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My APEX > Unit 8: Truncal > Flashcards

Unit 8: Truncal Flashcards

1
Q

nerves that innervate the chest

A

lateral pectoral, medial pectoral, long thoracic, and thoracodorsal nerves

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2
Q

origin of thoracic intercostal nerve

A

ventral rami of spinal nerves (T1-6)

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3
Q

origin of lateral pectoral nerve

A

brachial plexus (C5-7)

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4
Q

origin of medial pectoral nerve

A

brachial plexus (C8-T1)

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5
Q

origin of long thoracic nerve

A

brachial plexus (C5-7)

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6
Q

origin of thoracodorsal nerve

A

brachial plexus (C6-8)

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7
Q

innervation of thoracic intercostal nerve

A

cutaneous regions of the chest and breast
intercostal muscles

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8
Q

innervation of lateral pectoral nerve

A

pectoralis major

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9
Q

innervation of medial pectoral nerve

A

pectoralis minor
low region of pectoralis major

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10
Q

innervation of long thoracic nerve

A

chest wall superficial to the serratus anterior

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11
Q

innervation of thoracodorsal nerve

A

latissimus dorsi

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12
Q

where does the thoracoacromial artery arise from?

A

the axillary artery at the upper border of the pec minor muscle

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13
Q

goal of a fascial plane block

A

inject a LA into the correct fascial plane

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14
Q

PECS blocks provide anaglesia to

A

the breast and anterior chest wall

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15
Q

PEC block key benefit is that they remove the risks associated with

A

neuraxial or paravertebral blocks

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16
Q

PECS 1 injection

A

fascial plane between the pec major and minor

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17
Q

PECS 1 nerves anesthetized

A

medial pectoral and lateral pectoral

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18
Q

PECS 1 indications

A

procedures that require analgesia of the pec major muscles such as breast implantation and implantable cardiac device

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19
Q

PECS 2 injection site

A

fascial plane bewteen the pec major and minor (injection 1) and pec minor and serratus anterior (injection 2)

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20
Q

PECS 2 nerves anesthetized

A

medial pectoral, lateral pectoral, thoracic intercostals, long thoracic

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21
Q

PECS 2 indications

A

everything covered by PECS 1 +
procedures that also require analgesia of the axilla: mastectomy, sentinel node biopsy, and tumor resection

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22
Q

SAP block affords great coverage of

A

the intercostal nerves of the axillary region (doesn’t cover the medial chest)

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23
Q

SAP injection site

A

fascial plane between the latissimus dorsi and serratus anterior

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24
Q

SAP nerves anesthetized

A

thoracic intercostal (increased coverage vs. PECS 2), long thoracic, thoracodorsal

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25
Q

SAP indications

A

breast reconstruction with latissimus dorsi flap

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26
Q

patient position for PECS 1 & 2

A

supine with arm placed at side

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27
Q

transducer frequency for PECS 1&2 & serratus anterior

A

high (>7 MHz)

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28
Q

where to place transducer for PECS 1?

A

saigttal oreintation beneath the clvicle at the coracoid process (similar to an infraclavicular block)

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29
Q

what to identify on ultrasound for PECS 1?

A

distal axillary artery and vein; cadual and lateral to see the pec minor and serratus anterior muscles at the level of the 3rd and 4th rib

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30
Q

total LA volume for PECS 1

A

10-15mL in 5mL increments

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31
Q

target of needle for PECS 2

A

interfacial plane between the pec minor and serratus anterior muscles

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32
Q

total LA volume for PECS 2

A

10-15mL in 5mL increments

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33
Q

patient positin for SAP block

A

supine or in lateral decubitus position with the arm positioned forward over the chest

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34
Q

where to place the transducer for SAP block?

A

over the mid-axillary line in the upper region of the lateral chest wall; transverse position

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35
Q

what are you looking for on the ultrasound for a SAP block?

A

4th and 5th ribs in the coronal plane (parallel to the mid-axillary line); latissimus dorsi muscle superior to the serratus anterior muscle overlying the ribs

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36
Q

total LA volume for SAP block

A

20mL of long-acting LA in 5mL increments

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37
Q

in what order should you do a PECS 2 block? why?

A

do the deeper injection first (between the pec minor and serratus anterior muscles) to cause less distortion of the sonoanatomy for the 2nd injection

38
Q

failure to appreciate the thoracoacromial artery can cause what for PECS 1&2 and SAP blocks?

A

inadvertant puncture, vascular injury, hematoma, and LAST

39
Q

pneumothorax can occur with PECS1&2 and SAP blocks due to

A

the close proximity of the needle to the pleural space

40
Q

origin of intercostal nerves

A

ventral rami of the thoracic spinal nerves (T1-11)

41
Q

what do the intercostal nerves of the chest innervate?

A

T2-6
chest wall, intercostal muscles, and parietal pleura

42
Q

what does the intercostal nerves of the abdomen innervate?

A

T7-11
skin over the anterior abdomen, abdominal muscles, and parietal peritoneum

43
Q

intercostal nerve blocks pros

A

promote normal ventilation
facilitate deep breathing exercises needed during postop recovery
reduce risk of opioid-induced respiratory depression by decreasing opioid consumption

44
Q

indications for intercostal nerve block

A

rib fractures
herpes zoster
surgical procedures of chest and abdomen
chest-tube placement when epidural analagesia isn’t desired/possible

45
Q

intercostal nerve block coverage

A

1 dermatome level

46
Q

patient position for intercostal nerve block

A

sitting or prone

47
Q

frequency of transducer for intercostal nerve block

A

high (>7MHz)

48
Q

what are you looking for on the ultrasound for intercostal nerve blocks?

