Truncal blocks 2 Flashcards
Advantages of a thoracic paravertebral block include the ability to: (select 2)
a. produce unilateral epidural anesthesia
b. achieve segmental blockade
c. provide spinal anesthesia
d. eliminate the risk of LAST
a. produce unilateral epidural anesthesia
b. achieve segmental blockade
The objective of the paravertebral block is to
target the spinal nerves as they exit the vertebral foramen
The paravertebral block can be thought of as
a “unilateral epidural”
Indications for the paravertebral block include
segmental anesthesia or pain management of surgical procedures of the chest and abdomen when a neuraxial technique is contraindicated or refused
Unlike the intercostal blocks, the paravertebral block
anesthetizes multiple dermatomal levels, reducing the number of injections reuqired
For the paravertebral block, you can achieve bilateral blockade by
using a larger volume of local anesthetic
Complications of the paravertebral block include
LAST, pneumothorax, intrathecal injection, & post-dural puncture headache
List the borders of the paravertebral space
anterior–> parietal pleura
medial–> vertebral body and intravertebral foramen
posterior–> transvers process and superior costotransverse ligament
The paravertebral block can be used for the following surgical procedures:
thoracic
breast
cholecystectomy
herniorraphy
appendectomy
The paravertebral block can be used for pain management of
rib fractures
flail chest
blunt abdominal trauma
osteoporotic vertebral fractures
herpes zoster
You can perform the PVB block at any level (thoracic or lumbar), however the _________ approach may be difficult due to ________–
lumbar; increased depth of the PVS
What is the hemodynamic status of patients who get a PVB?
although sympathetic nerves are blocked, there’s less hemodynamic instability vs. neuraxial anesthesia
The PVS also contains the ________________ which increases the risk of LAST
intercostal vessels
Select the BEST regional anesthesia techniques that provide analgesia to a patient with rib fractures. (Select 3)
a. intercostal
b. transverse abdominus plane
c. iPACK
d. erector spinae
e. paravertebral
f. fascia iliaca
a. intercostal
d. erector spinae
e. paravertebral
What is the objective of the erector spinae block?
fascial plane technique that targets the dorsal and ventral rami of the thoracolumbar nerves at the level of injection
What are indications for the erector spinae block?
neuropathic pain
rib fractures
lumbar spine surgery
thoracic surgery
cardiac surgery
breast surgery
bariatric surgery
& numerous abdominal procedures
What are complications of the erector spinae block?
pneumothorax, LAST
The erector spinae consists of three paired muscles that extend from the sacrum to the skull base:
iliocostalis
longissimus
spinalis
(I Like Standing)
What contributes to a failed ESP block?
at the lumbar level, the facet joints align with the transverse processes which makes it easy to mistake the facet joint for the transverse process
Bilateral injections are required for an ESP block for
midline or transverse procedures
A single injection for the ESP block at the thoracic level covers approximately
8-11 dermatome levels
A single injection at the lumbar level for the ESP block covers approximately
3-4 dermatome levels
When performing a thoracic ESB, the trapezius muscle is often
superficial to the erector spinae muscles
The objective of the TAP block is to anesthetize the
thoracolumbar nerves as they travel in the fascial plane between the internal oblique and transversus abdominus muscles
Indications for a TAP block include
procedures on the abdomen
What are the TAP block approaches?
subcostal approach
lateral approach
posterior approach
Where on the abdomen do the three approaches cover?
subcostal approach- procedures above the umbilicus
lateral & posterior approach–> procedures below the umbilicus
Complications of the TAP block include
LAST, peritoneal injury
What are the four paired muscles that form the anterolateral abdominal wall?
rectus abdominis
transverse abdominis
external oblique
internal oblique
What is the triangle of Petit?
it is the inferior lumbar triangle and it provides a key anatomic reference point for performing a TAP block with a landmark technique
What is the posterior border of the lumbar triangle?
latissimus dorsi
What is the anterior border of the lumbar triangle?
external oblique
What is the inferior border of the lumbar triangle?
iliac crest
What is the inside of the triangle of the lumbar triangle?
internal oblique
The thoracolumbar nerves arise from __________-
T6 to L1 to innervate the IO & TA muscles
Indications for TAP block includes
hernia repair, open appendectomy, laparoscopic abdominal procedures, radical prostatectomy, gynecologic surgeries, and C-sections
The TAP block provides analgesia to the
abdominal wall (skin & muscle) and the parietal peritoneum
What kind of needles are better for TAP blocks?
blunt tip needles because the y increase tactile feel and reduce the risk of visceral injury
With the TAP block to ensure the lateral cutaneous branches of the thoracolumbar nerves are blocked, guide the needle
tip to the midaxillary line
Describe the landmark technique of the TAP block.
identify the anterior superior iliac spine and follow the iliac crest posteriorly to the point where it moves slightly inward
advance the needle over the crest until you feel a pop, this is inside the triangle of petit and means the needle is between the IO & TA
Factors that contribute to LAST with a TAP block include:
a large volume of LA at each site
accidental intravascular injection into a thoracic intercostal artery or deep circumflex iliac artery
increased rate of LA absorption due to the compact area of the fascia
