Stoelting Study 13

Front 1

3. What are some special considerations that should be made in the preoperative

Back 1

3. Considerations that should be made in the preoperative evaluation of a patient who is to undergo a peripheral nerve block include the patient's coagulation status, the presence of any neuropathy in the involved nerves, the presence of any skin infection overlying the area where the needle will be inserted, and the presence of any anatomic abnormalities or difficulties with the usuallandrnarks for the performance of the nerve block. In addition, the patient should be evaluated in the usual manner with regard to history, physical examination, and laboratory analysis. The anesthesiologist must be prepared to administer another anesthetic in the event that the peripheral nerve block is not sufficient for surgical anesthesia and the surgery must proceed

Front 2

4. What is the benefit of preoperative medication for patients who are to undergo a peripheral nerve block?

Back 2

4. Preoperative medication for patients who are to undergo a peripheral nerve block may reduce the level of anxiety. Patients are often more receptive to receiving a peripheral nerve block if they are assured they will be made comfortable during the anesthetic and surgical procedures. (185; 1520)

Front 3

5. Where should a peripheral nerve block be performed'?

Back 3

5. Peripheral nerve blocks that are not perfonned in the operating room should be performed in an area with the appropriate monitors, drugs, equipment, and oxygen should their use become urgently necessary. (l8S)

Front 4

6. What type of needle should be used to perform a peripheral nerve block? What are some advantages to using a control syringe for the performance of a peripheral nerve block?

Back 4

6. Needles that are used to perfonn a peripheral nerve block should have a blunted needle tip that will push a nerve away rather than traverse it. Advantages to using a control syringe for the perfonnance of a peripheral nerve block are that it may provide for better control, it facilitates aspiration with one hand, and it It may provide for better control, it facilitates aspiration with one hand, and it sterility.

Front 5

7. During the performance of a peripheral nerve block, what does a paresthesia indicate? What is another method that may be used to locate the nerve?

Back 5

7. A paresthesia during the performance of a peripheral nerve block indicates that the nerve has been localized by the needle tip. If the pain persists or escalates during injection, there is a risk of an intraneural injection of the local anesthetic solution. If this occurs, the administration of the solution should be terminated and the patient evaluated. Another method that may be used to locate the nerve is with the delivery of an electrical current from a nerve stimulator. The electrical stimulus will produce a neural impulse that is conducted down the nerve, stimulating the motor end plate. This causes a motor response that will be visibly evident to the anesthesiologist. Proper location of the needle can be guided by the characteristic of the motor response as well as the degree of motor response from a given current. (l85)

Front 6

8. Why are lower concentrations of local anesthetic used for peripheral nerve blocks than for spinal anesthesia?

Back 6

8. Lower concentrations of local anesthetic are used for peripheral nerve blocks than for spinal anesthesia secondary to the much greater volume of local anesthetic that is necessary to diffuse sufficiently to block nerves. This limits the total dose of local anesthetic delivered and reduces the risk of local anesthetic toxicity. (185-186)

Front 7

9. For what surgical procedures is a cervical plexus block most often performed? What areas become anesthetized by a cervical plexus block?

Back 7

9. A cervical plexus block is most often performed for carotid endarterectomy, lymph node dissection, and plastic surgical procedures. · The skin under the mandible extending to the level of the second rib becomes anesthetized with a cervical plexus block. In addition, there is relaxation of the skeletal muscles of the neck. Cervical plexus blockade is achieved by blockade of both deep and superficial nerves of the plexus. The superficial cervical plexus nerves are primarily responsible for cutaneous innervation.

Front 8

10. What nerves form the cervical plexus?

Back 8

10. The cervical plexus is derived from nerves Cl to C4.

Front 9

11. What landmarks are used to locate the cervical plexus for blockade?

Back 9

11. Landmarks that may be used to locate the cervical plexus for blockade include the mastoid process, Chassaignac's tubercle, and the transverse process of C4.

Front 10

12. How is blockade of the deep cervical plexus achieved? What volume of local anesthetic solution is deposited during the performance of a deep cervical plexus block?

Back 10

12. Blockade of the deep cervical plexus can be achieved with either a single injection at C4 or with multiple injections at C2, C3, and C4. The single injection technique relies on cephalad spread of the local anesthetic. Typically 3 to 5 mL of local anesthetic is injected for the performance of a deep cervical plexus block.

