Upper and Lower PNBs Flashcards
Blocking this nerve may help allow you to place a tourniquet on the arm of an awake patient
Intercostobrachial nerve (Arises from T2 and is blocked with a field block)
Inter scalene targets these roots
C5, 6, and 7 (the stoplight)
What does inter scalene block?
Blocks the upper trunk! So it’s good for shoulder and upper arm procedures. Not great for lower arm procedures because it blocks the lower roots that innervate the hand and forearm.
The cupola of the lung is higher on which side?
Right side
S/S of Horner’s syndrome?
Horny Pam!
Ptosis, anhidrosis, and miosis.
As little as ___mL in the vertebral artery can result in sz activity
1mL
Horner’s syndrome occurs as a result of what?
Blockade of the stellate ganglion (located at C7). Indicates successful block.
Pneumothorax may have occurred if pt complains of
Coughing or chest pain during needle insertion or manipulation
Complications of inter scalene block
Horner's syndrome Phrenic Nerve Paralysis RLN Injury Pneumothorax Epidural/Spinal injection Seizure Bezold jarisch reflex
What is the Bezold Garish Reflex?
Will see bradycardia and hypotension!
Venous pooling results in a profoundly undefiled ventricle. The heart slows to improve diastolic filling.
Doing this pre-op and decrease the risk of BJR
Pre-op beta blockade
Supraclavicular is good for
Surgeries at or below the elbow
Complications of supraclavicular block
Pneumo
Horner’s Syndrome
Subclavian artery injection
Infraclavicular block is good for
surgeries below the elbow
Infraclavicular block will block this part of the plexus
Cords
Acceptable motor response for infraclavicular block
Triceps or anything below the elbow
Complications of infraclavicular block
- Vascular puncture (SA and SV are right around the cords here)
- Pneumo (though lower risk here compared to inter scalene and supraclavicular)
- More painful to perform because you’re going through pec major and pec minor
This block often misses the ulnar nerve
Interscalene
This block often misses the musculocutaneous nerve
Axillary
Axillary nerve block is good for
surgeries below the elbow
But misses the MC! Make sure you hit that shit up too!
Nerves that come from the lumbar, sacral, and coccygeal plexuses
Lumber Plexus (Anterior):
- Femoral
- Obturator
- LFC
- Iliohypogastric
- Ilioinguinal
- Genitofemoral
Sacral Plexus (Posterior)
- Sciatic
- Posterior femoral, BIIIITTCHHHH
Coccygeal
- Pundendal
Lumbar and Sacral Plexus nerve roots
Lumbar = L1-4 and sometimes T12
Sacral = L4-S4
Sensory and motor innervation of the LFC
Sensory: Lateral thigh
Motor: None
Sensory and motor innervation of the femoral nerve
Sensory: Anterior thigh
Motor:
- Anterior = Sartorius
- Posterior = Quads
Sensory to the posterior aspect of the thigh is provided by
The posterior femoral nerve
The sural nerve is composed of branches from these two nerves
Tibial and common peroneal (the two major branches of the sciatic)
Borders of the femoral triangle
It’s a triangle like the SAIL of a ship!
S = Sartorius A = Adductor longus IL = Inguinal ligament
This branch of the femoral nerve gives rise to the saphenous nerve
Posterior branch of the femoral nerve
Stimulation of the tibial nerve will cause this motor response
Plantar flexion and inversion of the foot
What is has more influence on spread in subarachnoid blocks? Volume or dose?
Dose.
For epidurals, both volume AND dose matter.
What spinal nerve roots are most resistant to LAs?
L5 and S1
These are the largest and most resistant spinal nerves.
L5-S1 interspace is the largest interspace in the vertebral column
