Uppper Extremity Regional Anesthesia

Question 0

What forms neurovascular bundle?

Answer 0

Trunks 3 and subclavian artery

Question 1

Roots

5 facts

Answer 1

Arise from ventral primary rami of C5-T1 spinal n
Exit Posterior to vertebral artery
Lateral through cervical transverse process
Emerge between ant & middle scalene m-interscalene groove
Surrounded by prevertebral fascial sheath - LA deposit into it

Question 2

Trunks facts

Answer 2

3
Pass under the clavicle & over 1st rib
Joined by SC artery & form neurovascular bundle

Question 3

Musculocutaneous n

Answer 3

Lateral cord
Lateral cutaneous n of forearm - sensory skin
Elbow flexion - motor (coracobrachialis, brachialis, bicep brachii)

Question 4

Median n

Answer 4

Arises from medial & lateral cord
Sensory: palmar surface of the hand first 3.5 fingers
Anterolateral surface of hand

Motor: flexor muscles of the forearm/hand
Flexion of wrist/opposition of middle, forefinger, thumb, pronation of forearm

Question 5

Ulnar n

Answer 5

Medial cord - arises
Sensory: skin over medial surface of hand, 1.5 fingers
Motor: flexion of wrist, flex/opposition of medial 2 fingers towards thumb, adduction of fingers

Question 6

Axillary n

Answer 6

C5-6, arises from posterior cord
Sensory: posterior shoulder & arm
Motor: shoulder abduction - deltoid & teres muscle

Surgery of forearm & hand
3 nerves: radial, median, ulnar

Question 7

Radial n

Answer 7

C5-T1 posterior cord
Sensory: posterior (regions of forearm & hand) lateral surface of arm
Motor: extension of elbow, supination of forearm, extension wrist/fingers

Question 8

Suprascapular n

Answer 8

C5-6 upper trunk
May require separate anesthetizing for shoulder procedure
Cape of shoulder
Typically blocked by interscalene approach to BP

Question 9

What nerve is not part of BP

Answer 9

Intercostalbrachial nerve T2
Lateral branch of intercostal nerve
Sensory: axillary & upper posterior medial side of the arm

Question 10

Hyperechoic

Answer 10

Brighter, white

Nerves below clavicle

Question 11

Hypoechoic

Answer 11

Darker grayish-black

Nerves above clavicle

Question 12

Echogenicity

Answer 12

Degree of brightness of a structure displays on ultrasound

Influenced by the amount of beam returning to the transducer

Question 13

What is the goal of US for interscalene block

Answer 13

To identify scalene muscles & nerve roots between

Question 14

Horner’s syndrome

Answer 14

d/t proximal spread to C3-4 & cervical sympathetic chain
S/S: ipsilateral ptosis, anhydrosis, myosis, nasal congestion,

Associated w/interscalene block