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Regional FINAL > Upper Extremity Blocks > Flashcards

Upper Extremity Blocks Flashcards

(71 cards)

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1
Q

What are the 4 most common upper extremity blocks?

A

Axillary, interscalene, supraclavicular, infraclavicular

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2
Q

What is the most frequently performed upper extremity block?

A

Axillary

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3
Q

What is the interscalene block used for?

A

shoulder, upper arm

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4
Q

What is a major risk with the supra/infraclavicular blocks?

A

Close to lung –> PTX

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5
Q

What is the infraclavicular block used for?

A

Lower arm, hand. Better for tourniquet pain. Reliable block of musculocutaneous, axillary nerves

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6
Q

Where does the supraclavicular portion of the brachial plexus lay?

A

posterior triangle of the neck

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7
Q

Where does the infraclaviuclar portion of the brachial plexus lay?

A

axilla

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8
Q

What is the order of the brachial plexus anatomy??

A

Roots Trunks Divisions Cords Branches

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9
Q

What is the superior/upper trunk innervated by?

A

C5, C6 rami

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10
Q

What is the middle trunk innervated by?

A

C7 ramus

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11
Q

What is the inferior/lower trunk innervated by?

A

C8, T1 rami

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12
Q

Where does the inferior/lower trunk lay?

A

On the 1st rib, posterior to the subclavian artery

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13
Q

What are nerve trunks enveloped by?

A

Fascial sheath

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14
Q

Where does the fascial sheath originate from?

A

posterior fascia of anterior scalene muscle + anterior fascia of the middle scalene muscle

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15
Q

What is the sheath of the brachial plexus also known as?

A

interscalene space, it is a closed space

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16
Q

Can you inject LA outside the sheath?

A

Yes, but must allot time for the block to “set up” if this is the case

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17
Q

Ventral division

A

flexor

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18
Q

Dorsal division

A

extensor

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19
Q

What do the 3 posterior divisions form?

A

posterior cord

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20
Q

What do the anterior divisions of the superior/middle trunks form?

A

lateral cord

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21
Q

What does the anterior division of the inferior trunk become?

A

medial cord

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22
Q

What does the lateral cord become?

A

musculocutaneous nerve, lateral root of median nerve

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23
Q

What does the medial cord become?

A

ulnar nerve, medial root of median nerve

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24
Q

What does the posterior cord become?

A

axillary, radial nerves

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25
What supplies the ventral portion of the upper extremity?
branches of lateral, medial cords (medial, ulnar, musculocutaneous nerves)
26
What supplies the dorsal portion of the upper extremity?
branches of posterior cord
27
What is the major nerve supply to the dorsal extensor muscles (triceps)?
radial nerve
28
What is the nerve supply to the flexor muscles of the ventral portion of the arm?
musculocutaneous
29
What does the musculocutaneous nerve innervate?
sensory -- lateral aspect of forearm between wrist and elbow (as lateral antebrachial cutaneous nerve)
30
What is the sensory/motor innervation of the forearm and hand?
median, ulnar nerves
31
What supplies most of the flexor and pronator muscles?
median
32
What else does the median nerve supply?
sensory -- ventral thumb/1st/2nd finger, lateral 3rd finger
33
What does the ulnar nerve supply?
motor -- most of the small flexor muscles. sensory -- medial portion of 3rd, 4th finger, rest of palm. NO sensory of forearm
34
What do you do for a muscle twitch guided brachial plexus block?
22g insulated B-bevel needle --> visible twitch. Advance needle SLOWLY until you see twitch, then decrease mA
35
How much is the brachial plexus test dose?
1 mL
36
How much volume should you inject at a time for a brachial plexus block?
3-5 mL until you inject full volume
37
Where is the needle/catheter placed for interscalene block?
at level of the trunks
38
Which level does the criocid cartilage correlate to?
C6 (Chassaignac's tubercle)
39
What can you palpate that is the level of the trunks?
groove between anterior/middle scalene muscles
40
How is the needle inserted for an interscalene block without US?
perpendicular then angled slightly caudad
41
How much volume is injected for interscalene block without US?
30-35 mL
42
What kind of US is used for interscalene?
High frequency
43
How much volume is injected for interscalene block with US?
20 mL
44
What is hydrodissection?
When the LA injected creates an expanding hypoechoic area that surrounds/englufs the brachial plexus
45
What kind of needle do you use for US interscalene?
22g 2"
46
Where do you palpate the subclavian artery?
behind midpoint of clavicle, just above superior surface of the 1st rib and between the scalene muscles
47
How much volume is used for a subclavian approach?
30-35 mL
48
What should you watch out for with the subclavian approach?
Horner's Syndrome -- miosis, ptosis, anhydrosis. PTX
49
What is the alternate to the subclavian approach, and why was it developed?
intersternocleidomastoid block -- d/t the high risk of PTX/Horner's with subclavian.
50
Where do you inject the needle for intersternocleidomastoid block?
between heads of the sternocleidomastoid muscle
51
What nerves can be reached/stimulated from alternate subclavian approach?
suprascapular, superior trunk, middle trunk, divisions, cords
52
What happens when you stimulate the superior trunk?
contraction of biceps, deltoids. Elbow flexion, ABDuction of arm
53
What happens when you stimulate the middle trunk?
Tricep contraction. Elbow extension
54
What happens when you stimulate the divisons and cords?
Pronation of hand. Digit flexion, pectoral contraction
55
What is the axillary block used for?
Procedures at or below elbow
56
What should you do during an axillary block?
pressure applied to the axillary artery to minimize distance between skin and SQ tissue and neurovascular bundle
57
What are the two types of axillary blocks?
LOR, transarterial
58
What kind of needle is used for LOR axillary?
22g 1.5" B-bevel (pop better felt with shorter needle)
59
How much do you administer for LOR axillary?
3-5 mL test dose, wait 1 minute. Inject the rest in 5 mL increments.
60
What should you do while injecting an axillary block?
hold firm pressure to the area immediately behind the needle to prevent retrograde flow of the LA
61
What is the total volume for axillary block?
40 mL
62
What else does the pressure in axillary LOR block do?
anesthetizes musculocutaneous nerve and terminal branch, lateral AC nerve also
63
How can you help block the musculocutaneous nerve during the axillary LOR block?
inject 3-5 mL into body of coracobrachialis muscle before taking needle out. Pull up and then redirect needle, give 3-5 mL more into SQ tissue --> conduction blockade of medial brachial cutaneous and intercostobrachialis nerves
64
What do you do immediately after axillary block?
ADDuct, hold close to body to encourage cephalad spread
65
What kind of needle is used for axillary transarterial block?
21g 1.5" (can go as small as 26g 1/2")
66
What kind of US is used for axillary block?
high frequency
67
How much is injected for US axillary block?
5-10 mL under direct observation, 20-30 mL total
68
What kind of needle is used for US axillary block?
22g 2"
69
What do you do when cont cath needle is in right spot?
inject 5-10 mL NS -- expands sheet, allows catheter placement and protects from IV injection
70
How far do you insert catheter?
3-5 cm
71
How much LA do you give with cont cath?
30-35 mL incrementally

Regional FINAL (4 decks)

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