Unit 8 - Truncal Blocks Flashcards
whats the difference in a PECS1 & PECS2 block
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
where do intercostal nerves originate
from ventral rami of thoracic spinal nerves (T1-T11)
distribution of anesthesia with paravertebral block
Intervertebral blocks provide coverage for only one dermatome level, the procedure must be performed at each level where anesthesia is desired
boundaries of paravertebral space
- Anterior - Parietal pleura
- Medial - Vertebral body and intravertebral foramen
- Posterior - Transverse process and superior costotransverse ligament
indications for paravertebral blockade
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
target of erector spinae plane block
dorsal and ventral rami of the thoracolumbar nerves at the level of injection
borders of the triangle of Petit
- 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
the triangle of petit is used as an anatomic reference point for which block
TAP block
where is LA injected in TAP block
in the fascial plane between the internal oblique (I0) and transverse abdominis (TA) muscles
how are the IO and TA muscles innervated
thoracolumbar nerves arising from T6-L1
TAP block approaches
- Subcostal approach - procedures above the umbilicus
- Lateral and posterior approach - procedures below the umbilicus
indications of rectus sheath block
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.
where does the QL muscle reside
muscle resides between the anterior to the middle layers of the TLF
where is LA injected for QL blocks
- 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
LA target injection site in QL blocks
thoracolumbar fascia
nerves anesthetized by TAP block
lower intercostal n.
iliohypogastric n.
inguinal n.
a PECS2 block targets the fascial plane between:
Pec major & pec minor
pec minor & serratus anterior
where is LA injected for PECS1 block
Fascial plane = Between
pectoralis major and pectoralis minor
where is LA injected for serratus anterior plane block
Fascial plane = Between
latissimus dorsi and serratus anterior
objective for intercostal block
provide motor and sensory anesthesia of the trunk from the xiphoid to the pubis (single dermatome level)
intercostal n. block indications
- acute & chronic pain syndromes of chest/upper abd
- rib fx
- herpes zoster (shingles)
- cholecystectomy
- chest tube insertion
intercostal nerve block complications
PTX
LAST
LA volume for intercostal n block
3-5 mL per dermatome level
target of paravertebral block
spinal nerves exiting vertebral foramen
“unilateral epidural”
paravertebral block indications
Segmental anesthesia or pain management of surgical procedures of the chest and abdomen when a neuraxial technique is contraindicated or refused
complications of paravertebral block
- LAST
- PTX
- intrathoracic intrathecal injection
- PDPH
borders of paravertebral space
- anterior = parietal pleura
- medial = vertebral body & intervertebral foramen
- posterior border = transverse process & superior costotransverse ligament
indications of erector spinae block
- Neuropathic pain
- rib fractures
- lumbar spine surgery
- thoracic surgery
- cardiac surgery
- breast surgery
- bariatric surgery
- numerous abdominal procedures
complications of erector spinae block
LAST
PTX
3 paired muscles of erector spinae
- iliocostalis
- longissismus
- spinalis
approx how many dermatome levels are covered by a thoracic ESP block
8-11 dermatome levels
approx how many dermatome levels are covered by a lumbar ESP block
3-4 dermatome levels
where does TAP block provide analgesia
abdominal wall (skin & muscle) and parietal peritonium
where is LA injected in TAP block
between IO and TA muscles
complications of TAP block
LAST
peritoneal injury
4 paired muscles of anterolateral abdominal wall
- rectus abdominis
- transverse abdominis
- external oblique
- internal oblique
anatomic boundaries of inferior lumbar triangle
- Inferior border = Iliac crest
- Posterior border = Latissimus dorsi
- Anterior border = External oblique
- Inside of the triangle (floor) = Internal oblique
3 approaches to TAP block
- subcostal
- lateral
- posterior
where is LA injected for a rectus sheath block
fascial plane between rectus abdominis and posterior rectus sheath
target of rectus sheath block
thoracolumbar nerves and the anterior cutaneous branches as they travel in the fascial plane between the rectus abdominis muscle and posterior rectus sheath.
indications of rectus sheath block
procedures with midline abd incision
complicaiton of rectus sheath block
LAST due to inadvertent vascular injection (inferior epigastric arteries travel within the rectus sheath).
QL block low frequency transducer is used for
QL3
complications of rectus sheath block
Inadvertent peritoneal puncture and visceral injury (kidney, liver, and spleen)
which nerve block produces anesthesia by injecting LA into thoracolumbar fascia
QL1
