Upper extremity blocks 3 Flashcards
The objective of the infraclavicular block is to
Deposit LA around the cords of the brachial plexus below the clavicle, the LA will also spread around the axillary artery
Indications for the infraclavicular block include
Procedures involving the upper arm, elbow, wrist, and hand
Landmarks needed for nerve stimulation technique for the infraclavicular block include
Clavicle, coracoid process
Describe the transducer position for USG infraclavicular block
Parasagittal on the chest just medial to the coracoid process (below the clavicle)
At the infraclavicular level, the nerves appear
Hyperechoic
Due to the high variability of the location of the cords, using
nerve stimulation in conjunction with ultrasound-guidance can help you better localize the cords
If you can’t identify the cords, a reliable block can be achieved by
depositing local anesthetic in a U-shaped fashion around the axillary artery
The three most common errors that increase the risk of pneumothorax with the infraclavicular block include
needle insertion too medial
directing the needle medially
needle insertion depth exceeds 6 cm
What landmarks are needed for the infraclavicular block
clavicle & coracoid process
When stimulating the lateral cord, you should expect to see
median–> flexion of first 3.5 digits
opposition of the thumb
musculocutaneous–> elbow flexion* not a reliable indicator of lateral cord stimulation though because the musculocutaneous nerve leaves the lateral cord early
When stimulating the posterior cord, you should expect to see
extension of the wrist and digits
aBduction of the thumb
When stimulating the medial cord, you should expect to see
median–> flexion of the first 3.5 digits, opposition of the thumb
ulnar–> flexion of 4th and 5th digits, ADDuction of the thumb
When compared to the supraclavicular approach to the brachial plexus, the infraclavicular approach has a higher risk of:
a. intravascular injection
b. patient discomfort
c. pneumothorax
d. respiratory compromise
a & b
The _______ block is the most painful of the brachial plexus blocks due to the multiple muscle layers that must be traversed to accomplish this procedure.
infraclavicular
Inserting the needle ____________________ reduces the risk of pneumothorax in the infraclavicular approach.
inserting the needle caudal to the clavicle at the coracoid process in a slightly lateral direction
With the infraclavicular approach, puncture of the subclavian artery/vein
may be difficult to compress and must be observed closely
Which has a higher risk of pneumothorax: supraclavicular or infraclavicular.
supraclavicular
Which region is MOST likely to be inadequately anesthetized following an axillary block with a transarterial technique?
a. lateral forearm
b. medial forearm
c. first digit
d. fifth digit
a. lateral forearm
Describe the objective of the axillary block technique.
deposit local anesthetic around four of the terminal branches of the brachial plexus (median, radial, ulnar, and musculocutaneous)
What nerve is not blocked by the axillary block?
axillary nerve
What are the indications for performing the axillary block?
procedures involving the elbow, forearm, wrist, and hand
Describe the transducer position for the axillary block.
short-axis of the arm distal to the insertion of the pectoralis major muscle
What landmarks are needed for nerve stimulation and transarterial techniques for the axillary block?
axillary artery
coracobrachialis muscle
pectoralis major muscle
biceps muscle
triceps muscle