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SUM'20 - Regional > Week 4 Regional Peripheral Blocks > Flashcards

Week 4 Regional Peripheral Blocks Flashcards

head and neck, lower, upper

1
Q

complications of Head and neck blocks:

A 
IV injection
Subarachnoid or epidural placement of LA
Nerve injury
Bleeding
Infection
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2
Q

Absolute Contraindications (of any nerve block):

A
  • Patient refusal
  • Uncorrected coagulation deficiencies
  • Infection at the site of the block
  • Systemic anticoagulation
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3
Q

Relative Contraindications (of any nerve block):

A
  • Arbitrary values for platelet counts of less than 100,000
  • Prothrombin time (PT), activated partial thromboplastin time (aPTT), and bleeding times that are elevated
  • Severe bleeding with or without symptomatic hypovolemia or the potential for severe bleeding
  • Patient age
  • Uncooperative and/or Confused patients
  • Chronic neurological disorders
  • Local anesthetic allergy
  • Caution with patients that have history of Mobitz I, II, or third degree heart block ***
  • Peripheral neuropathy
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4
Q

Cervical Plexus

A

insert image

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5
Q

cervical plexus blocks can be used in various surgical procedures including

A
  • neck and shoulders,
  • Para/thyroid operations, and
  • carotid endarterectomies
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6
Q

Cervical plexus is formed from the ;

A

the anterior rami of C1-C4

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7
Q

Cervical plexus supplies sensation to the:

A

Supplies sensation to the

  • jaw,
  • neck,
  • occiput,
  • chest and
  • shoulder
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8
Q

Lumbar plexus supplies _______ innervation to:

A

motor AND Sensory innervation to anterior portion

-and cutaneous sensory medial lower leg

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9
Q

The largest nerve trunk in the body?

A

Sciatic

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10
Q

Sciatic nerve is derived from :

A

anterior rami of L4-S3

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11
Q

Name the 4 major nerves that supply all of the lower extremity:

A
  1. Lateral cutaneous nerve (common peroneal)
  2. Femoral nerve (anterior crural nerve)
  3. Obturator nerve
  4. Sciatic nerve
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12
Q

Lumbar Plexus Block does not supply complete anesthesia of LE because it cannot achieve blockade of:

A
  • the sacral roots that supply the sciatic nerve

- need to do a different blocks for complete block of LE

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13
Q

This block has the HIGHEST complication raters of any peripheral nerve block:

A

Posterior Lumbar Plexus (PSOAS COMPARTMENT) block

-it is relatively close to multiple sensitive structures

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14
Q

Needle size and gauge needed to perform a Posterior lumbar plexus (psoas) compartment block:

A
  • 8-15cm insulated

- 21 g

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15
Q

When performing a Posterior lumbar plexus (psoas) compartment block what femoral motor response is elicited? What is the mV requirement?

A
  • Quadriceps

- < or = 0.5 mA

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16
Q

When performing a Posterior lumbar plexus (psoas) compartment block how much volume of LA is administered?

A

20-30mL of LA

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17
Q

LA volumes greater than 20mL may increase the risk of: (2)

A
  1. bilateral spread and

2. contralateral limb involvement

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18
Q

Name the nerves involved in a femoral 3 in 1 block:

A
  1. femoral
  2. lateral femoral cutaneous
  3. obtruator nerves
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19
Q

Considerations for femoral nerve block: (3)

A
  1. local infection
  2. hx of vascular grafting
  3. local adenopathy (large lymph nodes)
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20
Q

Needle size and gauge to perform a femoral block:

A

short 5 cm insulated needle

22G

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21
Q

volume of LA injected when performing a femoral block:

A

30-40 mL of LA

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22
Q

a femoral 3 in 1 block by most is regarded as :

A

femoral nerve block only

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23
Q

indications for femoral block:

A
  • post op pain relief of knee surgeries (hip and ankle)

- surgical indications: soft tissue exploration, biopsy, repair of lac of the anterior thigh

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24
Q

blocking the SAPHENOUS vein occurs in what block?