Front 11

14. What are four potential complications of a cervical plexus block?

Back 11

14. Complications of a cervical plexus block incJude intravascular injection into the vertebral artery; blockade of the phrenic, superior laryngeal, and recurrent laryngeal nerves; Horner's syndrome; and injection into the epidural or subarachnoid space

Front 12

15. Why should bilateral cervical plexus nerve blocks be avoided?

Back 12

15. Bilateral blockade of the cervical plexus should be avoided so as not to achieve a bilateral phrenic nerve block. (186; 1540)

Front 13

16. For what surgical procedures is a brachial plexus block useful? What areas become anesthetized by a brachial plexus block?

Back 13

16. Brachial plexus blocks are useful for surgery on the shoulder or upper extremity. Areas anesthetized by a brachial plexus block include all the muscles and most of the sensation of the upper extremity

Front 14

17. What nerve roots form the brachial plexus?

Back 14

17. The brachial plexus is derived from the anterior rami of C5 to Tl.

Front 15

18. What landmarks are used to locate the brachial plexus for blockade?

Back 15

18. Landmarks that may be used to locate the brachial plexus for blockade include the anterior and middle scalene muscles, the interscalene groove, the transverse process of C6, the clavicle, the axillary artery, and the subclavian artery pulse.

Front 16

19. What four local anesthetic solutions are used for brachial plexus blockade?

Back 16

19. Among the local anesthetic solutions that may be used for brachial plexus blockade are bupivacaine, mepivacaine, lidocaine, and ropivacaine.

Front 17

20. What are three different approaches to blockade of the brachial plexus?

Back 17

20. The three different approaches to blockade of the brachial plexus are the interscalene, supraclavicular, and axillary approaches.

Front 18

22. How can prolonged brachial plexus blockade be achieved via the interscalene approach?

Back 18

22. Prolonged brachial plexus blockade via the interscalene approach can be achieved with the placement of a catheter for the continuous infusion of local anesthetic solution.

Front 19

23. What are some advantages of brachial plexus blockade via the interscalene approach?

Back 19

23. Advantages of brachial plexus blockade via the interscalene approach include: relatively low risk of pneumothorax, ease of palpation of necessary landmarks, and the ability to perform the block with the patient's arm at his or her side.

Front 20

24. What is a disadvantage of brachial plexus blockade via the interscalene approach?

Back 20

f. A disadvantage of brachial plexus blockade via the interscalene approach is the inconsistency with which the ulnar nerve is blocked, making it likely that surgery involving the distribution of the ulnar nerve will necessitate supplemental anesthesia.

Front 21

21. How is a brachial plexus block via the interscalene approach achieved? What volume of local anesthetic is deposited with this approach to brachial plexus blockade?

Back 21

21. Brachial plexus blockade via the interscalene approach begins with localizatior of the interscalene groove by palpation. The patient is placed in the supine position with his or her head turned to the opposite side. The lateral edge of the sternocleidomastoid muscle is located, and posterior palpation will tint encounter the belly of the anterior scalene muscle before locating the interscalene groove, which lies between the anterior scalene and middle scalene musdes. The needle is then placed in the interscalene groove at approximately the C6 level. Further localization can then be achieved with either a nerve stimulator or by eliciting paresthesias. Typically, 30 to 40 mL of local anesthetic is deposited, with intennittent aspirations on the syringe to avoid intravascular injection. The administration of 40 mL of local anesthetic has a greater likelihood of achieving blockade sufficient for shoulder surgery.

Front 22

25. What are some potential complications of brachial plexus blockade via the interscalene approach?

Back 22

Complications of brachial plexus blockade via the interscalene approach include phenic and recurrent laryngeal nerve blocks; epidural, intrathecal, and intravascular injections; and nerve damage.

Front 23

26. How is a brachial plexus block via the supraclavicular approach achieved? What volume of local anesthetic is deposited with this approach to brachial plexus blockade?

Back 23

26. Brachial plexus blockade via the supraclavicular approach can be achieved by injecting local anesthetic where the nerves of the brachial plexus cross the first lllJectmg lOCal anesthetic where the nerves of the brachial plexus cross the first of the subclavian artery pulse. Once the first rib is encountered care should be taken not to advance the needle into the dome of the lung. When a paresthesia is tbtained, 20 to 30 mL of local anesthetic should be deposited, with intermittent aspirations on the syringe to avoid intravascular injection.

Front 24

27. What are some advantages of brachial plexus blockade via the supraclavicular approach?

Back 24

27. Advantages of brachial plexus blockade via the supraclavicular approach include its rapid onset and density with relatively less volume of anesthetic and the ability to perform the block with the patient's arm at his or her side.

