Unit 8: Regional Anesthesia: Upper and Lower Extremity Blocks

Question 1

describe major sensory regions in relation to dermatome

Answer 1

c4 sup aspect of shoulder
c6 lateral shoulder
c7 3rd digit
c8 5th digit
t1 medial aspect of the arm
t2 axilla

Question 2

which nerves are sensory only from brachial plexus?

Answer 2

medial brachial cutaneous
medial antebrachial cutanesous

Question 3

which are the combined sensory and motor nerves in brachial plexus?

Answer 3

axillary
radial
musculcutaneous
median
ulnar

Question 4

How do you clinically assess for radial n. block?

Answer 4

Push’er: Ie elbox extension against resistance (tricepes contraction)

Question 5

How do you clinically asses for musculocutaneous n. block?

Answer 5

Pull em: ie elbox flexion against resistance. (biceps contraction)

Question 6

How do you clinically assess for median n. block?

Answer 6

pinch me: pinch index finger

Question 7

How do you clinically assess for ulnar n. block?

Answer 7

pinch u: pinch pinky finger

Question 8

When can ISB not be used?

Answer 8

procedures of the forearm or hand because the lower trunk (c8-t1) is not reliably blocked.

Question 9

What are the symptoms of Horner’s syndrome?

Answer 9

ptosis, mioosis, and anhidrosis. This is oculosympathetic palsy

Question 10

When can supraclavicular block be used? When can it not be used?

Answer 10

Used: upper arm, elbow, forearm, wrist and hand.
Not used: shoulder surgeries because suprascapular nerve may be missed

Question 11

which complication is the highest risk with supraclavicular block?

Answer 11

pneumothorax

Question 12

Which brachial plexus block is the most painful?

Answer 12

Infraclavicular block because the needle transects so many different layers

Question 13

What is one way to decerase the risk of pneumothorax when performing infraclavicular block?

Answer 13

insert the needle caudal to the clavicle at the coracoid process and angle slightly laterally

Question 14

Which nerve is not blocked when doing an axillary block?

Answer 14

Axillary nerve

Question 15

How long after an intravenous upper extremity nerve block must you wait before deflating the cuff?

Answer 15

At least 20min, but if releasing before 40min must deflate incrementally.

Question 16

Describe plexus innervation of the LE

Answer 16

inervated by two plexuses
1. lumbar plexus L1-L4
2. Sacral Plexus: L4-S4

Question 17

which six nerves come from lumbar plexus?

Answer 17

iliohypogastric n
ilioinguinal n
genitofemoral n
lateral fem cutaneous
obturator n
femoral n

Question 18

which nerves come from the sacral plexus?

Answer 18

sup. gluteal n
inf. gluteal n.
post. cutaneous n.
pudendal n.
sciatic n.

Question 19

Foot and ankle are innervated by what nerves?

Answer 19

saphenous n
sural n
superficial peroneal n
deep peroneal n
posterior tibial n

Question 20

How do you clinically assess nerves of the hip?

Answer 20

flexion > femoral n
extension > sciatic n

Question 21

how do you clinically assess nerves of the knee?

Answer 21

flexion > sciatic n
extension > femoral n

Question 22

how do you clinically assess nerves of the foot and ankle?

Answer 22

plantar flexion > tibial n
dorsiflexion > peroneal n
eversion superficial peroneal n
inversion > deep peroneal n

Question 23

When can PENG block be used?

Answer 23

Hip fracture
hip arthoplasty

Question 24

which nerves are anesthetized with a fascia iliaca block?

Answer 24

femoral n
obturator n
lateral femoral cutaneous n

Question 25

which structures make up the border of the femoral triangle?

Answer 25

sartorius muscle
adductor longus m.
inguinal ligament

Question 26

What is a major draw back to popliteal nerve blocks?

Answer 26

foot drop and numbness of the sole which can lead to patient falls.

Question 27

How can you minimize risk of nerve injury when performing ankle blocks?

Answer 27

use a lower volume of LA, and avoid using epi. this decreases the risk of nerve compression and ischemia.

Question 28

Where can post. tibial n. be blocked at the ankle?

Answer 28

just above medial malleolus

Question 29

where can sural n. be blocked at the ankle?

Answer 29

just above lateral malleolus

Question 30

where can superficial peroneal n. at the ankle be blocked?

Answer 30

lateral aspect of the lower leg 5 cm above lateral malleolus