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33 Cards in this Set
- Front
- Back
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What are some advantages of peripheral nerve blocks? |
very similar to spinal/epidural. Can be awake, don't need to intubate, don't require GETA risks, faster discharge and turnover etc. |
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What is the advantage with chronic pain sndromes of using PNBs? |
PNBs can actually PREVENT chronic pain syndromes from developing |
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Why is this the case? |
because the nervous system does not undergo a sensitization process that you often see with post op |
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What is the relation to opioid use? |
many patients that get PNBs do not require any post op opioids at all |
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What would be a case where you DO NOT wnat to perform a peripheral nerve block? |
in someone with extremity trauma or a surgery that can predispose to compartment syndrome |
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Should the patient be anesthetized/sedated before you perform the block? |
you want them coherent at least so you can confirm the block was a success |
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some risks of regional blocks |
1. damage to surrounding anatomic structures including nerves, blood vessels, spinal cord, lungs 2. pneumothorax 3. intravascular, systemic local anesthetic toxicity with CV collapse, hypotension, cardiac arrest etc. 4. epidural hematoma 5. allergic reactions |
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What is the best way to minimize these risks |
to ensure correct needle placement |
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And what is a good technique to be sure you can do this? |
continuous aspiration of the needle as you advance |
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What does this do? |
it shows if you get any blood or CSF back and you know you're in a bad place |
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What does a paresthesia experienced by the pt indicate? |
you're likely hitting a nerve |
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What if the pt has extreme pain when you start to inject the local? |
they probably have an intraneural injection taking place |
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And how should you inject local anesthetic in general when you're performing a block? |
very slowly and diligently so you can monitor for signs of toxicity |
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What is the primary method we use to localize peripheral nerves for block? |
U/S |
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When do you do an interscalene block? |
for shoulder surgeries |
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What nerve is commonly missed by an interscalene block? |
the ulnar nerve |
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What nerve can be damaged with an interscalene injection? |
the phrenic |
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When is supraclaviclar block indicated? |
for blocking the arm in the mid-humerus down to the fingers. It blocks the brachial plexus basically |
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What is the biggest risk of a supraclavicular block? |
PTX |
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What about intraclavicular? |
blocking the elbow down |
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risk of intraclavicular? |
can ding the subclavian vessels |
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What is the Bier block? |
it's an IV injection that's meant to block the hand for things like carpal tunnel releases, trigger finger releases, etc.
you have to bring a tourniquet up before you inject the local IV |
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What are some questions to be asking the patient to make sure they're not experiencing systemic toxicity? |
metallic taste in their mouth dizziness tinnitus perioral numbness
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What do you do if they report the CNS symptoms? |
then you stop injecting any local and monitor closely for progressive toxicity |
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big post op benefits to PNBs? |
no extubation and emergence required fast discharge and turnover no post op N/V from opioids less chronic pain syndromes developing |
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4 examples of lower extremity blocks |
lumbar plexus femoral nerve sciatic nerve ankle |
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What areas of the leg are innervated by the lumbar plexus? |
basically the inner and anterior thigh areas |
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When would a lumbar plexus be indicated? |
when you're having a total hip, in hip fractures, etc. |
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What nerve has to also be blocked to give total lower limb anesthesia? |
the sciatic nerve. If you block the lumbar plexus AND the sciatic, then you'll have complete blockage of the lower limb |
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What would be a good nerve to block for procedures on the anterior thigh? |
the femoral nerve |
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What do you block with sciatic nerve blocks? |
the leg distal to the knee joint basically
surgeries would include BKAs, tibial fractures, ankle surgeries |
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Why do an ankle block? |
for foor procedures like toe amputations |
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What type of block can give anesthesia for breast procedures, VATS, rib fractures, mastectomies etc? |
thoracic paravertebral blocks |