Front 25

28. What are some potential complications of brachial plexus blockade via the supraclavicular approach?

Back 25

28. Complications of brachial plexus blockade via the supraclavicular approach include its relatively increased risk of a pneumothorax. In fact, the incidence of a pneumothorax with this technique is about 1 %, making it a poor choice for patients with respiratory compromise. Other complications include phrenic nerve I block, Homer's syndrome, and nerve injury.

Front 26

29. What are two techniques for blockade of the brachial plexus via the axillary approach? What volume of local anesthetic is deposited with this approach to brachial plexus blockade?

Back 26

29. Brachial plexus blockade via the axillary approach can be done either by the transarterial approach or by eliciting paresthesias. The axillary artery and brachial plexus run together in the axillary sheath, and this is the basis for this approach to blockade of the brachial plexus. In either approach the arm must be abducted and externally rotated. The axillary artery is palpated, and the needle is advanced toward the artery until either traversing the artery (transarterial approach) or eliciting paresthesias. In the transarterial approach, local anesthetic solution is deposited both anterior and posterior to the axillary artery. Thirty to 40 mL of local anesthetic is deposited with the axillary approach to brachial plexus blockade, with frequent intermittent aspirations on the syringe to confirm the needle tip is not in the axillary artery or vein.

Front 27

30. What is the orientation of the nerves of the brachial plexus relative to the axillary artery in the axilla?

Back 27

to. The nerves of the brachial plexus are reliably in a specific orientation to the axillary artery in the axilla. The musculocutaneous nerve has typically exited the axillary sheath at this level. The ulnar nerve lies inferior to the axillary artery, the radial nerve posterolateral, and the median nerve superior to the . axillary artery.

Front 28

31. Why are frequent aspirations necessary during brachial plexus blockade via the axillary approach?

Back 28

31. Frequent aspiration is necessary during brachial plexus blockade via the axillary approach to avoid the injection of local anesthetic into the axillary artery.

Front 29

32. What nerves may require supplementation with blockade of the brachial plexus via the axillary approach? How is this achieved?

Back 29

32. The intercostobrachial and musculocutaneous nerves may require supplementation with blockade of the brachial plexus via the axillary approach. The intercostobrachial nerve, a branch of the T2 intercostal nerve, is easily supplemented with the infiltration of local anesthetic in the subcutaneous tissue over the proximal medial aspect of the axilla. The musculocutaneous nerve frequently requires supplementation because its takeoff from the axillary sheath may be proximal to the injection site. The musculocutaneous nerve can be supplemented with an injection of local anesthetic either between the biceps and brachialis muscles at approximately the mid humerus or within the body of the coracobrachialis muscle.

Front 30

33. What are some advantages of brachial plexus blockade via the axillary approach?

Back 30

33. Advantages of brachial plexus blockade via the axillary approach are its technical ease, reliable anesthesia of the hand and forearm, and relative safety.

Front 31

34. What are some disadvantages of brachial plexus blockade via the axillary approach?

Back 31

34. Disadvantages of brachial plexus blockade via the axillary approach are its insufficient blockade for surgery of the shoulder or upper arm, the need to supplement it with a musculocutaneous nerve block, and the requirement for the patient to abduct and laterally rotate his or her arm. (189; 1525)

Front 32

41. How should an intercostal nerve block be performed? What volume of local anesthetic should be deposited for intercostal nerve blockade '?

Back 32

41. Intercostal nerve blocks are performed by first positioning the patient prone with a pillow supporting the patient's abdomen. The ribs corresponding to the designated nerve are then palpated. Starting with the lowest nerve to be blocked, the needle is inserted 6 to 8 cm from the midline until it contacts the rib. After contact with the rib the needle is walked off the inferior portion of the rib until it lies in the intercostal groove. After aspiration on the syringe to exclude intravascular injection, 3 to 5 mL of local anesthetic should be deposited for each intercostal nerve block.

Front 33

42. What is the potential problem with administering local anesthetic too far laterally during an intercostal nerve block?

