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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 ____
trunks
Nerve roots leave the intervertebral foramina they converge to form trunks,then ___
divisions
Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, ____
cords
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
Musculocutaneous
Axillary
Radial
Median
Ulnar
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
Coagulopathy
Sepsis
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
Indications
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
Procedure:
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
Procedure:
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
unsucessful
Techniques: Interscalene blk
Complications
intra art inj to verterbral art (rapid seizure act)
-Epidural, subarach, subdurl inj
-Pnemo
-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
Complications
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
Indications
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
Procedure:
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
Complications:
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
T