Upper Peripheral Nerve Blocks Flashcards
What are the advantages of an induced sympathectomy?
- intraop reduction of blood loss
- postop improvement in perfusion
Advantages of regional anesthesia?
- can avoid general anesthesia
- cardiac disease
- pulmonary disease
- avoid use of opiates
- reduced N/V
- induced sympathectomy
- preemptive analgesia
Contraindications for regional anesthesia?
- pt refusal
- pt cooperation
- coagulopathy
- infection at the surgical site
- septicemia
- neurological complications
What equipment do you need at the bedside when admin regional anesthesia?
- monitors
- suction
- means of PPV (ambu bag, mask, oxygen)
- airway (intubation equipment)
- IV access
- Drugs (emergency meds, lipids, anxiolytics)
Accidental admin of intrathecal LA could cause a __________. Which could lead to?
- total spinal
- cardiac and resp depression
The brachial plexus supplies ALL _______ function to the upper arm?
- motor
The brachial plexus supplies almost all sensory function to the upper arm except?
- the posterior shoulder (which is supplied by the caudad branches of the cervical plexus)
The brachial plexus consists of what 5 divisions?
- roots
- trunks
- division
- cord
- branches
What are the terminal branches of the brachial plexus?
- musculocutaneous (C5-C7)
- axillary (C5-C6)
- radial (C6-T1)
- median (C7-T1)
- ulnar (C8-T1)
The musculocutaneous nerve is located at what landmark?
- exists high from the axillary sheath
- pierces the corachobracialis
Motor innervation of the MCN causes what motor mvmts of which muscles?
- flexion of the biceps, brachialis and coracobrachialis
The MCN provides sensory information to what aspect of the arm?
- lateral mid forearm, up to wrist
Where does the axillary nerve exit the brachial plexus? And what muscles does it innervate?
- leaves the plexus at the lower border of the pectoralis major
- innervates the deltoid and teres minor
The axillary nerve provides sensory innervation to what aspect of the arm?
- inferior shoulder
- upper lateral arm
The radial nerve provides motor innervation to what muscles?
- triceps, supinator and extensors of the forearm
The radial nerve provides sensory innervation to what aspect of the arm?
- posterior and forearm
- lateral border of elbow
- thumb and dorsal surface of hand
The motor innervation of median nerve involves what muscles?
- flexors and pronator muscles of forearm (flexion of wrist)
The median nerve provides sensory information to what aspect of the hand and arm?
- palmar surface of hand, index and middle flinger (also majority of forearm)
The ulnar nerve provides motor innervation to what muscles?
-flexor carpi ulnaris (abducts fingers)
The ulnar nerve provides sensory innervation to what aspect of the arm and hand?
- pink and middle finger
Equipment needed for peripheral nerve blocks:
- nerve stimulator
- 22g “B” bevel (insulated) - B bevel has a bigger angle
Things to consider before administering a block (ie: meds, positioning)
- intraop drugs: fentanyl, versed
- intraop positioning
- verbal conversation
Different approaches to the brachial plexus for upper arm blocks:
- interscalene
- supraclavicular
- infraclavicular
- axillary
- terminal nerves
The interscalene approach is ideal for what surgeries?
- surgery for the shoulder or upper arm
- shoulder and clavicle procedures
- procedures proximal to the elbow
