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Ultrasound > Upper Limb Blocks > Flashcards

Upper Limb Blocks Flashcards

1
Q

Indications for Cervical Plexus Block:

A

*Carotid endarterectomy
* Lymph node dissections and plastic repairs (Neck)
* Shoulder surgery (supplement brachial plexus)
* Tracheostomy
* Thyroidectomy and Parathyroidectomy
* Central venous cannula via the internal jugular or subclavian routes
* Injuries to the ear, neck and clavicular region including clavicular fractures and acromio-clavicular dislocations

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2
Q

Superficial Cervical Plexus Block:

The ____ is marked and from this point local anaesthetic ( ____ cc) is infiltrated subcutaneously along the ____ border

A
  • mid-point of the SCM
  • 7-10 cc
  • superior & Inferior
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3
Q

Cervical Plexus Block U/S picture

A
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4
Q

where is LA injected for a cervical plexus block

A

into the cervical plexus, just beneath the SCM approx 0.25-0.5 cm deep

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5
Q

nerve anatomy

A

Roots, Trunks, Divisions, Cords

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6
Q

interscalene should only be used for what?

A

shoulder surgery

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7
Q

ID what nerve roots for ISC block

A

C5, C6

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8
Q

Main side effect of ISC block?

A

Phrenic Nerve blockade

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9
Q

What nerve often gets injured during an ISC block?

A

Dorsal Scapula Nerve

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10
Q

What nerve root always bifurcates?

A

C6

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11
Q

Damage to the Dorsal scapula nerve will cause what?

A

inability to abduct arm (damages levitator scapuli) winged scapula

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12
Q

Why do we not want to advance needle down to C7 during a ISC block?

A

vertebral artery is colocated here

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13
Q

the phrenic nerve runs along the ____ and joins up to ____.

This is why we insert needle posterior-lateral through the middle scalene muscle.

A

Anterior scalene muscle
C5

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14
Q

how do perform interscalene block?

A

insert needle through the middle scalene muscle, placing tip just beneath C6, injecting no more than 20 cc local (10cc ideal)

AVOID C7 (VA risk) and do not inject >20cc LA as it could cause phrenic nerve paralysis.

AVOID going over C5 as it could cause 100% phrenic nerve block

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15
Q

How much LA does Leonard inject for ISC block

A

10cc

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16
Q

Recent literature suggests how much LA is needed for an ISC block?

A

6 cc

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17
Q

Leonard used to perform ‘awake’ shoulder surgeries how?

A

Target controlled INF (TCI) propofol 30-50 mcg/kg/min + ISC block

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18
Q

Can Exparel be used for Interscalene block?

A

YES

do NOT exceed 10cc Exparel (133 mg)

19
Q

Interscalene LA drug recommendations

A
20
Q

Interscalene block pic

A
21
Q

Interscalene block u/s pic

A
22
Q

ISC block complications

A
  • Epidural
  • spinal
  • VA injection
  • Phrenic Nerve block
  • RLN, Vagus, Cervical sympathetic nerves blocked
  • Horners
  • Pneumothorax (RARE)
23
Q

Horners Syndrome

A

Face droop
pupil dilated

disappears before block wears off

24
Q

hematoma 2/2 to LA injection can cause what

A

compression neuropraxia

25
Q

Interscalene is what layer block?

A

root

26
Q

Supraclavicular is what layer block?

A

trunk

27
Q

Supraclavicular block pic

A
28
Q

Supraclavicular block is for what surgery?

A

Humerus, Elbow, Hand

29
Q

technique for supraclavicular block

A

insert needle into brachial plexus sheath in between MSM and ASM. Inject 10cc ensuring spread to “corner pocket”

30
Q

what to avoid in a supraclavicular block:

A
  • Pneumothorax (avoid needle tip beyond 1st rib)
  • SCA
31
Q

Infraclavicular involves what layer of nerves?

A

Cords

32
Q

Infraclavicular covers what area?

A

Humerus, Elbow, Hand

33
Q

Infraclavicular pic

A
34
Q

Infraclavicular U/S pic

A
35
Q

why do we lie the pt supine during the infraclavicular block?

A

to dilate the SCV

36
Q

why do we abduct the arm behind the head during a infraclavicular block?

A

rolls the clavicle back and improves probe access

37
Q

which block involves a very steep angle of insertion?

A

infraclavicular

38
Q

What block?
will see:
- Pec Major
- Pec minor
- Axillary Artery
- Axillary vein
- 3 cords arranged “horseshoe” around the artery
-

A

Infraclavicular

39
Q

typical dose for infraclavicular block

A

20cc

Bupivicaine (0.25-0.5%) or Ropivicaine (0.2-0.5%)

40
Q

Axillary BPB for what procedures

A

Elbow, forearm, hand

41
Q

What layers of nerves does thee Axillary BPB involve?

A

Terminal Branches

42
Q

Dermatomal coverage for nerve block of the arm

A
43
Q

patient positioning for axillary BPB

A
  • supine
  • arm out 9o degrees
44
Q
A

Ultrasound (3 decks)

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