Week 12 Upper Extremities

Question 1

What is a superficial cervical block for?

Answer 1

Surgery of the neck, shoulder, thyroid, CEA

Question 2

What are the landmarks for superficial cervical block?

Answer 2

• Mastoid Process
• Transverse procress of C-6
• Posterior border of SCM

Question 3

How do you find the transverse process of C-6?

Answer 3

-Palpable behind clavicular head of SCM just below level of cricoid

Question 4

Describe a field block technique for a superficial cervical block?

Answer 4

• 10 to 15 mL
• Superior and inferior redirections along posterior border of SCM
• DO NOT go any deeper than 1 cm.

Question 5

What are complication of a superficial cervical block?

Answer 5

• Infection
• Hematoma
• LA Toxicity
• Nerve Injury
• Phrenic nerve block
• Inadvertant subarachnoid or epidural
• TIA
• Recurrent Laryngeal nerve block

Question 6

What are the landmarks for interscalene block?

Answer 6

• Sternal head of SCM
• Clavicular head of SCM
• Upper border of cricoid cartilage
• Clavical

Question 7

When doing a interscalene block with a nerve stimulator you see shoulder movement. What nerve is this?

Answer 7

-Suprascapular nerve

Question 8

What are complications to a interscalene block?

Answer 8

• NEUROPATHY
• MECHANICAL -PLEXUS INJURY
• INFECTION
• PNEUMOTHORAX
• LA TOXICITY
• Spinal or epidural
• intervertebral injection
• Phrenic nerve block
• Hormer’s syndrome

Question 9

What are indication for a supraclavicular block?

Answer 9

• Any upper extremity NOT involving shoulder

- Excellent for elbow and hand

Question 10

T/F: Bilateral supraclavicular block can be done.

Answer 10

FALSE

Question 11

What are the land marks for a supraclavicular block?

Answer 11

• Lateral insertion fo SCM to clavicle
• Clavicle
• Patients midline

Question 12

What is the position for a supraclavicular block?

Answer 12

-Semi sitting blockwith head to opposite side
-Lower shoulder with elbow flexed and relaxed
-Palm supinated
monitor for stimulation

Question 13

What is the best technique for a supraclavicular block?

Answer 13

-ULTRASOUND

Question 14

What are the complications of a supraclavicular block?

Answer 14

-Phrenic nerve block
-Horner’s Syndrome
-Pneumo
-LA toxicity
-Nerve Damage
-

Question 15

What would be a contraindication for a infraclavicular block?

Answer 15

-Coagulation

Question 16

What are the landmarks for infraclavicular block?

Answer 16

• Clavicle
• Jugular Notch
• Acromioclavicular joint (AC)
• Coracoid process

Question 17

What are some complication of an infraclavicular block?

Answer 17

• Hematoma
• Nerve Damage
• LA Toxicity
• Low risk of Pneumo if not directed medially

Question 18

What are the indication for axillary block?

Answer 18

-Surgery of forearm, wrist, or hand

Question 19

What may not be cover with a axillary block?

Answer 19

-musculocutaneous nerve

Question 20

What three sheaths run with axillary artery?

Answer 20

• Radial
• Medial
• Ulnar

Question 21

What are the landmarks of a axillary block?

Answer 21

Pulse of axillary artery

• Coracobrachialis muscle
• Pec. Major
• Biceps
• Triceps

Question 22

What are the indication for a wrist block?

Answer 22

• Carpel Tunnel
• Hand
• Finger

Question 23

What tendons reside next to the median nerve?

Answer 23

• Plamaris longus

- Fexor carpi radial

Question 24

Where does the radial nerve reside?

Answer 24

-Brachioradialis muscle

Question 25

Where does the ulnar nerve reside?

Answer 25

• ulnar artery

- tendon of lexor carpi ulnaris

Question 26

Where do the nerves run on the digit?

Answer 26

-Ventrolateral aspect of the finger

Question 27

What drug would never be used for a digit block?

Answer 27

-Epinephrine