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77 Cards in this Set

  • Front
  • Back
Before performing a peripheral nerve block what should you check for in your patient assessment?
1) presence of existing neuropathy
2) confirm normal coagulation
3) recognize presence of a skin infection in area to be used
What must be available to perform a block?
appropriate monitors
equipment
drugs available (should adverse reactions to LA occur)
IV catheter in place
Lidocaine and Mepivacaine 1% to 1.5% produce surgical anesthesia
a) onset in how many minutes
b) duration in hours
a) 10-20 minutes onset

b) duration of 2-3 hours
Ropivacaine 0.5% and Bupivacaine 0.375%-0.5%

Onset:
Duration:
Onset: slower onset than Lidocaine and Mepivacaine

Duration: 6-8 hours

Less motor blockade
What are paresthesias?
Paresthesias are radiating electric shock-like sensations that can occur during regional anesthetic procedures.
Why do you not inject LA in the presence of persistent paresthesia?
Don't want intraneural injection

intense pain and high likelihood of permanent injury.
Is cathodal stimulation more or less efficient than anodal stimulation when using nerve stimulation to evoke a motor response?
Cathodeal stimulation is more efficient
During nerve stimulation, a motor response is evoked with currents of approximately _________mA.
0.5mA

sufficient proximity of the block needle to the nerve
Ultrasound imaging

Give 2 advantages for using it.
1) improves block success

2) minimizes local anesthetic volume
Name one major advantage for using ultrasound imaging.
variability in surface landmarks, body habitus, and patient positioning can be appreciated
Why are peripheral nerve catheters more prone to dislodgement than epidural catheters?
Movement of skin near the catheter entry point is usually greater.
What nerves make up the cervical plexus?
C1-C4
What block is most often used in patients undergoing carotid endarterectomy?
Cervical plexus block


Superficial block alone is sufficient although most do both superficial and deep.
What nerves make up the brachial plexus?
C5-C8 and T1
Skin over the shoulders is supplied by what plexus?
Cervical plexus
Medial aspect of the arm is innervated by _________?
intercostobrachial branch of the 2nd intercostal nerve
Interscalene block is placed at what level of the brachial plexus?
Roots/trunks
Supraclavicular block is placed at what level of brachial plexus?
Trunks/divisions
Infraclavicular block is placed at what level of the brachial plexus?
Cords
Axillary block is placed at what level of the brachial plexus?
Branches
During an interscalene block which nerve may be spared?
C8-T1 Ulnar nerve
fibers that innervate the ulnar side of the forearm and hand
Complications of an interscalene block include?
ipsilateral phrenic nerve block
hemiparesis of the diaphragm
Because the phrenic nerve lies on the anterior scalene muscle what is the incidence of diaphragmatic paralysis after an interscalene block?
100%
What patients will poorly tolerate an interscalene block?
Those with respiratory insufficiency

contralateral phrenic nerve palsy
What is the most serious complication of a supraclavicular block?
Pneumothorax

about a 1% incidence
EXAM QUESTION

Which block provides excellent anesthesia for procedures on the hand,forearm, and elbow?
Infraclavicular block
or even the
Axillary block
Which block spares the musculocutaneous nerve?
Axillary block
Which nerve provides most of the sensory innervation to the palm of the hand?
Median nerve
Which nerve provides sensation to the dorsal and palmar sides of hand?
Ulnar nerve
What is the benefit of intercostal nerve blocks?
provide sensory and motor anesthesia of the chest wall in a dermatomal distribution without associated sympathetic nervous system blockade.
What are the 2 major risks of intercostal nerve blocks?
1) pneumothorax
2) inadvertent intravascular injection of local anesthetic solution
Where is absorption of LA the highest?
Intercostal nerve blocks
The saphenous nerve is the only branch of which nerve to contribute to innervation below the knee?
Femoral nerve
Which nerve is frequently missed in 3-in-1 blocks?
obturator nerve
What nerves give rise to the sacral plexus?
L4-5, S1-3
What nerves give rise to the lumbar plexus?
L1-4
How many nerves supply the foot?
5
What are the nerves that supply the foot?
1) tibial nerve
2)sural nerve- lateral side of foot
3) saphenous nerve- medial aspect of foot
4)Deep peroneal nerve- innervates webing b/w 1st-2nd toes
5) superficial peroneal nerve-dorsum of foot
The saphenous nerve is a branch off what main nerve?
Femoral
Bier block can be used for procedures lasting less than how long?
2 hours
Commonly used anesthetic for bier blocks include...
0.5% Lidocaine

