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Spring 2020 - APA Foundations 1 > Upper Peripheral Nerve Blocks - Quiz 6 > Flashcards

Upper Peripheral Nerve Blocks - Quiz 6 Flashcards

1
Q

What considerations should be taken for Placing a Peripheral Nerve Block?

A

Tourniquet Placement

Bone Grafting

Duration of Surgery

Single Injection vs Continous Peripheral Nerve Block

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2
Q

What are the Risks and Contraindications of Placing a Peripheral Block?

A
  • Patient Cooperation
  • Bleeding Disorders
  • Sites of Infection
  • Nerve Injury
  • Local Anesthetic Toxicity
  • Catheter Retention
  • Retroperitoneal Hematoma
  • Falls from Femoral Nerve Catheter
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3
Q

What should you think about when choosing a Local Anesthetic for a Peripheral Block?

A

Desired Onset

Desired Duration

Desired Sensory/Motor Block

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4
Q

Procaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 5mg/kg
Duration: 20-30 min

With Epi
Max: 7mg/kg
Duration: 30 min

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5
Q

Chloroprocaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 11mg/kg
Duration: 15-30 min

With Epi
Max: 14mg/kg
Duration: 30 min

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6
Q

Lidocaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 4mg/kg
Duration: 30-120 min

With Epi
Max: 7mg/kg
Duration: 3 hrs

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7
Q

Mepivacaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 4mg/kg
Duration: 90-180 min

With Epi
Max: 7mg/kg
Duration: 20-30% Longer

Avoid in Pregnancy

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8
Q

Prilocaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 7mg/kg
Duration: 30-90 min

With Epi
Max: 8mg/kg
Duration: 2 hrs

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9
Q

Bupivacaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 2mg/kg
Duration: 2-4 hrs

With Epi
Max: 3mg/kg
Duration: 3-4 hrs

Avoid in Pregnancy til term

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10
Q

Ropivacaine

Max Dose w/wo Epi?

Duration of Action w/wo Epi?

A

Without Epi
Max: 5mg/kg
Duration: 2-6 hrs

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11
Q

What are the different Block Techniques?

A

Field Block

Paresthesia

Nerve Stimulation

Ultrasound

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12
Q

What is the Field Block Technique?

A

Local Anesthetic targets terminal cutaneous nerve to minimize incisional pain

Dont use if its going to be in the way or if there is tissue acidosis

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13
Q

What is the Paresthesia Technique?

A

Used to be the Main Technique

Needle is placed near target nerve until there is paresthesia, then inject the LA

Gotta know anatomy

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14
Q

What is the Nerve Stimulation Technique?

A

Wire attached to Insulated needle is placed near nerve and causes muscle contractions at less than 0.5 mA

Inject 30-40 mL of LA w/ gentle aspiration and divided doses

(< 0.2 mA = Intraneural)

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15
Q

What is the Ultrasound Technique for Peripheral Block Placement?

A

Used Alone or w/ other Techniques

Piezoelectric crystals emit high-frequency sound waves thru different tissues and return a signal to transducer at 1-20 MHz

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16
Q

How does the amplitude of the return signal of an Ultrasound create the picture?

A

The crystals deform to make and electronic 2D image

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17
Q

What is Echogenicity?

A

How efficient sound passes thru a substance

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18
Q

What is Hypoechoic?

A

Sound easily Passes

Appear Dark or Black

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19
Q

How do Hyperechoic structures appear on the Ultrasound?

A

Bright & White

20
Q

What is Anechoic?

A

No Ultrasound Reflection

21
Q

What is the Linear Ultrasound Probe used for?

A

High Frequency High-Res w/ less tissue penetration

Superficial Nerves

First Choice

22
Q

What is the Curvilinear Ultrasound Probe used for?

A

Low Frequency w/ more tissue penetration

Low-Res & Poor Image

Good for Deeper Structures

23
Q

What do Nerves look like on the Ultrasound?

A

Honeycomb

Best seen in Cross Section

24
Q

What is In-Plane Needle Alignment when using Ultrasound?

A

Needle is placed along the long side of the transducer so you can see the entire shaft & tip

Need great hand-eye

Easy to lose image

25
Q

What is the Out-of-Plane Needle Alignment when using Ultrasound?