A

intercostal space between ribs; hyperchoic pleural line as the base

49
Q

lung sliding during ventilation means

A

confirmation of the location of the lung

50
Q

total LA volume for intercostal nerve block

A

3-5mL

51
Q

position for intercostal nerve block for obese patients

A

sitting with patient supported by table/stand

52
Q

pro of intercostal nerve block with free block needle

A

increases control and maneuverability during procedure

53
Q

for intercostal nerve block, how many levels may be needed for analgesia and motor relaxation for upper abdominal surgeries?

A

5-6 levels

54
Q

why would it be difficult to block T1-5?

A

thickness of paraspinal muscles and proximity of the scapula

55
Q

possible complications with intercostal nerve block

A

LAST
pneumothorax
respiratory insufficiency for those with severe COPD who depend on their intercostal muscles for ventilation

56
Q

boundaries of the paravertebral space

A

anterior = parietal pleura
medial = vertebral body and intravertebral foramen
posterior = transverse process & superior costotransverse ligament

57
Q

why are sympathetic ganglia anesthetized by a paravertebral block?

A

medial aspect of the paravetebral space is a continuation of the epidural space

58
Q

surgical indications for paravetebral block

A

thoracic
breast
cholecystectomy
herniorraphy
appendectomy

59
Q

pain management indications for paravertebral block

A

rib fractures
flail chest
blunt abdominal trauma
osteoporotic vertebral fractures
herpes zoster where coverage of >1 dermatome is needed

60
Q

patient position for paravertebral block

A

lateral decubitus with block side up

61
Q

transducer of frequency for paravertebral block

A

high

62
Q

what are you looking for on the ultrasound for paravertebral block?

A

lateral to the spinous process: intercostal space, paravertebral space

63
Q

total LA volume for paravertebral block

A

5-10mL in divided doses

64
Q

possible complications of paravertebral block

A

LAST due to inadvertant intravascular injection
pneumothorax
intrathecal injection (spinal anesthesia)
PDPH

65
Q

erector spinae function

A

help the vertebral column stay upright
assist in moving the vertebral column (extension and lateral flexion)

66
Q

erector spinae muscle group includes

A

iliocostalis
longissimus
spinalis

67
Q

what does the erector spinae block target?

A

the dorsal and ventral rami of the thoracolumbar nerves at the level of injection

68
Q

what happens if LA is injected deep to the erector spinae muscle group and superficial to the transverse process?

A

significant craniocaudal spread

69
Q

ESB indications

A

neuropathic pain
rib fractures
lumbar spine surgery
thoracic surgery
cardiac surgery
breast surgery
bariatric surgery
numerous abdominal procedures

70
Q

for ESB, how many dermatome levels are covered with 1 injection at the thoracic level?

A

8-11

71
Q

for ESB, how many dermatome levels are covered with 1 injection at the lumbar level?

A

3-4

72
Q

what may cause a failed block for ESB?

A

mistaking the facet joint for the transverse process

73
Q

muscles of the anterolateral abdominal wall

A

rectus abdominis
transversus abdominis
external oblique
internal oblique

74
Q

key anatomic reference for TAP block with landmark technique

A

inferior lumbar triangle AKA triangle of Petit

75
Q

borders of triangle of Petit

A

posterior = latissimus dorsi
anterior = EO
inferior = iliac crest
floor = IO

76
Q

target for TAP block

A

fascial plane between the IO and TA muscles

77
Q

what innervates the IO and TA muscles?

A

thoracolumbar nerves arising from T6-L1

78
Q

TAP block indications

A

hernia repair
open appendectomy
laparoscopic abdominal procedures
radical prostatectomy
gynecologic surgeries
cesarean section

79
Q

TAP block provides anesthesia to

A

the abomdinal wall (skin and muscle) and the parietal peritoneum

80
Q

TAP block approaches

A

subcostal for procedures above the umbilicus
lateral and posterior for procedures below the umbilicus

81
Q

total LA volume for TAP block

A

20mL in 5mL increments

82
Q

why are blunt tip needles better for TAP blocks?

A

increased tactile feel
reduced risk of visceral injury

83
Q

possible complications of TAP block

A

injury to abdominal organs if the needle enters the peritoneum
LAST due to large volume of LA at each site, accidental intravascular injection into a thoracic intercostal artery or deep circumflex iliac artery, or increased rate of LA absorption bc of compact area of fascia

84
Q

indications for the rectus sheath block

A

procedures that require a midline abdominal incision:
umbilical hernia repair in the pediatric population
c-section with midline incision
postpartum laparoscopic tubal ligation

85
Q

total LA volume for rectus sheath block

A

10mL in 5mL increments

86
Q

where is the quadratus lumborum muscle?

A

between the anterior and middle layers of the thoracolumbar fascia (TLF)

87
Q

where is LA injected for QL 1?

A

lateral to the QLM

88
Q

where is LA injected for QL 2?

A

posterior to the QLM

89
Q

where is LA injected for QL 3?

A

anterior to the QLM

90
Q

indications for QLM block

A

QL 1 = abdominal surgery below the umbilicus
QL 2&3 = abdominal surgery below or above the umbilicus (up to T6)

91
Q
A

My APEX (1 decks)

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