A

femoral NB

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25
Q

Lateral Femoral cutaneous nerve block is (type of block)

What area?

A
  • purely sensory nerve

- to lateral aspect of the thigh

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26
Q

Complications with lateral femoral cutaneous nerve blocks are:

A

rare

complications are rare

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27
Q

lateral fem. cutaneous NB’s are used in the dx and tx of:

A

meralgia parasthetica (pain syndrome; tingling/numbness/burning pain of outer thigh)

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28
Q

procedures of what areas that use a posterior lumbar plexus (psoas compartment) block ?

A

Hip
knee
anterior thigh

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29
Q

Needle size and gauge for completing a Lateral femoral cutaneous nerve block:

A

short: 3-4 cm

22 g

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30
Q

after careful aspiration, how much volume of LA is injected above and below the fasica lata of a lateral femoral cutaneous NB?

A

10-15mL of LA

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31
Q

In theory, direct nerve injury is possible, but in clinical practice this is one of the few nerve blocks:

for lateral femoral cutaneous NB

A

with no side effects or complications

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32
Q

Obturator Nerve is both a

A

motor and sensory nerve

  • sensory: hip & knee joints, medial thigh
  • motor: adductors of hip
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33
Q

Obturator Nerve block is most often performed in combination with

A

femoral and sciatic nerve blocks

… for complete anesthesia of the knee

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34
Q

What nerve block is required to complete anesthesia of the knee?

A

obturator nerve

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35
Q

obturator nerve often gets pinched in what position?

A

lithotomy

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36
Q

Landmark to identify in obturator block:

A

tip of the pubic tubercle

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37
Q

needle length required for obturator block:

A

10cm block needle — inserted until bone is contacted

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38
Q

what motor response is elicited in an obturator block?

A

thigh ADDuction

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39
Q

volume of LA injected in an aobturator block?

A

15-20 mL of LA

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40
Q

sciatic block is in combination with what two additional blocks to provide complete anesthesia and post-op analgesia for LE surgery?

A
  1. Lumbar Plexus

2. Femoral Block 3 in 1

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41
Q

the sciatic nerve is the continuation of the

A

upper division of the sacral plexus

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42
Q

sciatic nerve originates from the

A

lumbosacral trunk and is composed of

nerve roots L4-5, S1-3

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43
Q

Sciatic nerve innervates the muscles of the

A

posterior thigh
skin of the leg
muscles of the LE (MAINLY by tibial and peroneal portions of sciatic nerve)

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44
Q

Needle length for a sciatic block:

A

Long, 10 cm at perpendicular angle

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45
Q

volume injected in a sciatic block

A

25 mL of LA

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46
Q

what motor response is elicited in a sciatic block? What is PREFERRED for surgical anesthesia?

A
  • Plantar or dorsiflexion

- Plantar flexion: distal ankle, foot, toes, or foot inversion

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47
Q

Major risk with sciatic nerve (popliteal approach) block?

A

vascular puncture

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48
Q

sciatic nerve divides into:

A
  1. Common Peroneal

2. Tibial

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49
Q

Posterior approach (popliteal) to sciatic nerve block needle length and gauge:

A

insulated 5-10cm

22g

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50
Q

volume of LA injected for a Posterior approach (popliteal) to sciatic nerve block

A

30-40ml

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51
Q

saphenous nerve may be blocked by injecting:

A

5-10mL of LA in a subcutaneous ring

from the medial aspect of the tibia to the border of the patellar tendon

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52
Q

saphenous nerve block is done with what size needle?

A

short 2 cm

distal to the tibial tuberosity and medially

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53
Q

Ankle block indications - it is used for both

A

analgesia and anesthesia

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54
Q

in an ankle block, avoid excessive LA volumes and avoid

A

epinephrine

(to avoid risk of ischemic complications

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55
Q

Avoid epi in: (4)

A

Fingers
Toes
Penis
Nose

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56
Q

An ankle block includes what 5 nerves?