Back 33

42. It is recommended that the injection of local anesthetic for an intercostal nerve block be done 6 to 8 cm from midline. If the injection is done too far laterally the intercostal nerve could potentially be blocked distal to the takeoff of its lateral cutaneous branches

Front 34

43. What are some potential complications of intercostal nerve blockade?

Back 34

43. Complications of intercostal nerve blockade include intravascular injection and · pneumothorax. Multiple nerve blocks with a large total dose of administered local anesthetic may also result in significant plasma levels of local anesthetic. The close proximity of the vessels to the nerve in the inferior costal groove make systemic toxicity of local anesthetics an important consideration when performing intercostal nerve blocks. (191; 1544)

Front 35

44. What are the four major nerves of the lower extremity? What are the two branches · of the sciatic nerve? .

Back 35

t The four major nerves of the lower extremity are the sciatic, femoral, lateral femoral cutaneous, and obturator nerves. The sciatic nerve branches just above or at the popliteal fossa into the tibial nerve, passing medially, and the common I peroneal nerve, passing laterally.

Front 36

45. What nerves form the sciatic nerve?

Back 36

45. The sciatic nerve is derived from the anterior rami of L4 to S3.

Front 37

46. For what procedure is sciatic nerve blockade most often used?

Back 37

46. Sciatic nerve blockade is most often used together with other nerve blocks for surgery below the knee that does not require a tourniquet. Alone, sciatic nerve blockade provides incomplete anesthesia of the foot and lower leg.

Front 38

47. How is sciatic nerve blockade achieved? What volume of local anesthetic should be deposited for sciatic nerve blockade?

Back 38

47. Sciatic nerve blockade is classically achieved by having the patient lie in the lateral position with the nondependent knee raised. The needle is inserted about 5 cm caudad to a line connecting the posterior superior iliac spine and the greater trochanter of the femur. Confirmation of needle placement can be made by either eliciting paresthesias or with the use of a nerve stimulator. About 2S hetic should be deposited for a sciatic nerve block.

Front 39

48. What nerves form the femoral nerve?

Back 39

48. The femoral nerve is derived from L2, L3, and L4.

Front 40

49. For what procedure is femoral nerve blockade most often used? .

Back 40

49. Femoral nerve blockade is most often used together with other nerve blocks for surgery in the leg. Alone, femoral nerve blockade provides anesthesia of the anterior thigh and may be used for muscle biopsies in that area.

Front 41

50. How is femoral nerve blockade achieved? What volume of local anesthetic should be deposited for femoral nerve blockade?

Back 41

so. Femoral nerve blockade is achieved with the injection of 10 to 20 mL of local anesthetic just below the midpoint of the inguinal ligament and just lateral to the femoral artery.

Front 42

50. How is femoral nerve blockade achieved? What volume of local anesthetic should be deposited for femoral nerve blockade?

Back 42

50. Femoral nerve blockade is achieved with the injection of 10 to 20 mL of local anesthetic just below the midpoint of the inguinal ligament and just lateral to the femoral artery.

Front 43

51. What nerves form the lateral femoral cutaneous nerve?

Back 43

51. The lateral femoral cutaneous nerve is derived from L2 and L3. (191; 1533)

Front 44

52. For what procedure is lateral femoral cutaneous nerve blockade most often used?

Back 44

52. Lateral femoral cutaneous nerve blockade is most often used for anesthesia for the lower extremity in conjunction with other nerve blocks. Alone, lateral femoral cutaneous nerve blockade provides incomplete anesthesia of the anterolateral thigh.

Front 45

53. How is lateral femoral cutaneous nerve blockade achieved? What volume of local anesthetic should be deposited for lateral femoral cutaneous nerve blockade?

Back 45

53. Lateral femoral cutaneous nerve blockade is achieved by inserting a needle 2 em medial and 2 em below the anterior superior iliac spine and depositing 5 to 10 mL of local anesthetic. I

Front 46

54. What nerves form the obturator nerve?

Back 46

54. The obturator nerve is derived from L3 and L4, with occasional minor contributions from L2.

Front 47

55. For what procedure is obturator nerve blockade most often used?

Back 47

55. Obturator nerve blockade is most often used for anesthesia for knee surgery in conjunction with other nerve blocks. Alone, obturator nerve blockade provides primarily motor blockade of the thigh adductor muscles. (

Front 48

56. How is obturator nerve blockade achieved? What volume of local anesthetic should be deposited for obturator nerve blockade?

Back 48

56. Obturator nerve blockade is achieved with the patient in the supine position. The needle is inserted 1 to 2 cm lateral and caudad to the pubic tubercle. The needle is walked 2 to 3 cm laterally and caudad off the inferior pubic ramus ntH it passes into the obturator canal. Ten to 15 milliliters of local anesthetic should be deposited for obturator nerve blockade.

