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35 Cards in this Set

  • Front
  • Back
Brachial plexus provides majority of the ___& ___ innerv. to the ___ ext.
sensory & motor innev
to the upper ext.
surg proced on the upper ext can be performed by blockade of the _____ at one of seveal sites or terminal branches
brachial plexus
Brachial plexus provides ____innervation to the upper ext.
somatic innerv.
Brachial plexus formed by the union of the ventral rami of the ____ thru ___ & __ thoracic nerves
C5-C8 & T1
Nerve roots leave the intervertebral foramina they converge to form ____
Nerve roots leave the intervertebral foramina they converge to form trunks,then ___
Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, ____
Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, cords, ___
terminal nerves
Randy Travis Drinks Cold Beers
Rami, Trunks, Divisions, Cords, Branches
Terminal Branches
My Aunt Rapes My Uncle
The brachial plexus is enclosed by a ____sheath its origin at the intervertebral foramina to the upper arm
fascial sheath
Indications of the Brachial Plexus
Sole anesthetic surg procedure on upper ext, shoulder, FA, Arm
-Reduction of fractures, dislocations, suturing of tendons, repair of lacs
Indications of the Brachial Plexus
additions to general, post op pain mang.
-dec need of narcs
-dec incidence of post anesth NV, atelectasis, hypotension, illeus
Chronic pain mang
-Reflex Sympathetic dystrophy (RSD)
-Frozen shoulder (aid PT)
- Brachial plexopathies
Contraindications of the Brachial Plexus
Pt refuse
Pre-exist resp compromise
Pt require bilat upper ext blk
-second to bilat phrenic nerve blk, total vol of local is toxic
Intascalene carries a risk of knocking out the
diaphragm (phrenic nerve )
Regional anesthesia choices
intrascalene brach plex blk
axillary blk
Supraclavicular brach plex blk
Infraclavicular brach plex blk
Techniques: Interscalene blk
Perfer tech anest or relax shoulder
Post-op pain rotator cuff rep
Palliate acute pain, herpes zoster, brach plx neuritits, shoulder,upper ext trauma & CA pain
Techniques: Interscalene blk
Procedure Pt position
Pt supine, head flt rotated 30-40 deg to opp side
Techniques: Interscalene blk
Procedure: Palpate
Palpate the interscalene groove at level of the cricoid cartilage (C6)
-if groove not apparent ask pt to lift head
Techniques: Interscalene blk
Sterile prep/drape
-Lido 1% local
-25G 1.5 in or 22G 2in stimuplex needle insert perpendicular to the skin
-slight medial & caudal deviation until parathesia or motor evoked response is elcited
Techniques: Interscalene blk
30-40 ml of local w/ negative aspiration every 5ml
-0.5% Bupivacaine or Chirocaine w/ 1:200 K epi
The use of epi is
a potent vasoconstrictor keeps med around longer
If a hematoma develops the attempt of the block was
Techniques: Interscalene blk
intra art inj to verterbral art (rapid seizure act)
-Epidural, subarach, subdurl inj
-Stellate ganglion blk -> Horners sign (myosis, ptosis, anhidrosis) 30-50% of blks
Horners Sign
Myosis: bld shot eye, small pupil
Ptosis: droopy eye
Anhidrosis: Lack of sweating on one side of face
Techniques: Interscalene blk
Phrenic nerve blk - feeling of heaviness one side of chest
Recurrent laryngeal nerve blk (30-50% -> hoarsness & weak voice)
Infection, hematoma, nerve injury
Techniques of Axillary blk
Any surg procedure mid humerus to hand
-not necessary to seek parathesia (use in child reduce fx's)
-Less major complications
-easy technique to master
Axillary blk can be used for the following
AV fistula, Carpal tunnel syn
Ganglion cyst
Techniques of Axillary blk
Procedure: Pt position
Supine, arm abd 90deg, ext rotated
-Brach art palpated, follow pulse prox far as possible
-sterile prep/drape
-1% lido directly over pulse
Techniques of Axillary blk
25G 1.5in needle insert below art pulsation
-parathesias are elicited & after neg aspiration local anesthetic inj (40-45 mls bupivacaine or chirocaine 5mg/kg)
Techniques of Axillary blk
Procedure: use of nerve stimulator during inj.
Use a nerve stimulator w/ 22G stimuplex needle, after appro muscle response inj 5ml local in 5ml incrmts w/ neg asp.
Techniques of Axillary blk
Procedure: Trans-arterial approach
22G 1.5in needle insert towards the artery until bright red blood asp.
-Move needle forward until bld asp ceases
-Inj can be performed post or ant or in both locations
For an Axillary Blk it may also be necessary to blk the ____muscle to blk the musculocutaneous nerve (3-5mls)
coracobrachialis (given into belly of the muscle)
Techniques of Axillary blk
Intra-vascular (art or ven) w/ seizure
Elicitation of parathesia esp in multiple sites, inc incidence of post op neuropathy
Hematoma & infection are rare
Regional anesth should not be done when pt is under gen anesth T or F