A
  1. posterior tibial
  2. deep peroneal nerve
  3. superficial peroneal nerve
  4. Sural nerve
  5. Saphenous nerve (terminal branch of femoral)

** if the surgery does not require all 5 nerves to be blocked, then do not do it**

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57
Q

The only nerve NOT a part of the sciatic system in an ankle block is:

A

saphenous nerve

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58
Q

In an ankle block, in each injection, what is the amount of LA injected?

A

5mL x 5 injections

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59
Q

In a Brachial Plexus block, the higher up the block…

A

the greater the area covered

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60
Q

Name the 5 anatomic areas for blocking the brachial plexus:

A
  1. Paravertebral
  2. Supraclavicular
  3. Infraclavicular
  4. Axillary
  5. Blocking the specific terminal nerves
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61
Q

** how many cervical nerves are there?

A

8 cervical - only 7 cervical vertebrae , but 8 nerves

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62
Q

how many thoracic nerves are there?

A

12 thoracic nerves

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63
Q

how many lumbar & sacral nerves are there?

A

5 lumbar

5 sacral

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64
Q

Spinal nerves mneumonic:

A

“Breakfast at 8, Lunch at 12, Dinner at 5”

8 cervical
12 thoracic
5 lumbar/ sacral

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65
Q

**Total number of spinal nerves?

A

31

8+12+5+5+1 (coccygeal) = 31

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66
Q

**Each spinal nerve has an

A

Anterior and posterior root

  • posterior roots form ganglia
  • anterior roots join to form plexuses
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67
Q

Brachial plexus if formed by the anterior divisions of:

A

C5, 6, 7, 8, and T1 nerves

between the scalenes

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68
Q

Lumbar plexus if formed by the roots of

A

lumbar 1-4

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69
Q

Sacral plexus is formed by the roots of

A

lumbar 4-5, sacral 1-3 nerves

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70
Q

Is there are thoracic plexus?

A

no - except T1 in brachial plexus

and some T12 in lumbar plexus

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71
Q

Break down of the Brachial plexus:

A
  • 5 roots
  • 3 trunks
  • 6 divisions
  • 3 cords
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72
Q

As ________ leave the intervertebral foramina, they form, trunks, divisions, cords, and then terminal nerves

A

Nerve roots

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73
Q

Three brachial trunks and roots formed by

A
  1. Superior c5-6
  2. Middle C7
  3. Inferior C8-T1
  • *all lie b/w anterior and middle scalene muscles
    • all pass over lateral border of 1st rib under clavicle and divide into anterior/posterior divisions
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74
Q

How many brachial divisions are there?

A

6 divisions (at lateral edge of the 1st rib; behind clavicle)

  • 3 anterior
  • 3 posterior
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75
Q

How many Cords are in the brachial plexus?

A

3

-names for their relationship to the axillary artery

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76
Q

Lateral cord is the union of

A

anterior divisions of upper and middle trunks

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77
Q

Posterior cord is

A

all 3 posterior divisions

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78
Q

Medial cord is continuation of

A

anterior division of the inferior trunk

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79
Q

**Major nerve of Lateral cord:

A

Musculocutaneous nerve

-gives off lateral branch of median nerve and terminates as musc.

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80
Q

**Major nerve of Posterior cord:

A

Radial Nerve

-gives off the axillary nerve and terminates as the radial nerve

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81
Q

**Major nerve of Medial Cord:

A

Ulnar Nerve

-gives off medial branch of the median nerve adn terminates as ul. nerve

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82
Q

At the lateral border of pectoralis minor muscle, each cord gives off a large branch before terminating as a major

A

terminal nerve

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83
Q

Axillary nerve terminates as:

A

radial nerve

84
Q

Medial head of median nerve terminates as:

A

ulnar nerve

85
Q

Lateral branch of the median nerve terminates as:

A

musculocutaneous

86
Q

**While not a major nerve of a cord, it is made by 2 large branches from the lateral and medial cords:

A

median nerve

87
Q

Interscalene block optimal for :

A

procedures of shoulder and upper arm

88
Q

Supraclavicular approach best for:

A

entire arm, including hand

89
Q

Infraclavicular approach indicated for:

A

procedures of

  1. hand,
  2. forearm,
  3. elbow, and
  4. upper arm
90
Q

Axillary approach indication for

A

procedures UP TO THE ELBOW

91
Q

**Which B.Plexus approach is not best for hand?

A

interscalene

92
Q

** which B.Plexus approach is not ideal for shoulder?

A

supraclavicular

93
Q

which B.Plexus approach does not include the bicep or tricep?