Front 49

57. How is blockade of the femoral, obturator, and lateral femoral cutaneous nerves with a single injection achieved? What volume of local anesthetic should be deposited for this "three-in-one" block?

Back 49

Blockade of the femoral, obturator, and lateral femoral cutaneous nerves can be achieved with a single injection. It is done by depositing a large volume of local anesthetic in the fascial envelope around the femoral nerve, applying distal pressure, and relying on the proximal spread of local anesthetic to bathe the lumbar plexus. It is most often done using a 5 em needle with the patient in the lumbar plexus. It is most often done using a 5 em needle with the patient in the cephalad direction until eliciting paresthesias, at which point the local anesthetic is deposited. Twenty to 40 milliliters of local anesthetic should be deposited for this "three-in-one" block with intermittent aspirations on the syringe to I minimize the risk of an intravascular injection. The administration of 40 mL of local anesthetic has a greater likelihoal of achieving blockade of the obturator nerve.

Front 50

58. What are the five nerves that supply the foot? What areas do each of these supply?

Back 50

58. The posterior tibial, sural, deep peroneal, superficial peroneal, and saphenous nerves supply the entire innervation to the foot. The posterior tibial nerve innervates the sole of the foot, heel, and plantar portion of the toes. The sural nerve ~nnervates the lateral portion of the foot and ankle. The deep peroneal nerve innervates primarily between the first two digits of the foot. The superficial peroneal nerve innervates the majority of the dorsum of the foot. The saphenous nerve innervates the medial foot and ankle.

Front 51

59. How is an ankle block achieved? What is the total volume of local anesthetic that is typically deposited in an ankle block?

Back 51

59. An ankle block can be achieved with three separate injections. The posterior tibial nerve is blocked by df'positing medicine behind the posterior tibial artery near the border of the medial malleolus and medial to the Achilles tendon. The sural nerve is blocked by depositing medicine lateral to the Achilles tendon near the lateral malleolus. The deep peroneal nerve is blocked by depositing medicine immediately lateral to the anterior tibial artery on the dorsum of the foot. Without withdrawing the needle, a cuff of local anesthetic is deposited both medially and laterally toward the malleoli to block the superficial peroneal and saphenous nerves. Fifteen to 20 milliliters of local anesthetic is deposited for an ankle block.

Front 52

60. For what procedure is an ankle block most often used?

Back 52

60. An ankle block is most often used for surgical procedures of the foot that do not require a tourniquet.

Front 53

61. What areas are supplied by the stellate ganglion? What are the most common indications for the performance of a stellate ganglion block?

Back 53

61. The stellate ganglion supplies the sympathetic innervation to the head and arm. The most common indications for the performance of a stellate ganglion block are for the diagnosis and treatment of complex regional pain syndromes and to increase blood flow in patients with vascular insufficiency in the upper extremity

Front 54

62. What is the origin of the stellate ganglion?

Back 54

62. The stellate ganglion is derived from the inferior and first thoracic ganglion of the cervical sympathetic chain.

Front 55

63. What landmarks are used for blockade of the stellate ganglion?

Back 55

63. Landmarks used to identify the location of the stellate ganglion include Chassaignac's tubercle, or the transverse process at C6, the sternocleidomastoid muscle, and the pulse of the carotid artery.

Front 56

64. How is blockade of the stellate ganglion achieved? What volume of local anesthetic solution is deposited during the performance of a stellate ganglion block?

Back 56

64. Blockade of the stellate ganglion is achieved through the insertion of the needle between the sternocleidomastoid muscle and the trachea over the transverse process of C6 until it is contacted. The needle is then withdrawn 2 to 3 mm, and 8 to 12 mL of local anesthetic solution is deposited.

Front 57

55. What are some signs of sympathetic nervous system blockade after the performance of a stellate ganglion block? Which of these provides conclusive evidence that the block has in fact been achieved?

Back 57

65. Signs of sympathetic nervous system blockade after the performance of a successful stellate ganglion block include ptosis, miosis, anhidrosis, nasal congestion, injection of the conjunctiva, vasodilation of the vessels in the extremity, and an increase in skin temperature of the extremity. Of all the signs of successful sympathetic nervous system blockade, only the increase in skin temperature of the extremity provides conclusive evidence that the block has in fact been achieved. The other signs may be achieved with the blockade of fibers that course lower than the stellate ganglion.

