Mm Chapter 17. Peripheral Nerve Blocks

Front 1

The greatest immediate risk of nerve blocks is

Back 1

systemic toxicity from inadvertent intravascular injection.

Delayed toxicity can follow the initial injection when rapid or excessive amounts of local anesthetics are absorbed systemically.

Front 2

Good surgical anesthesia is obtained only when

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local anesthetic is injected in close proximity to the nerve or nerves that are to be blocked.

Front 3

A perineural injection may produce a brief accentuation of the paresthesia, whereas an intraneural injection produces

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an intense, searing pain that serves as a warning to immediately terminate the injection and reposition the needle.

Front 4

Surgical anesthesia of the upper extremity and shoulder can be obtained following neural blockade of

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of the brachial plexus (C5–T1) or its terminal branches at several sites.

Front 5

most optimal for procedures on the shoulder, arm, and forearm.

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The interscalene approach

Front 6

Injection at the interscalene level tends to produce a block that is most intense at the____ dermatomes and least intense in the______ dermatomes.

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C5–C7

C8–T1

Front 7

most optimal for procedures from the elbow to the hand.

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The axillary approach to the brachial plexus

This approach tends to produce the most intense block in the distribution of C7–T1 (ulnar nerve)

Front 8

This approach tends to produce the most intense block in the distribution of C7–T1 (ulnar nerve)

Back 8

The axillary approach to the brachial plexus

Front 9

good homogeneous anesthesia to the brachial plexus and can be used for procedures involving the hand, forearm, elbow, and upper arm and are quite conducive for placement of an indwelling catheter for postoperative analgesia.

Back 9

Infraclavicular blocks

Front 10

can provide intense surgical anesthesia for short surgical procedures (< 45–60 min) on the forearm, hand, and even the leg.

Back 10

Intravenous regional anesthesia, also called a Bier block,

Front 11

block is very useful in numerous procedures involving the thigh and knee, such as skin grafting, knee arthroscopy, and patellar surgery, or as an adjunct to procedures distal to the knee that require anesthesia to the medial aspect of the lower leg (saphenous distribution).

Back 11

A femoral nerve block

Front 12

It is useful in procedures involving the hip, thigh, and knee.

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fascia iliaca blocks.

There has been a recent surge of interest in fascia iliaca blocks. Because it does not require a nerve stimulator, it can be performed very quickly, it is not very stimulating, and patients often do not require sedation. It is useful in procedures involving the hip, thigh, and knee.

Front 13

Blockade of the sciatic nerve is useful for

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many surgical procedures involving the hip, knee, or distal lower extremity. The nerve can be successfully blocked at numerous sites along its course.

Front 14

A popliteal nerve block is very useful for

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foot and ankle surgery and can result in complete anesthesia of the limb distal to the knee if a separate saphenous nerve block (terminal nerve of the femoral nerve) is also included.

Front 15

Paravertebral nerve blocks are being increasingly used as an effective technique for

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postoperative analgesia following mastectomy, inguinal hernia repair, and several procedures involving the chest and body wall.

Front 16

a motor response at approximately ______ indicates that the needle is in the appropriate position and local anesthetic can be injected.

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0.5 mA

Front 17

The high pressures generated by a direct intraneural injection can cause _______ (ischemic) injury to nerve fibers.

Back 17

hydrostatic

Front 18

Surgical anesthesia of the upper extremity and shoulder can be obtained following neural blockade of the

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brachial plexus (C5–T1)

Front 19

Some areas of the anterior shoulder are innervated by the

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superficial cervical plexus (C1–4).

Front 20

2 nerves must also be blocked separately to reliably prevent pain from an arm tourniquet.

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The medial brachial cutaneous (C8–T1) and intercostobrachial (T2) nerves

Front 21

The brachial plexus is formed by the union of

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anterior primary divisions (ventral rami) of the fifth through the eighth cervical nerves and the first thoracic nerves

Front 22

the median nerve and terminates as the______________.

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ulnar nerve

Front 23

The lateral cord gives off the lateral branch of the _______ nerve

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median

Front 24

The lateral cord terminates as the ______________.

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musculocutaneous nerve

Front 25

the posterior cord gives off the ______ nerve

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axillary

Front 26

posterior cord terminates as the ________ nerve.

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radial

Front 27

A___________ sleeve that is derived from the prevertebral and scalene fascia encloses the brachial plexus.

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fascial

This sheath extends from the intervertebral foramina to the upper arm and serves as the anatomic basis for brachial plexus blocks

Front 28

The ___________ approach is most optimal for procedures on the shoulder, arm, and forearm.

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interscalene

Front 29

interscalene approach does not provide optimal surgical anesthesia for procedures in the____ nerve distribution.

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ulnar

Front 30

The cervical spinal nerves blend into trunks between the

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anterior and middle scalene muscles

Front 31

This interscalene groove lies at the level of the

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cricoid cartilage

Front 32

At the lateral border of the anterior scalene muscle, the brachial plexus passes down between the _____ and ________ to enter the axilla.

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first rib and clavicle