A

infraclavicular

94
Q

which B.Plexus approach does not include the forearm?

A

Axillary

95
Q

Which B.Plexus approach is most appropriate for shoulder surgery?

A

interscalene

96
Q

Interscalene block is not recommended for surgery of

A
  • hand (or any surgery…
  • below the level of the elbow

**supplementary ulnar block may be required

97
Q

Interscalene block is indicated for surgical procedures on the clavicle, SHOULDER, elbow and upper arm with the exception of the

A

medial aspect of the arm

98
Q

For complete surgical anesthesia of the shoulder, a supplemental block of the

A

superficial cervical plexus block is needed

99
Q

***The Ulnar nerve is frequently not blocked in this block:

A

Interscalene block

100
Q

this block is NOT appropriate for surgeries distal to the elbow

A

Interscalene block

101
Q

Contraindications or considerations for an Interscalene block:

A
  1. Contralateral phrenic nerve paralysis
  2. Recurrent nerve paralysis (severe pulm dx)
  3. Contralateral pneumothorax
  4. Pt. requires a bilateral block
  5. Respiratory compromise
102
Q

Landmarks for interscalene:

A

” I = CCCE.IT” (read as “I SEE IT”) I = interscalene

  • Clavicle
  • Clavicular head of the Sternocleidomastoid muscle
  • Cricoid cartilage
  • External jugular vein
  • Interscalene Groove
  • Twitch response to DELTOID
103
Q

volume of LA injected for interscalene block?

A

20-30mL

104
Q

SE’s of Interscalene block:

A
  1. Horner’s Syndrome (transient)
  2. Phrenic Nerve block- ipsilateral (C3-5)
  3. Recurrent Laryngeal Nerve block
  4. Compression of Carotid artery lumen
105
Q

RLN paralysis presents as

A

hoarseness

106
Q

Major complication of Interscalene block:

A

Intravascular injection of VERTEBRAL artery –> CNS Toxicity

  • subarachnoid injection (total spinal)
  • epidural injection (high epidural)
  • pneumothorax
107
Q

How do you tx a pneumothorax?

A

needle decompression

  • 18G
  • 2 IC space; midclavicular
108
Q

Supraclavicular approach of a Brachial Plexus block occurs at the level of:

A

the 3 trunks

-where brachial plexus is most compactly arranged; “the spinal of the arm”

109
Q

advantages of Supraclavicular approach?

A

**No danger of missing peripheral or proximal nerve branches b/c of failure of LA spread

  • Low Vol LA req.
  • Quick onset
  • Arm can be in any position
110
Q

Major disadvantage of supraclavicular approach?

A

**Pneumothroax (MAJOR RISK)

  • difficult to perform and/or teach
  • need experience
111
Q

Contraindications of Supraclaviular approach:

A
  • same as interscalene
  1. Contralateral phrenic nerve paralysis
  2. Recurrent nerve paralysis (severe pulm dx)
  3. Contralateral pneumothorax
  4. Pt. requires a bilateral block
    - avoid bilateral phrenic NB
    - avoid pneumothorax
  5. Respiratory compromise
112
Q

pneumothorax occurs at what percentage in a supraclavicular approach? what decreases this?

A
  1. 5 - 5%

- improved safety with U/S

113
Q

Indications for a supraclavicular approach?

A
  • procedures AT or DISTAL to the elbow
  • Arm
  • Forearm
  • Hand
114
Q

**a supraclavicular approach is not ideal for? why?

It also spare what?