0.5% Prilocaine
During a bier block what is the minimal time the tourniquet must be left inflated?
20 minutes
After how long can the tourniquet on a bier block be deflated and left deflated?
40 minutes
What do you do between 20-40 minutes on a bier block if the surgical procedure has ended?
Tourniquet can be deflated, reinflated immediately, and then deflated after 1 minute.

This reduces the peak plasma level of local anesthetic.
What segment of the spinal cord is most concave?
L4
What level of the spinal cord is most convex?
T5
Motor block is how many dermatomes lower than the sensory block?
2 levels lower
Sympathetic block is how many dermatomes higher than the sensory block?
2-6 levels higher
Total CSF volume
120-150 ml total volume
Rate of formation of CSF
150 ml/day
Interscalene block is at what level of the brachial plexus?
Trunks
What is the largest upper extremity nerve?
Radial
What is the largest lower extremity nerve?
Sciatic
The lateral femoral cutaneous nerve has...
a) sensory only
b) motor only
c) sensory and motor
a) sensory only

LFC is L2-3
Femoral nerve is made of what lumbar nerves?
L2-3-4
Femoral nerve brances out into which distal nerve?
Saphenous
Obturator nerve is made of which nerves?
L2-3-4
Sciatic nerve is made from which nerves?
L4-5, S1-2-3
Sciatic nerve brances into which 2 nerves?
Common Peroneal and the Tibial
The common peroneal and the tibial nerve meet to form which nerve?
Sural
The common peroneal branches off to form which 3 nerves?
Superficial peroneal
Deep peroneal
Sural
What position must the patient be in to do a correct sciatic nerve block?
Prone position
What is the consequence of peroneal nerve damage

ie...patient legs in stirrups
foot drop
Widest level in the epidural space is...
L2
Narrowest level in the epidural space is...
C5
Blood flow is related to toxicity=the higher the tissue blood flow the higher the rate of tissue absorption and possibly toxicity.
ranking of blood flow is...
highest=tracheal
intercostal
caudal
paracervical
epidural
brachial plexus
subarachnoid,sciatic,femoral
lowest= subcutaneous
What is the usual dosing of cc's per desired segment in epidural anesthesia?
Notes: 1-2cc's per desired segment
Book: 1cc per desired segment
Epidural lidocaine dosing, onset, dose plain and dose with epi
1.5-2% concentration
onset 5-15 min
Dose plain 5mg/kg
Dose w/ epi 7 mg/kg
Duration 75-120 min
Reinject after 60-75 min
Bupivacaine/ Ropivacaine

Concentration
Onset
Dose plain
Dose w/ epi
Duration
Reinject:
Conc. 0.25-0.75%
Onset 10-20 min
Dose plain 2-3mg/kg
Dose w/ epi 3mg/kgB 3-4mg/kg R
Duration 120-240B 90-120R
Reinject: B:90min R:75-90min
What is the most important factor affecting spinal block level?
Baricity of solution
Horners syndrome
Stellate ganglion blockade
what are s/s?
ptosis
miosis (dilated)
enophthalmus
Anhidrosis
Axillary block is for surgery below what structure?
Below the elbow
What block do you use for procedures above the elbow?
Interscalene
What block is used for shoulder surgery?
Interscalene
pKa effects the _________ characteristics of a Local anesthetic
ONSET
Lipid solubility is a primary determinant of ____________.
Potency
Protein binding is a primary determinant of __________
Duration