or prone position with arms hanging freely
high frequency transducer in sagittal plane over costae approximately 6-8 cm from midline
identify 7th and 12th ribs
needle inserted in plane until between internal and innermost intercostal muscles

66
Q

intercostal nerve block pearls

A

difficult to perform above T7 because of scapula

excellent for analgesia but inadequate for surgical anesthetic

N931 Advanced Principles of Anesthesia I (6 decks)

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