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Flashcards > Upper Peripheral Nerve Blocks > Flashcards

Upper Peripheral Nerve Blocks Flashcards

0
Q

What are the advantages of an induced sympathectomy?

A
  • intraop reduction of blood loss

- postop improvement in perfusion

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1
Q

Advantages of regional anesthesia?

A
  • can avoid general anesthesia
  • cardiac disease
  • pulmonary disease
  • avoid use of opiates
  • reduced N/V
  • induced sympathectomy
  • preemptive analgesia
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2
Q

Contraindications for regional anesthesia?

A
  • pt refusal
  • pt cooperation
  • coagulopathy
  • infection at the surgical site
  • septicemia
  • neurological complications
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3
Q

What equipment do you need at the bedside when admin regional anesthesia?

A
  • monitors
  • suction
  • means of PPV (ambu bag, mask, oxygen)
  • airway (intubation equipment)
  • IV access
  • Drugs (emergency meds, lipids, anxiolytics)
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4
Q

Accidental admin of intrathecal LA could cause a __________. Which could lead to?

A
  • total spinal

- cardiac and resp depression

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5
Q

The brachial plexus supplies ALL _______ function to the upper arm?

A
  • motor
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6
Q

The brachial plexus supplies almost all sensory function to the upper arm except?

A
  • the posterior shoulder (which is supplied by the caudad branches of the cervical plexus)
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7
Q

The brachial plexus consists of what 5 divisions?

A
  • roots
  • trunks
  • division
  • cord
  • branches
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8
Q

What are the terminal branches of the brachial plexus?

A
  • musculocutaneous (C5-C7)
  • axillary (C5-C6)
  • radial (C6-T1)
  • median (C7-T1)
  • ulnar (C8-T1)
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9
Q

The musculocutaneous nerve is located at what landmark?

A
  • exists high from the axillary sheath

- pierces the corachobracialis

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10
Q

Motor innervation of the MCN causes what motor mvmts of which muscles?

A
  • flexion of the biceps, brachialis and coracobrachialis
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11
Q

The MCN provides sensory information to what aspect of the arm?

A
  • lateral mid forearm, up to wrist
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12
Q

Where does the axillary nerve exit the brachial plexus? And what muscles does it innervate?

A
  • leaves the plexus at the lower border of the pectoralis major
  • innervates the deltoid and teres minor
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13
Q

The axillary nerve provides sensory innervation to what aspect of the arm?

A
  • inferior shoulder

- upper lateral arm

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14
Q

The radial nerve provides motor innervation to what muscles?

A
  • triceps, supinator and extensors of the forearm
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15
Q

The radial nerve provides sensory innervation to what aspect of the arm?

A
  • posterior and forearm
  • lateral border of elbow
  • thumb and dorsal surface of hand
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16
Q

The motor innervation of median nerve involves what muscles?

A
  • flexors and pronator muscles of forearm (flexion of wrist)
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17
Q

The median nerve provides sensory information to what aspect of the hand and arm?

A
  • palmar surface of hand, index and middle flinger (also majority of forearm)
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18
Q

The ulnar nerve provides motor innervation to what muscles?

A

-flexor carpi ulnaris (abducts fingers)

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19
Q

The ulnar nerve provides sensory innervation to what aspect of the arm and hand?

A
  • pink and middle finger
20
Q

Equipment needed for peripheral nerve blocks:

A
  • nerve stimulator

- 22g “B” bevel (insulated) - B bevel has a bigger angle

21
Q

Things to consider before administering a block (ie: meds, positioning)

A
  • intraop drugs: fentanyl, versed
  • intraop positioning
  • verbal conversation
22
Q

Different approaches to the brachial plexus for upper arm blocks:

A
  • interscalene
  • supraclavicular
  • infraclavicular
  • axillary
  • terminal nerves
23
Q

The interscalene approach is ideal for what surgeries?

A
  • surgery for the shoulder or upper arm
  • shoulder and clavicle procedures
  • procedures proximal to the elbow
24
Q

The interscalene approach provides anesthesia to:

A
  • upper branches of the brachial plexus

- lower cervical plexus

25
Q

What fibers are frequently not anesthetized during the interscalene approach?

A
  • inferior fibers (ulnar nerve)
26
Q

What are the major anatomical structures used in the interscalene approach?

A
  • palpate posterior border of the SCM muscle at the level of C6 (cricoid cartilage)
27
Q

What is an ABSOLUTE contraindication for the interscalene approach?

A
  • contralateral recurrent laryngeal nerve palsy

- phrenic nerve palsy (contralateral)

28
Q

What are the RELATIVE contraindications for the interscalene approach? (3)

A
  • preexisting nerve injury
  • brachial plexus pathology
  • significantly impaired pulmonary function
29
Q

Indications for cervical plexus blocks?

A
  • unilateral surgical procedure of the neck

- block btw C2-C4 (block sensory of the skin)

30
Q

The supraclavicular approach is an effective block for:

A
  • all portions of the upper extremity: hand, forearm and upper arm
31
Q

What level of the brachial plexus is the supraclavicular approach is carried out?

A
  • “trunks”
32
Q

The supraclavicular approach has increase success for blocking:

A
  • the inferior trunk (ulnar and radial nerves)
33
Q

Contraindications for the supraclavicular approach:

A
  • contralateral phrenic paralysis
  • recurrent nerve paralysis
  • contralateral pneumothorax
34
Q

Landmarks for the supraclavicular approach:

A
  • lateral border of the clavicular head of SCM at the level of its insertion into the clavicle
35
Q

In the supraclavicular approach what should immediately happen after the needle has entered the interscalene grove?

A
  • motor response in the hand or arm

- the more distal the response = more reliable block

36
Q

Complications of the supraclavicular approach:

A
  • increased risk of a pneumothorax
  • Horner’s syndrome
  • phrenic nerve block
  • recurrent laryngeal nerve paralysis
  • neuropathy (nerve being pinned against the clavicle)
37
Q

Infraclavicular approach is indicated for what surgeries:

A
  • elbow
  • forearm
  • hand
38
Q

What are the landmarks for the infraclavicular approach?

A
  • medial clavicular head

- coracoid process

39
Q

In the infraclavicular approach what muscles are we looking to twitch?

A
  • pectoralis twitch (means we are to shallow)

- want median, radial or ulnar twitch (5-8 cm depth of needle)

40
Q

Axillary blocks are indicated for procedures:

A
  • below the elbow

- (safest and easiest approach to the plexus)

41
Q

How should patients arm by placed while doing an axillary block?

A
  • pt must be able to abduct arm and place it at a 90 degree angle
42
Q

For the axillary block, which terminal branch is not found in the axillary sheath?

A
  • musculocutaneous (need to give separate injection for this nerve)
43
Q

What is an ABSOLUTE contraindication for an axillary block

A
  • lymphangitis
44
Q

What are RELATIVE contraindications for an axillary block?

A
  • preexisting nerve injury

- brachial plexus pathology

45
Q

What are 3 techniques to the axillary approach?

A
  • nerve stimulator technique
  • transarterial technique
  • paresthesia technique
46
Q

Evaluation of the axillary block will usually show that which nerve is not blocked:

A
  • muscuclocutaneous

- often requires seperate injection into the belly of the corachobrachialis

47
Q

What is major disadvantage of a Bier block?

A
  • LA toxicity

Flashcards (5 decks)

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