Front 58

66. What are some potential complications of a stellate ganglion block?

Back 58

66. Complications of a stellate ganglion block include a pneumothorax, intravascular injection into the vertebral artery, recurrent laryngeal and phrenic nerve blockade, hematoma formation, and epidural and spinal injections.

Front 59

67. What areas are supplied by the celiac plexus? What are the most common indications for the perfonnance of a celiac plexus block?

Back 59

67. The celiac plexus innervates most of the abdominal viscera. The most common indications for the performance of a celiac plexus block is for intractable pain associated with cancer of the pancreas or upper abdominal viscera.

Front 60

68. What is the origin of the celiac plexus?

Back 60

68. The celiac plexus is derived from nerves from TS to T12.

Front 61

69. What landmarks are used for blockade of the celiac plexus?

Back 61

69. Landmarks used to identify the location of the celiac plexus include the body of the L1 vertebra and the twelfth rib, usually under radiologic guidance. (193,

Front 62

70. How is blockade of the celiac plexus achieved? What volume of local anesthetic . solution is deposited during the performance of a celiac plexus block?

Back 62

70. Blockade of the celiac plexus is usually achieved under the guidance of either l10graphy or fluoroscopy. The patient is placed in the prone position, and the needle is inserted lateral to the vertebral body of Ll and walked , the bone in an anterolateral directioo until radiological confirmation of leedle placement can be made. After aspiration, a 2 mL test dose of local solution is deposited before the remaining 25 to 35 mL of local nesthetic solution.

Front 63

71. What solutions other than local anesthetics may be deposited for celiac plexus blockade that is more permanent?

Back 63

71. Phenol and alcohol solutions may also be deposited for celiac plexus blockade. When phenol or alcohol solutions are used, the intent is for the neurolysis of nerves that are causing intractable pain, as from cancer. Typically, a celiac plexus nerve block with local anesthetic is administered before a block with a neurolytic to establish that blockade of the celiac ~lexus will in hct alleviate the patient's pain.

Front 64

72. What are some potential complications of a celiac plexus block?

Back 64

72. Potential complications of a celiac plexus block include hypotension; spinal, epidural, or irctravascullr injection; pneumothorax; puncture of abdominal vis;era; and puncture of the inferior vena cava or aorta leading to a retroperitoneal latoma. I

Front 65

73. For what is intravenous regional neural anesthesia (Bier block) commonly used?

Back 65

73. Intravenous regional neural anesthesia (Bier block) is commonly used for anesthesia for short surgical procedures on an extremity. (

Front 66

74. How is a Bier block achieved? What volume of local anesthetic is used in a Bier block?

Back 66

74. A Bier block is achieved by first placing an intravenous catheter distal in the extremity to be anesthetized. The extremity is then exsanguinated, a double tourniquet is placed proximal in the extremity, and the more proximal cuff is inflated. A dose of local anesthetic based on the patient's weight is administered slowly. The volume of bcal anesthetic is 25 to 50 mL in the upper extremity and 100 to 200 mL in the lower extremity. The cnset o: anesthesia is noted within 5 minutes. If the patient starts to develop tourniquet pain during the procedure, the distal cuff may be inflated and the proximal cuff deflated. (193,

Front 67

75. What local anesthetics are typically used for a Bier block?

Back 67

75. Local anesthetics that can be used for a Bier block include 0.5% lidocaine and prilocaine. The total dose of prilocaine used for a Bier block should be less than 600 mg to minimize the risk of methemoglobinemia that can result from the metabolism of prilocaine. Chloroprocaine is not used because of the concern for thrombophlebitis, nor is bupivacaine, owing to its potential for cardiotoxicity.

Front 68

76. What are some advantages of a Bier block?

Back 68

76. Advantages of a Bier block include its ease of administration, rapid onset, rapidity of recovery, and excellent skeletal muscle relaxation. (193-194; 1529

Front 69

77. What are some diiadvantages of a Bier block?

Back 69

n. Disadvantages of a Bier block include the abrupt onset of potentially se ... ere postoperative pain when the cuff is de~ated, the difficulty in maintaining a ness fie\~ and the potential for pain in an injured extreffilty during its exsanguination. (194;

Front 70

78. What is a potential complication of a Bier block? How can this risk be minimized?

Back 70

lmplications of a Bier block include the risk of excessive, toxic doses of local anesthetic reaching the systemic circulation with accidental deflation of the tourniquet. This risk can be minimized at the conclusion of the case by deflating the tourniquet in increments over time. This allows the local anesthetic to enter the systemic circulation over a greater period of time.