A

**Not ideal for shoulder surgery - not adequate block of the suprascapular and axillary nerves.

-Spares: distal branches. DOES NOT BLOCK ULNAR

115
Q

hyperechoic =

A

brighter areas = think bones / RIBS

116
Q

hypoechoic =

A

lighter areas = nerve plexus

117
Q

LA volume injected for a supraclavicular approach:

A

In 5mL increments while visualizing LA spread around brachial plexus

20-30mL In-plane
30-40mL Out of Plane

118
Q

when you’re looking for the “snow man” to what are you looking for?

A

brachial plexus

119
Q

SCL block in plane with US technique, what needle size is used?

A

22g

120
Q

If using PNS in a SCL block, what motor response are you looking to elicit?

A

arm, forearm, or hand

121
Q

An Infraclavicular approach blocks the brachial plexus at the level of

A

the cords

122
Q

Avoid using an infraclavicular approach in pts with:

A
  • vascular catheters in SCL region

- ipsilateral pacemaker

123
Q

Infraclavicular approach is excellent for procedures

A

distal to the elbow

124
Q

The terminal nerve that is blocked by an infraclavicular approach?

A

musculocutaneous

125
Q

is the upper arm and shoulder anesthetized with an infraclavicular approach.

A

no

126
Q

needle length for infraclavicular approach:

A

8cm

127
Q

motor response elicited with infraclavicular PNS stimulation?

A

finger flexio or extension

128
Q

LA vol injected for infraclavicular apporach:

A

20-30ml

129
Q

Advantages of Axillary block:

A
  • Less risk of major complications

- Suitable for ER and OP use

130
Q

Primary disadvantage of axillary block?

A

extent of anesthesia is insufficient for shoulder or upper arm surgery WITHOUT using LARGE volumes of solution

131
Q

relationship of nerves to axillary artery (at the axillary level):

Median nerve:

A

anterior to the axillary artery

132
Q

relationship of nerves to axillary artery (at the axillary level):

Ulnar nerve:

A

posterior to the axillary artery

133
Q

relationship of nerves to axillary artery (at the axillary level):

Radial nerve:

A

Posterior and somewhat lateral

134
Q

For an adequate block, you must additionally block what nerve in conjunction with the axillary block?

A

musculocutaneous

-because it is outside the neuro sheath

135
Q

Musculocutaneous block is essential to complete the anesthesia for the

A

forearm and wrist

-commonly included when performing an axillary blcok

136
Q

Trans-arterial axillary technique, has fallen out of favor due to what?

A
  • arterial puncture (axillary artery)
  • inadvertent LA injection
  • risk of hematoma
  • pressure must be held for 5mins
137
Q

LA used for brachial plexus

- can epi be used?

A

yes

-may be used w/or w/o epinephrine 1:200,000

138
Q

what LA is mostly used for B.Plexus blockade?

A

bupivacaine

0.375-.05% Bupivacaine or Ropivacaine
1-2% Mepivacaine or Lidocaine
1 % etidocaine

139
Q

in regards to LA:

when larger volumes are used….

A

… lower concentrations are also used.

140
Q

Digital nerves are the distal continuation of both the

A

median and ulnar nerves

141
Q

solutions for digital blocks should NEVER contain

A

epi

142
Q

**Never use epi in:

A

fingers, toes, penis, nose

143
Q

in a digital block what size and gauge are used?

A

short

23-25g

144
Q

when performing a digital block, how much and where is LA injected?

A

2-3mL of LA without Epi

on each side (both the dorsal and ventral branches of the digital nerve is carried out bilaterally)

145
Q

Supinate =

A

palm of hand / anterior / ventral

146
Q

Pronation =

A

back of hand / posterior/ dorsal

147
Q

Digital complications include not exceeding maximum volume of LA on each side? why?

A

2 mL on each side (4 mL total)

-can get compartment syndrome

148
Q

Max. tourniquet time for a digit:

A

15 mins

149
Q

Patients to use a tourniquet with caution in:

A
  • raynaud’s

- PVD

150
Q

best indication for a bier block:

A

used for brief minor surgery (up to 1 hour) of an extremity

151
Q

Carpal tunnel release is usually performed via this block

A

beir block

152
Q

most common complication with a beir block?

A

systemic toxicity

-b/c a potentially toxic dose of LA can be injected into the central circulation.