A

Needle is placed perpindicular to the transducer

Need to move transducer as needle advances

Easier Approach

26
Q

What are Single Injection Nerve Blocks?

A

Local Anestehtic is given one time

27
Q

What is involved in placing a Continous Peripheral Nerve Block?

A

Percutaneous catheter next to peripheral nerve, then give Local Anesthetic to prolong effects

28
Q

What are the types of Brachial Plexus Blocks?

A

Interscalene

Supraclavicular

Infraclavicular

Axillary

29
Q

What are the types of Terminal Nerve Blocks?

A

Median Nerve

Ulnar Nerve

Radial Nerve

Musculocutaneous Nerve

Digital Nerve

Intercostobrachial Nerve

30
Q

What is a type of Intravenous Regional Anesthesia?

A

Bier Block

31
Q

What are characteristics of an Interscalene Block?

A

Used for Shoulder/Upper Arm Procedures

Mostly blocks C5-C7 roots (possibly C3-C4 branches)

C8-T1 Ulnar Nerves Spared

Dont use for Elbow or lower surgeries

32
Q

What are Contraindications for a Interscalene & Supraclavicular Blocks?

A

Local Infection

Severe Coagulopathy

Local Anesthetic Allergy

Patient Refuse

33
Q

Why should extra caution be taken when placing an Interscalene Block for pts w/ Pulmonary Disease?

A

Interscalene blocks will block the ipsilateral Phrenic Nerve

34
Q

What are the possible complications of Interscalene Blocks?

A

Horner’s Syndrome

Recurrent Laryngeal Nerve Palsy - Hoarseness & Resp Distress

Seizure d/t Vertebral Artery Injection

Spinal/Epidural Injection

Pneumothorax

35
Q

What is Horner’s Syndrome?

A

Complication of Interscalene Block

Local Anesthetic travels to Cervicothoracic Ganglion causing myosis, ptosis, and anhydrosis

36
Q

What are the characteristics of a Supraclavicular Block?

A

Used for Elbow or lower surgeries

Unreliable for Axillary & Suprascapular Nerves

High risk for PTX using Paresthesia & Nerve Stimulator Techniques

37
Q

What are the possible complications of Supraclavicular Blocks?

A

Ipsilateral Phrenic Nerve Palsy

Horner’s Syndrome

Recurrent Laryngeal Nerve Palsy

Pneumothorax

Subclavian Artery Puncture

38
Q

What are characteristics of an Infraclavicular Block?

A

Blocks @ Level of Cords

Used for Elbow or Lower Procedures

Spares Intercostobrachial Nerve (T2)

39
Q

What is effected by an Axillary Block?

A

Multiple injections of LA at the lateral border of Pectoralis Minor blocks entire arm below the elbow

40
Q

What are the Contraindications to an Axillary Block?

A

Local Infection

Neuropathy

Bleeding Risk

41
Q

When are Terminal Nerve Blocks used?

A

Minor procedures w/ Limited Field

Supplement Incomplete Brachial Plexus Block

Can be anywhere along nerve, but Elbow & Wrist Preferred

42
Q

When is a Bier Block used?

A

Short Procedures - 45-60 min, Carpal Tunnel Release

43
Q

How long must the turniquet be inflated when placing a Bier’s Block?

A

15-20min to avoid Rapid IV Sytemic Bolus of LA

then slowly, incrementally deflate

44
Q

What are the Lower Extremity Peripheral Nerve Blocks?

A

Femoral Nerve

Lateral Femoral Cutaneous Nerve

Obturator Nerve

Posterior Lumbar Plexus

Saphenous Nerve

Sciatic Nerve

Ankle

45
Q

What are the types of Peripheral Nerve Blocks of the Trunk?

A

Superficial Cervical Plexus

Intercostal

Paravertebral

Transverse Abdominis Plane

46
Q

After which type of Blocks does a rapid absorption of LA occur leading to toxicity?

A

Intercostal Block

Caudal-Lumbar Epidural

Brachial Plexus Block

Sciatic-Femoral Block

Subcutaneous Block

Spring 2020 - APA Foundations 1 (10 decks)

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