Surgery - Regional Anesthesia/analgesia

Front 1

Why use regional anesthesia with general anesthesia

Back 1

-decreased requirements for inhalation anesthetics
-improved muscle relaxation
-preemptive analgesia

Front 2

Pre-emptive analgesia
-define

Back 2

-local anesthesia that prevents transmission of noxious stimuli to the spinal cord, thus preventing excitation of interneurons in the dorsal horn

Front 3

Local anesthetic
-mechanism of action

Back 3

-prevent NA+ influx into nerve ---> prevents depolarization of propagation of action potential

Front 4

Differential nerve blocks are important due to:

Back 4

-Sympathetic > A-delta, C-fiber (sensory > A-alpha (motor)
-Size
-Myelination
-Rate of discharge

Front 5

Local anesthetic
-disposition

Back 5

-distribution
-absorption
-elimination

Front 6

Local anesthetic
-efficacy of block depends on

Back 6

-concentration
-proximity to nerve
-volume

-distribution

Front 7

Local anesthetic toxicities
-general

Back 7

Systemic
-cardiovascular
-CNS
-Methemglobinemia

Allergic Reactions (rare)
-localized
-systemic

Local Tissue toxicity

Front 8

CNS toxicity
-common with

Back 8

-lidocaine

Front 9

Cardiovascular toxicity
-occurs with

Back 9

-bupivicaine

Front 10

Distal Limb block
-nerves blocked on forelimb

Back 10

-radial n.
-ulnar n.
-median n.

Front 11

IVRA
- aka

Back 11

-IV Regional Anesthetic
-Bier Block

Front 12

IVRA
-how to perform

Back 12

-place tourniquet and inject drug IV to lose sensation in everything distal
-careful when removing tourniquet because drug can go systemic

Front 13

Brachial Plexus Block
-indications

Back 13

-procedures within or distal to the elbow

Front 14

Brachial Plexus Block
-nerves blocked

Back 14

-radial n.
-median n.
-ulnar n.
-musculocutaneous and axillary nerves

Front 15

Brachial plexus block
-drugs

Back 15

-lidocaine
or
-bupivicaine

Front 16

Brachial plexus block
-landmarks

Back 16

-point of the shoulder
-first rib
-transverse processes of the cervical vertebrae

Front 17

Brachial Plexus Block
-downside to use

Back 17

-motor block too

Front 18

RUMM Block
-purpose

Back 18

-distal forelimb
-possibly with fewer complications

Front 19

RUMM Block
-nerves

Back 19

-Radial n.
-Ulnar n.
-Musculocutaneous n.
-Median n.

Front 20

Epidural Anesthesia
-injection occurs where

Back 20

Lumbosacral space
-dorsal cranial iliac crest
-dorsal spinous processes of L7 and S1

Front 21

Epidural Local Anesthesia
-Extent of anesthesia is dependent on

Back 21

-volume
-concentration of drug injected

Front 22

Epidural Local Anesthesia
-surgerys (low to high drug concentratoin)

Back 22

-abdominal surgery
-hindlimb surgery
-perineal surgery

Front 23

Knee Surgery
-what nerves get blocked
-where are they on the spinal cord

Back 23

-Sciatic n. & Femoral n.

-L4

Front 24

Epidural Local anesthesia
-advantages

Back 24

-frequently combined with epidural opioids
-good muscle relaxation
-decreased requirement for inhalation anesthesia

Front 25

Epidural Local Anesthesia
-disadvantages

Back 25

-sympathetic blockade (hypotension, loss of motor tone, etc.)
-motor blockade

Front 26

Epidural Opioid
-advantages

Back 26

-prolonged segmental analgesia
-minimal sedation
-reduced inhalation anesthetic requirement

Front 27

Epidural opioid
-disadvantages

Back 27

-requires technical expertise

Front 28

Epidural Opioids
-drugs

Back 28

-Morphine*****

-Buprenorphine (not used due to preservative)
-Fentanyl (not used due to short half-life)

Front 29

Epidural Opioids
-when to use

Back 29

-perioperative analgesia for the hind limb, abdomen, perineum
-pancreatitis
-extensive soft tissue wounds
-orthopedic trauma

Front 30

Epidural opioids
-side effects

Back 30

-pruritis (uncommon)
-urinary retention*
-delayed respiratory depression?
-vomiting

Front 31

Epidural opioids
-complications

Back 31

-ineffective analgesia
-epidural hematoma
-epidural abscess

Front 32

Epidural opioids
-contraindications

Back 32

-sepsis
-coagulopathy
-pyoderma

Front 33

Dental Nerve Block
-indications

Back 33

Analgesia for face and oral cavity
-dental extractions
-skull fracture repair
-maxillofacial surgery
-inflammatory/ulcerative conditions

Front 34

Dental nerve blocks
-advantages

Back 34

-analgesia during dentistry (reduced MAC)
-pre-emptive analgesia?
-post-op analgesia (improved recovery)
-less stress at emergence

Front 35

Label the sensory innervation to the head

Back 35

-A) facial n.
-B) dorsal cutaneous n.
-C) ophthalmic n. (V)
-D) vagus n.
-E) maxillary n. (V)
-F) mandibular n. (V)
-

Front 36

Dental nerve block
-nerves blocked

Back 36

-infraorbital n.
-mandibular alveolar n.
-mental n.
-maxillary n.

Front 37

Dental nerve blocks
-key anatomical sites of the skull

Back 37

-infraorbital canal
-infraorbital foramen
-mandibular foramen
-mental foramina

Front 38

Infraorbital nerve block
-function
-where to inject

Back 38

-anesthesia for the maxilla rostrol to the molars

-palpate infraorbital foramen and insert needle caudally

Front 39

Mandibular n.
-branching pattern

Back 39

-exits skull at foramen ovale
-branches to lingual n. and buccal n.
-enters mandibular foramen as mandibular alveolar n.
-exits mandible at mental foramen as mental n.

Front 40

Mandibular Alveolar nerve block
-function
-where to inject

Back 40

-anesthesia for mandible

-palpate the nerve (medial side) ---> insert the needle ventral to the mandible and cranial to the angular process

Front 41

Mental nerve block
-function
-where to inject

Back 41

-anesthesia for mandibular incisors, canines, first 2 premolars

-direct caudally into the middle mental foramen

Front 42

Intercostal nerve block
-indications

Back 42

-lateral thorocotomy
-rib fracture

Front 43

Intercostal nerve block
-where to inject

Back 43

-2 rib spaces cranial and 2 rib spaces caudal to the injury site at the caudal border of the rib near the intervertebral foramen

Front 44

Intercostal nerve block
-proposed mechanism of action

Back 44

-diffusion through pleura
or
-direct blockage of intercostal nerves

Front 45

Intercostal nerve block
-blocked nerves

Back 45

-thoracic n.
-sympathetic chain
-splanchnic n.

Front 46

Interpleural analgesia
-indications

Back 46

-thorocotomy
-rib fracture
-thoracic wall, pleural, mediastinal metastasis
-pancreatitis
-cholecystectomy
-renal surgery

Front 47

Interpleural analgesia
-drug use

Back 47

-bupivicaine

Front 48

Interpleural analgesia
-comparison of buprenorphine and bupivicaine post-op

Back 48

Bupivicaine
-lower heart rate and respiratory rate
-lower total pain score
-higher partial pressure of oxygen

Front 49

Intraarticular local anesthetic
-indications

Back 49

-stifle surgery
-shoulder surgery
-elbow surgery

Front 50

Intraarticular analgesia
-drug

Back 50

-bupivicaine