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APEX > Unit 8 - Truncal Blocks > Flashcards

Unit 8 - Truncal Blocks Flashcards

1
Q

whats the difference in a PECS1 & PECS2 block

A

PECS 1
* Injection site = Fascial plane between the pec major and pec minor

PECS 2
* Injection site = Fascial plane between the pec major and pec minor

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1
Q

where do intercostal nerves originate

A

from ventral rami of thoracic spinal nerves (T1-T11)

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2
Q

distribution of anesthesia with paravertebral block

A

Intervertebral blocks provide coverage for only one dermatome level, the procedure must be performed at each level where anesthesia is desired

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3
Q

boundaries of paravertebral space

A
  1. Anterior - Parietal pleura
  2. Medial - Vertebral body and intravertebral foramen
  3. Posterior - Transverse process and superior costotransverse ligament
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4
Q

indications for paravertebral blockade

A

Surgical procedures:
* Thoracic
* Breast
* Cholecystectomy
* Herniorraphy
* Appendectomy

Pain Management
* Rib fractures
* Flail chest
* Blunt abdominal trauma
* Osteoporotic vertebral fractures
* Herpes zoster where coverage of more than one dermatome is needed

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5
Q

target of erector spinae plane block

A

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

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6
Q

borders of the triangle of Petit

A
  • Posterior border = Latissimus dorsi
  • Anterior border = External oblique
  • Inferior border = Iliac crest
  • Inside of the triangle (floor) = Internal oblique
  • The transverse abdominis is deep to the 10
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7
Q

the triangle of petit is used as an anatomic reference point for which block

A

TAP block

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8
Q

where is LA injected in TAP block

A

in the fascial plane between the internal oblique (I0) and transverse abdominis (TA) muscles

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9
Q

how are the IO and TA muscles innervated

A

thoracolumbar nerves arising from T6-L1

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10
Q

TAP block approaches

A
  • Subcostal approach - procedures above the umbilicus
  • Lateral and posterior approach - procedures below the umbilicus
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11
Q

indications of rectus sheath block

A

procedures that require a midline abdominal incision
ex- umbilical hernia repair in the pediatric population, cesarean section when a midline incision is required, and postpartum laparoscopic tubal ligation.

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12
Q

where does the QL muscle reside

A

muscle resides between the anterior to the middle layers of the TLF

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13
Q

where is LA injected for QL blocks

A
  • QL 1 - LA is injected lateral to the QLM
  • QL2 - LA is injected posterior to the QLM
  • QL 3 - LA is injected anterior to the OLM
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14
Q

LA target injection site in QL blocks

A

thoracolumbar fascia

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15
Q

nerves anesthetized by TAP block

A

lower intercostal n.
iliohypogastric n.
inguinal n.

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16
Q

a PECS2 block targets the fascial plane between:

A

Pec major & pec minor
pec minor & serratus anterior

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17
Q

where is LA injected for PECS1 block

A

Fascial plane = Between
pectoralis major and pectoralis minor

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18
Q

where is LA injected for serratus anterior plane block

A

Fascial plane = Between
latissimus dorsi and serratus anterior

19
Q

objective for intercostal block

A

provide motor and sensory anesthesia of the trunk from the xiphoid to the pubis (single dermatome level)

20
Q

intercostal n. block indications

A
  • acute & chronic pain syndromes of chest/upper abd
  • rib fx
  • herpes zoster (shingles)
  • cholecystectomy
  • chest tube insertion
21
Q

intercostal nerve block complications

A

PTX
LAST

22
Q

LA volume for intercostal n block

A

3-5 mL per dermatome level

23
Q

target of paravertebral block

A

spinal nerves exiting vertebral foramen

“unilateral epidural”

24
Q

paravertebral block indications

A

Segmental anesthesia or pain management of surgical procedures of the chest and abdomen when a neuraxial technique is contraindicated or refused

25
Q

complications of paravertebral block

A
  • LAST
  • PTX
  • intrathoracic intrathecal injection
  • PDPH
26
Q

borders of paravertebral space

A
  • anterior = parietal pleura
  • medial = vertebral body & intervertebral foramen
  • posterior border = transverse process & superior costotransverse ligament
27
Q

indications of erector spinae block

A
  • Neuropathic pain
  • rib fractures
  • lumbar spine surgery
  • thoracic surgery
  • cardiac surgery
  • breast surgery
  • bariatric surgery
  • numerous abdominal procedures
28
Q

complications of erector spinae block

A

LAST
PTX

29
Q

3 paired muscles of erector spinae

A
  1. iliocostalis
  2. longissismus
  3. spinalis
30
Q

approx how many dermatome levels are covered by a thoracic ESP block

A

8-11 dermatome levels

31
Q

approx how many dermatome levels are covered by a lumbar ESP block

A

3-4 dermatome levels

32
Q

where does TAP block provide analgesia

A

abdominal wall (skin & muscle) and parietal peritonium

33
Q

where is LA injected in TAP block

A

between IO and TA muscles

34
Q

complications of TAP block

A

LAST
peritoneal injury

35
Q

4 paired muscles of anterolateral abdominal wall

A
  1. rectus abdominis
  2. transverse abdominis
  3. external oblique
  4. internal oblique
36
Q

anatomic boundaries of inferior lumbar triangle

A
  • Inferior border = Iliac crest
  • Posterior border = Latissimus dorsi
  • Anterior border = External oblique
  • Inside of the triangle (floor) = Internal oblique
37
Q

3 approaches to TAP block

A
  1. subcostal
  2. lateral
  3. posterior
38
Q

where is LA injected for a rectus sheath block

A

fascial plane between rectus abdominis and posterior rectus sheath

39
Q

target of rectus sheath block

A

thoracolumbar nerves and the anterior cutaneous branches as they travel in the fascial plane between the rectus abdominis muscle and posterior rectus sheath.

40
Q

indications of rectus sheath block

A

procedures with midline abd incision

41
Q

complicaiton of rectus sheath block

A

LAST due to inadvertent vascular injection (inferior epigastric arteries travel within the rectus sheath).

42
Q

QL block low frequency transducer is used for

A

QL3

43
Q

complications of rectus sheath block

A

Inadvertent peritoneal puncture and visceral injury (kidney, liver, and spleen)

44
Q

which nerve block produces anesthesia by injecting LA into thoracolumbar fascia

A

QL1

APEX (54 decks)

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