153
Q

You never proceed with a beir block without what?

A

an IV in the opposite arm

emergency medication administration

154
Q

Always check what before a beir block procedure?

A

the Tourniquet pressure tubing valves apparatus

155
Q

Beir block needle size:

Where is it introduced?

A

small IV catheter 22g

-introduced in the dorsum of the pts hand of the arm to be anesthetized

156
Q

for a beir block, the extremity is wrapped in esmarch bandage from _____ to ______.

A

distal to proximal.

157
Q

the proximal cuff is inflated and maintains a cuff pressure at:

A

150mmHg above SBP

  • upper: 250 mmHg
  • lower: 350-400mmHg
158
Q

how is functionality of the cuff checked for a beir block?

A

for occlusion of the radial artery pulse

-check both cuffs

159
Q

when the esmarch bandage is removed, the pts arm is returned to horizontal position. the arm should be:

A

stark white/pale

completely w/o blood or circulation

160
Q

What LA is used in a beir block?
How much is administered?
Injected over how long?
Anesthesia is established after?

A 
-0.5% Lidocaine
Administer:
-25ml for FA
-50ml for Arm
-100ml for thigh
-popular dose is 40ml

Over: 2-3 mins

Anesthesia in: 5-10 mins

161
Q

The proximal tourniquet is left inflated in a beir block until

A

the pt c/o of tourniquet pain (~ 20-30mins)

*often can give versed or a little propofol to help them relax

162
Q

When is the distal tourniquet inflated in a beir block?

A

when the proximal is deflated.

-distal cuff should be over an anesthetized area

163
Q

in a beir block, when anticipated duration of the surgery is 20 mins or less what should be done?

A

the proximal distal tourniquet should remain inflated for at least that period of time (at least 20 mins)

164
Q

LA that are NOT used in a beir block?

A

bupivicaine or chloroprocaine

165
Q

Due to the risk of /and single m/c complication of systemic toxicity (due to leak or premature tourniquet release), what must we ensure is done for SAFETY in all beir blocks:

A
  • *HAVE AN IV LINE IN THE OPPOSITE ARM
  • always check tourniquet pressure-tubing-valves before procedure
  • appropriate monitoring (HR, BP, O2, etc)
  • slow tourniquet release
166
Q

Every pt receiving a major conduction nerve block should (2):

A
  1. have IV access

2. monitored for timely detection of systemic toxicity of LA

167
Q

Larger doses of LA for major conduction or plexus blocks are routinely monitored for signs of LA toxicity for

A

30 mins after block placement

168
Q

Although a toxic reaction occurs during or immediately on injection of LA in almost all instances, the PEAK serum level of LA occur:

A

20 mins following injection

169
Q

**This block results in the highest blood levels of LA per volume injected of any block in the body:

A

Intercostal block (peripheral block of the trunk)

-care must be taken to avoid toxic levels

170
Q

**This block has one of the highest complication rates of any peripheral nerve block:

A

Intercostal block (peripheral block of the trunk)

  • d/t proximity of intercostal artery and vein
  • risk of iv LA injection
  • pneumothorax (underlying pleura)
171
Q

Intercostal block (peripheral block of the trunk) needle size and gauge:

A

22-25g

short - 3-4cm needle

172
Q

following aspiration of an Intercostal block (peripheral block of the trunk), what should you see in your syringe?

A

nothing!

173
Q

TAP Block is :

A

transversus abdominis plane block

-peripheral block of the trunk

174
Q

Main use of TAP blocks?

