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Anesthesia Exam 1 > Upper extremity blocks > Flashcards

Upper extremity blocks Flashcards

1
Q

What are some considerations of whether to do regional or general anesthesia?

A
  • Patient preference
  • Co-existing medical conditions
  • Surgical considerations
  • Skill of anesthesia provider
  • Surgeon preference
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2
Q

What are some advantages of regional anesthesia?

A
  • Can avoid general anesthesia
  • Better for patients with cardiac or pulmonary disease
  • Avoid use of post-op opiates
  • Induced sympathectomy- intraoperative reduction in blood loss and postoperative improvement in perfusion
  • Reduced nausea/vomiting
  • Preemptive analgesia-reduces postoperative pain and analgesic requirements
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3
Q

What are some contraindications to regional anesthesia?

A
  • Patient refusal
  • Patient unable to cooperate
  • Coagulopathy
  • Existing neurological complications
  • Infection near the site of injection
  • Septicemia
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4
Q

What is included in the set up for regional anesthesia?

A
  • Monitors
  • Suction
  • Means of PPV (ambu-bag, mask, oxygen)
  • Airway (intubation equipment)
  • IV access
  • Drugs (emergency medications, anxiolytics, lipids)
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5
Q

What are three ways to verify needle placement during a block?

A
  • Ultrasound
  • Nerve stimulator
  • Parasthesas (not ideal)
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6
Q

What type of needle do you use for upper extremity nerve blocks?

A

22 G “B” bevel insulated needle.

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7
Q

How many milliamps do you start at on the nerve stimulator and what do you dial down to?

A

Start at 1.0 milliamps and dial down to 0.5. Want twitch to still be there at 0.5, but go away by 0.3.

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8
Q

What surgeries can be performed under an interscalene block?

A

Shoulder or upper arm.

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9
Q

What does an interscalene block provide anesthesia to?

A

Upper branches of the brachial plexus and the lower cervical plexus.

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10
Q

How much LA do you inject for an interscalene block?

A

20-30ml

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11
Q

What nerve is often spared during an interscalene block?

A

Ulnar nerve. Your ring and little finger will not be numb, can pinch and spread fingers.

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12
Q

What is the landmark for the interscalene block?

A

Lateral border of the sternocleidomastoid muscle at the level of C6.

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13
Q

What are some contraindications to an interscalene block?

A

Absolute:
-Contralateral recurrent laryngeal nerve palsy
-Phrenic nerve palsy
Relative:
-Preexisting nerve injury
-Brachial plexus pathology
-Significantly impaired pulmonary function

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14
Q

What should you see twitching to verify placement during an interscalene block?

A

Bicep or distal hand.

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15
Q

How do you evaluate an interscalene block?

A
  • Push (arm extension-radial nerve)
  • Pull (arm flexion- musculocutaneous nerve)
  • Close (index finger-median nerve)
  • Open (little finger-ulnar nerve)
  • Sensory loss to shoulder
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16
Q

What are some complications from an interscalene block?

A
  • Intravascular injection
  • Subarachnoid/epidural injection
  • Pneumothorax
  • Recurrent laryngeal nerve block
  • Horner’s syndrome
  • Phrenic nerve block
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17
Q

What are some indications for a cervical plexus block?

A

-Unilateral surgical procedures of the neck- carotid endartectomy if combined with a deep cervical plexus block

18
Q

What is the landmark for a cervical plexus block? How many mls of LA is injected?

A

Midpoint of the posterior border of the SCM. The needle is tunneled superiorly and then inferiorly along the posterior border and 5ml is injected subcutaneously in both directions.

19
Q

What is blocked during a supraclavicular block?

A
  • Carried out at the trunks of the brachial plexus

- Effective block for all portions of the upper extremity (hand, forearm, upper arm)

20
Q

What are some contraindications to a supraclavicular block?

A
  • Contralateral phrenic paralysis
  • Recurrent nerve paralysis
  • Contralateral pneumothorax
21
Q

What are the landmarks for insertion of a supraclavicular block?

A

Lateral border of the clavicular head of the SCM at the level of the insertion into the clavical in the groove between the scalene muscles. Needle only goes 0.5-1cm directed caudally, not very deep.

22
Q

What are some complications with supraclavicular blocks?

A
  • Increased risk of pneumothorax
  • Horner’s syndrome
  • Phrenic nerve block
  • Recurrent laryngeal nerve paralysis
  • Neuropathy
23
Q

What are indications for an infraclavicular block?

A

Surgery on the elbow, forearm, hand

24
Q

What are the landmarks for an infraclavicular block?

A

Needle is inserted at a 45 degree angle to the skin at the idpoint between the coracoid process and the medial clavicular head

25
Q

If performing an infraclavicular block and you observe a pectoralis twitch what should you do?

A

Keep advancing the needle, you want to see median, radial or ulnar twitch.

26
Q

What are the indications for an axillary block?

A

-Procedures below the elbow ie forearm or hand surgery.

27
Q

What nerves are blocked during an axillary block? What nerve is spared?

A
  • Median, ulnar and radial nerve

- Musculocutaneous is spared

28
Q

What are the contraindications to an axillary block?

A
  • Lymphangitis
  • Preexisting nerve injury
  • Brachial plexus pathology
29
Q

What is the landmark for an axillary block?

A

Have the patient in the supine position with arm extended and at a 90 degree angle. Palpate the axillary artery as proximal as possible.

30
Q

How many mls of LA are injected for an axillary block?

A

30ml.

31
Q

How do you evaluate an axillary block?

A

Push-radial nerve

Pull- musculocutaneous which is often spared and requires a separate injection into the belly of the coracobrachialis

Close-medial nerve
Open-Ulnar nerve

32
Q

What are some complications from an axillary block?

A

Hematoma, Intravascular injection, and Infection

33
Q

Where is LA injected for a touch up block of the radial nerve?

A

1-2 cm lateral to the biceps tendon. A fanlike injection of 4-6 mls

34
Q

Where is LA injected for a touch up block of the median nerve?

A

1 cm medial to brachial artery, 3-5ml injected.

35
Q

Where is LA injected for a touch up block of the ulnar nerve?

A

1 cm proximal to the ulnar groove, 3-5 ml injected

36
Q

Where is the LA injected for a touch up block of the musculocutaneous nerve?

A

Deep in the body of the coracobrachialis.

37
Q

How much and what kind of LA is injected for a bier block?

A

40 ml of 0.5% lidocaine.

38
Q

How long of cases are bier blocks effective for?

A

Ideal for 60 minutes but can be effective for up to 120 minutes.

39
Q

What location of surgeries can bier blocks be used for?

A

Forearm and hand surgeries.

40
Q

What are some disadvantages of bier blocks?

A

-Local anesthetic toxicity

Anesthesia Exam 1 (5 decks)

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