Clinical Correlations Brachial Plexus

Front 1

Brachial plexus provides majority of the ___& ___ innerv. to the ___ ext.

Back 1

sensory & motor innev
to the upper ext.

Front 2

surg proced on the upper ext can be performed by blockade of the _____ at one of seveal sites or terminal branches

Back 2

brachial plexus

Front 3

Brachial plexus provides ____innervation to the upper ext.

Back 3

somatic innerv.

Front 4

Brachial plexus formed by the union of the ventral rami of the ____ thru ___ & __ thoracic nerves

Back 4

C5-C8 & T1

Front 5

Nerve roots leave the intervertebral foramina they converge to form ____

Back 5

trunks

Front 6

Nerve roots leave the intervertebral foramina they converge to form trunks,then ___

Back 6

divisions

Front 7

Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, ____

Back 7

cords

Front 8

Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, cords, ___

Back 8

terminal nerves

Front 9

Randy Travis Drinks Cold Beers

Back 9

Rami, Trunks, Divisions, Cords, Branches

Front 10

Terminal Branches
My Aunt Rapes My Uncle

Back 10

Musculocutaneous
Axillary
Radial
Median
Ulnar

Front 11

The brachial plexus is enclosed by a ____sheath its origin at the intervertebral foramina to the upper arm

Back 11

fascial sheath

Front 12

Indications of the Brachial Plexus

Back 12

Sole anesthetic surg procedure on upper ext, shoulder, FA, Arm
-Reduction of fractures, dislocations, suturing of tendons, repair of lacs

Front 13

Indications of the Brachial Plexus

Back 13

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

Front 14

Contraindications of the Brachial Plexus

Back 14

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

Front 15

Intascalene carries a risk of knocking out the

Back 15

diaphragm (phrenic nerve )

Front 16

Regional anesthesia choices

Back 16

intrascalene brach plex blk
axillary blk
Supraclavicular brach plex blk
Infraclavicular brach plex blk

Front 17

Techniques: Interscalene blk
Indications

Back 17

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

Front 18

Techniques: Interscalene blk
Procedure Pt position

Back 18

Pt supine, head flt rotated 30-40 deg to opp side

Front 19

Techniques: Interscalene blk
Procedure: Palpate

Back 19

Palpate the interscalene groove at level of the cricoid cartilage (C6)
-if groove not apparent ask pt to lift head

Front 20

Techniques: Interscalene blk
Procedure:

Back 20

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

Front 21

Techniques: Interscalene blk
Procedure:

Back 21

30-40 ml of local w/ negative aspiration every 5ml
-0.5% Bupivacaine or Chirocaine w/ 1:200 K epi

Front 22

The use of epi is

Back 22

a potent vasoconstrictor keeps med around longer

Front 23

If a hematoma develops the attempt of the block was

Back 23

unsucessful

Front 24

Techniques: Interscalene blk
Complications

Back 24

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

Front 25

Horners Sign

Back 25

Myosis: bld shot eye, small pupil
Ptosis: droopy eye
Anhidrosis: Lack of sweating on one side of face

Front 26

Techniques: Interscalene blk
Complications

Back 26

Phrenic nerve blk - feeling of heaviness one side of chest
Recurrent laryngeal nerve blk (30-50% -> hoarsness & weak voice)
Infection, hematoma, nerve injury

Front 27

Techniques of Axillary blk
Indications

Back 27

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

Front 28

Axillary blk can be used for the following

Back 28

AV fistula, Carpal tunnel syn
Ganglion cyst

Front 29

Techniques of Axillary blk
Procedure: Pt position

Back 29

Supine, arm abd 90deg, ext rotated
-Brach art palpated, follow pulse prox far as possible
-sterile prep/drape
-1% lido directly over pulse

Front 30

Techniques of Axillary blk
Procedure:

Back 30

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)

Front 31

Techniques of Axillary blk
Procedure: use of nerve stimulator during inj.

Back 31

Use a nerve stimulator w/ 22G stimuplex needle, after appro muscle response inj 5ml local in 5ml incrmts w/ neg asp.

Front 32

Techniques of Axillary blk
Procedure: Trans-arterial approach

Back 32

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

Front 33

For an Axillary Blk it may also be necessary to blk the ____muscle to blk the musculocutaneous nerve (3-5mls)

Back 33

coracobrachialis (given into belly of the muscle)

Front 34

Techniques of Axillary blk
Complications:

Back 34

Intra-vascular (art or ven) w/ seizure
Elicitation of parathesia esp in multiple sites, inc incidence of post op neuropathy
Hematoma & infection are rare

Front 35

Regional anesth should not be done when pt is under gen anesth T or F

Back 35

T