Truncal blocks Flashcards
A pectoralis 2 nerve block targets the fascial plane between the:
a. pectoralis major and pectoralis minor muscles
b. medial pectoralis and lateral pectoralis nerves
c. pectoralis minor and serratus anterior muscles
d. serratus anterior and latissimus dorsi muscles
a. pec major & pec minor & c. pec minor and serratus anterior muscles
What is the objective of the serratus anterior plane block.
targets the axillary region (not the chest)
What is the objective of the PECS 1 & PECS 2 block?
Pecs blocks are interfascial plane blocks that provide anesthesia and/or analgesia to the anterior chest wall without the risks of paravertebral or intercostal blockade
Indications for performing the PECs blocks include
breast surgery, thoracotomy, and insertion of a port-a-cath, AICD, or subpectoral prosthesis
Indications for performing the serratus anterior block is
breast reconstruction with latissimus dorsi flap
The local anesthetic volume for the PECS 1 block is
10-15 mL
The local anesthetic volume for the PECS 2 block is
10-15 mL
The local anesthetic volume for the serratus anterior block is
20 mL
Complications of the pecs 1 & pecs 2 blocks include
failure to appreciate the thoracoacromial artery may lead to inadvertent puncture, vessel injury, hematoma, and LAST
Key nerves that innervate the chest include
thoracic intercostal nerve
lateral pectoral nerve
medial pectoral nerve
long thoracic nerve
thoracodorsal nerve
The origin of the thoracic intercostal nerve is the
ventral rami of spinal nerves (T1-T6)
The regions innervated by the thoracic intercostal nerve include
the intercostal muscles
cutaneous regions of the chest & breast
The origin of the lateral pectoral nerve is the
brachial plexus (C5-C7)
The regions innervated by the lateral pectoral nerve include
pectoralis major
The origin of the medial pectoral nerve is the
brachial plexus (C8-T1)
The regions innervated by the medial pectoral nerve include
pectoralis minor
lower region of pectoralis major
The origin of the long thoracic nerve is the
brachial plexus (C5-C7)
The regions innervated by the long thoracic nerve include
the chest wall superficial to the serratus anterior
The origin of the thoracodorsal nerve is the
brachial plexus (C6-C8)
The regions innervated by the thoracodorsal nerve include the
latissimus dorsi
The serratus anterior plane block affords greater coverage of the
intercostal nerves of the axillary region (it does not cover the medial chest)
What are the nerves anesthetized with the PECS 1 block?
medial pectoral
lateral pectoral
What is the injection site of the PECs 1 block?
fascial plane between the pec major and pec minor
What is the injection site of the PECS 2 block?
fascial plane between the pec major & pec minor & fascial plane between the pec minor & serratus anterior
What are the nerves anesthetized in the PECS 2 block?
medial pectoral
lateral pectoral
thoracic intercostals
long thoracic
Why is a PECS 2 block indicated?
everything covered by PECS 1 & also require analgesia of the axilla such as mastectomy, sentinel node biopsy, tumor resection
What is the site of injection of the serratus anterior block?
fascial plane between the latissimus dorsi & serratus anterior
What nerves are anesthetized with the serratus anterior block?
thoracic intercostals (increased coverage vs. PECs 2)
long thoracic
thoracodorsal
The recommended maximal local anesthetic dose for PECs blocks is
0.2 mg/kg
The recommended maximum dose for SAP blocks is
0.4 mg/kg
PECS blocks & SAP blocks may result in ____________ due to the proximity of the needle
pneumothorax; to the pleural space
Benefits of an intercostal nerve blockade include: (select 2)
a. multi-level coverage after a single injection
b. decreased risk of opioid-induced respiratory depression
c. hemodynamic stability
d. low risk of local anesthetic toxicity
b. decreased risk of opioid-induced respiratory depression
c. hemodynamic stability
What is the objective of an intercostal nerve block?
provide motor and sensory anesthesia of the trunk from the xiphoid to the pubis (single dermatome level)
Indications of an intercostal nerve block include
acute and chronic pain syndromes of the chest and upper abdomen, including rib fractures, herpes zoster, cholecystectomy, and chest tube insertion
Select complications of an intercostal nerve block include
pneumothorax, LAST
The local anesthetic volume needed for an intercostal nerve block is
3-5 mL per dermatome level
The intercostal nerves originate from the
ventral rami of the thoracic spinal nerves (T1-T11)
The risk of LAST with an intercostal nerve block is increased because
the rapid rate of local anesthetic uptake due to high vascularity
Respiratory insufficiency may occur in patients with
severe COPD who depend on their intercostal muscles for ventilation
Blocking ______________ can be difficult due to the thickness of the paraspinal muscles and proximity of the scapula
T1-T5; you should use a paravertebral block instead
Describe the landmark technique for an intercostal block
place patient in sitting, lateral or prone position
locate the site using the sharp posterior angulation of the rib and slide laterally to the lateral border of the sacrospinalis muscle
advance needle until it hits bone and slowly walk off