A

analgesia

175
Q

**indications for TAP block:

A
  • *C/Section
  • hernia
  • appendectomy
  • abdominal hysterectomy
  • prostatectomy
176
Q

TAP blocks can be given bilaterally for: (2)

A
  1. midline incisions

2. laparoscopic procedures

177
Q

TAP Blocks can be used for post-op analgesia for procedures below

A

the umblilicus

178
Q

**What are the nerves targeted in the TAP Block?

A
  1. Subcostal -T12
  2. Ilioinguinal -L1
  3. Iliohypogastric - L1
179
Q

**For a TAP Block, the goal is to inject LA b/w the internal oblique and transversus abdominis muscle targeting the :

A

spinal nervers in T7-L1

180
Q

TAP blocks can provide intra-op and post op analgesia for up to

A

36hrs

181
Q

**3 planes are identified in a TAP block:

A
  1. Transversus Abdominis (LA injection site)
  2. Internal oblique
  3. External Oblique

“TAP: TIE”

182
Q

on u/s, muscles appear as striated _____ structures with ____ layers of fascia at their borders.

A

Striated: hypoechoic (darker)

Hyperechoic (brighter) layers

183
Q

needle size and gauge for TAP block

A

long, 10cm

21 G

184
Q

volume of LA injected for a TAP block

A

20-30mL

185
Q

On LA injection during a TAP block, what is observed on US?

A

separation of the 2 fascial layers – LA vol should expand the plane

186
Q

Normal PT, INR, PTT levels

A

PT 11-14
PTT 25-35
INR 0.8-1.2 (<1.5 INR OK)

187
Q

For a skin wheal what % and amount of lidocaine is used?

A

1% and 3mL

188
Q

**Cervical plexus is innervated by 4 cutaneous branches - what are they?

A

C2-C4

  1. C2 Lesser occipital and
  2. C2 Great Auricular
  3. C3 Transverse Cervical
  4. C4 Supraclavicular
189
Q

When do you want to use a Retrobulbar block?

A

When you do not want the eye to move

190
Q

Before you push meds/LA, what do you do?

A

ASPIRATE

191
Q

With the pt supine and looking up (@ ceiling) what needle size and gauge would you use for a retrobulbar block?

A

25-27 gauge

-inserted 0.75 - 1.25 inch

192
Q

after negative aspiration, how much LA would you inject for a RB. Block?

A

2-4ml

193
Q

**what nerve supplies the airway mucosa from the level of the epiglottis to the distal airways?

A

vagus nerve

194
Q

**What nerve, a branch of the superior laryngeal nerve, supplies the larynx above the vocal cords and the lower part of the pharynx?

A

• The internal laryngeal

195
Q

**what provides motor innervation to the cricothyroid muscle?

A

• The external laryngeal branch

196
Q

**what nerve supplies the larynx below the vocal folds and the upper part of the esophagus?

A

• The recurrent laryngeal nerve

197
Q

**what nerve is primarily parasympathetic but also contains some cervical sympathetic fibers and motor fibers to the laryngeal muscles?

A

• The Vagus nerve

198
Q

When performing a SLN block what size needle is appropriate?

A

25g

199
Q

**When performing a SLN block how would you know if you are TOO deep?

A

when you aspirate before injection and get AIR

AIR = Too deep

200
Q

How much 1% lidocaine is deposited in a SLN Block?

Where? (there are two locations)

A
  • 2ml within the Thyrohyoid membrane (below/ internal)

- 1-3ml as you withdrawal needle above

201
Q

analgesia of the globe generally precedes:

A

akinesia of the eye muscles

202
Q

Translaryngeal (Trans-tracheal) block is also known as:

A

recurrent nerve block

-provides anesthesia of the airway mucosa below the cords and laryngeal mucosa above the vocal cords and epiglottis

203
Q

what sized needle is inserted in the midline into CTM, aspirating as needle advanced. (slightly caudal) in a RLN block?

A

22 ga or 25 ga

204
Q

***before 3-4 mL of 4% lidocaine is injected rapidly at end of expiration and the needle withdraw for a RLN Block, what must be done?

A

Once AIR is freely aspirated

205
Q

Most common complication of an ocular block?

A

intra-arterial injection: LA toxicity

206
Q

Oculocardiac reflex afferent and efferent responses:

A
  • afferent = via the ophthalmic branch of cranial nerve V (trigeminal nerve)
  • efferent = via cranial nerve X (vagus nerve)
  • leads to severe bradycardia and potentially hypotension, atrioventricular block, ventricular ectopy, and rarely asystole

SUM'20 - Regional (17 decks)

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