Upper Extremity Blocks

Question 0

The biggest contraindication for regional anesthesia is _________________. Other medical contraindications are _____________, ___________, or __________ near the site.

Answer 0

patient refusal
coagulopathy
neurological compliction
infection

Question 1

Inducing a sympathectomy with regional anesthesia will reduce ______________ and improve ______________

Answer 1

Intraoperative Blood Loss

Postoperative perfusion

Question 2

For regional anesthesia you have to be ready to treat _____________ toxicity. You should prepare: M ____ S ______ M _____ A _______ I ____ D________ incase you need it!

Answer 2

Local anesthetic toxicity
Monitor
Suction
Means of PPV
Airway
IV access
Drugs

Question 3

What are the 3 ways to ID a nerve for a nerve block?

Answer 3

Nerve Stimulator,
Ultasound,
Parathesia

Question 4

The Brachial Plexus provides almost all __________ innervation to the upper extremity except for the _______ branches of the cervical plexus which supply the _________ shoulder

Answer 4

sensory
caudad
posterior

Question 5

Nerve stimulation depends on ________ of the current and _________ duration. Red is _____ and Black is _______.

Answer 5

Intensity
pulse
+
-

Question 6

When using the nerve stimulator, Use a 22g _____ Bevel, ____ Needle.

Answer 6

B bevel

insulated

Question 7

The B Bevel has (more/less) of an angle than A?

Answer 7

more of an angle

Question 8

The ______________ block is ideal or surgery of the shoulder or upper arm. You will block the ________ branches of the brachial plexus and the _________ cervical plexus

Answer 8

interscalene
upper
lower

Question 9

With the interscalene block, you frequently spare the ________ nerve. This means you will not anesthetize the ________ fingers for sensation.

Answer 9

ulnar

little finger & ring finger

Question 10

The major landmark for the interscalene approach is the posterior border of the __________ at the level of ____. You will roll finger posterior to palpate the groove between the ___________muscles

Answer 10

Sternocleidomastoid
C6
anterior and middle scalene

Question 11

Absolute contraindications for an interscalene block are: ____________________ palsy and ________________ palsy

Answer 11

Contalateral recurrent laryngeal nerve

Phrenic nerve

Question 12

With the interscalene block, becareful with impaired pulmonary function because of the close proximity to the __________ nerve

Answer 12

Phrenic

will probably lose 1/2 of the diaphragm

Question 13

To evaluate the interscalene block muscle tone:
Push (extend): \_\_\_\_\_\_\_\_\_ Nerve  
Pull (Flex): \_\_\_\_\_\_\_\_\_\_\_ Nerve
Close fist: \_\_\_\_\_\_\_\_\_\_\_ Nerve
Open Fist: \_\_\_\_\_\_\_\_\_\_ Nerve

Answer 13

Radial
Musculocutaneous
Median
Ulnar

Question 14

A complication to the interscalene/ supraclavicular block is _____________ syndrome. With this you’ll see 3 s/s: _____________ ,__________, & ____________. It is common but will go away.

Answer 14

Horner’s syndrome
Anhydriasis
Ptosis
Miosis (pupils constrict)

Question 15

The ____________ block has increased success of blocking the inferior trunk ( less chance of ulnar sparing)

Answer 15

Supraclavicular

Question 16

The supraclavicular has a much higher risk for __________________.

Answer 16

Pneumothorax

Question 17

With the supraclavicular block, you should see a response in the ____________ immediately after the needle is in the __________ groove. The more distal the response….. the more _______ the block.

Answer 17

Hand/ arm
interscalene
reliable

Question 18

T/F: The infraclavicular approach will block the shoulder

Answer 18

False! The block works at the elbow and down

Question 19

The ______________ block is indicated for surgery on elbow, forearm, hand.

Answer 19

Infraclavicular

Question 20

The major landmarks for the infraclavicular blocks is the _______ clavicular head and the __________ process. You inject the needle in towards the ___________

Answer 20

Medial
Coracoid
shoulder ( go laterally)

Question 21

When doing the infraclavicular block, initially look for a __________ twitch…. But you are still too shallow. You want to see _____________ twitch which will be about 5-8cm deep.

Answer 21

Pectoralis

Terminal Nerve

Question 22

The Axillary block is for procedures at what level?

Answer 22

BELOW the elbow

Question 23

The ___________ block is the safest and easiest approach to the plexus. This is because you can easily palpate the ______________.

Answer 23

Axillary

axillary artery

Question 24

With the axillary block, the pt must be able to: _________________

Answer 24

Abduct arm and place at 90 degree angle

Question 25

An absolute contraindication to the Axillary block is ______________

Answer 25

Lymphangitis

Question 26

When doing an axillary approach, the ________ nerve will be superior (anterior) to the axillary artery, The _________ nerve will be inferior to the ax. artery and the ___________ nerve will be posterior to the ax. artery.

Answer 26

Median
Ulnar
Radial

Question 27

Aside from the nerve stimulator and paresthesia technique, you can also use the _______________ technique with the axillary approach.

Answer 27

Transarterial

Question 28

For the axillary block, since the _____________ nerve is not in the sheath, you do a separate injection into the belly of the ______________

Answer 28

musculocutaneous

Corcobrachialis

Question 29

The onset of a Bier Block is usually _____ minutes. Its ideal for forearm/hand cases that are about _____ to _____ minnutes.

Answer 29

5

60 - 120