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EDAIC Online course (BCSAC 2021) > Regional Anaesthesia > Flashcards

Regional Anaesthesia Flashcards

1
Q

Nerve anatomy ?

A
  1. Neurons contain cell bodies, dendrites and axons
  2. Endoneurium is a connective tissue enveloping individual nerve fibres
  3. Perineurium cover fascicles formed by a bundle of nerve fibres.
  4. Epineurium covers bundles of perineurium
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2
Q

Neurons ?

A
  1. Contain positive and negative charges
  2. The inside of the cell is negative (-90mV)
  3. Depolarization results in intracellular charge becoming more positive
  4. Sodium channels open to allow influx
  5. Threshold is at +35mV
  6. For every 3Na efflux, 2K influx
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3
Q

Neurons, action potential ?

A

Read from book

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4
Q

Dynamics of Local anaesthetics ?

A
  1. LA in their ionised form bind to sodium channels and prevent sodium entering the nerve cell
  2. Thus action potential is blocked and no sensory information is sent to the brain
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5
Q

Types of nerve fibres ? See pictures

A
  1. A-Alpha: Myelinated / Motor - Efferent to skeletal muscles
  2. A-Beta: Myelinated / Touch, pressure & proprioception - Afferent from skin.
  3. A-Gamma: Myelinated / Motor - Efferent to muscle spindles.
  4. A-Delta: Pain (sharp + Fast) & temperature - Efferent from skin
  5. B-type: Myelinated / Preganglionic sympathetic - Efferent to vascular smooth muscles
  6. C-type: Unmyelinated / Pain (dull + slow) and temperature - Afferent from skin / Postganglionic sympathetic - Efferent to vascular smooth muscle.
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6
Q

Order of blockade and recovery of nerve fibres?

A

B fibres > C fibres = A-delta > A-gamma > A-beta > A-Alpha

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7
Q

Stages of blockade?

A
  1. Vasomotor block, dilation of skin vessels and increased cutaneous flow
  2. Blockade of cold sensation
  3. Sensation f warmth by patient
  4. Temperature discrimination lost
  5. Slow and fast pain lost
  6. Pessure sense abolished
  7. Loss of proprioception
  8. Motor paralysis
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8
Q

Anatomy of the vertebrae ?

A
  1. Consists of pedicle, transverse process, superior/ inferior articular processes and spinous process
  2. Each vertebrae connected to eachother by intervertebral discs
  3. There are two superior and inferior articular processes (facet joints)
  4. Pedicles contain a notch superiorly and inferiorly to allow spinal nerve to root to exit the vertebral column.
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9
Q

Spinal cord?

A
  1. End at L1/L2 in adults

2. Ends at L3 in infants

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10
Q

Blood supply of the spinal cord?

A
  1. Anterior spinal artery (x1)- Formed by vertebral arteries at the base of the skull. Supplies 2/3 of the anterior spinal cord.
  2. Posterior spinal arteries (x2) - Formed by posterior cerebellar arteries - Travels down the dorsal surface of the spinal cord medial to the dorsal nerve root. Supplies 1/3 of the posterior spinal cord
  3. Additional blood flow is provided to the anterior and posterior spinal arteries from intercostal and lumbar arteries.
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11
Q

Artery of Adamkiewicz?

A
  1. Radicular artery arising from the aorta. It is large and unilateral on the left side
  2. Supplies the lower anterior 2/3 of the spinal cord.
  3. Supplies 68% of perfusion to the lower thorax and upper lumbar areas.
  4. Injury results in anterior spinal artery syndrome.
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12
Q

CSF ?

A
  1. Fills subarachnoid space
  2. Total volume 150ml
  3. About 25-35ml present in the subarachnoid space
  4. Produced at a rate of 450mls / 24 hours
  5. Specific gravity is between 1.003 & 1.009
  6. Produced by the choroid plexus
  7. Absorbed into the dural venous sinuses via arachnoid villi
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13
Q

Boundaries of the Epidural space?

A
  1. Extends from the foramen magnum to the sacral hiatus
  2. Anterior boundary: Posterior longitudinal ligament
  3. Lateral boundries: Pedicles and intervertebral ligaments
  4. Posteriorly: Ligamentum flavum
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14
Q

Brachial plexus? See picture

A
  1. Contribution from C4-T2

2. Divided into; Roots, trunks, divisions, cords and branches

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15
Q

Brachial plexus location?

A
  1. Brachial plexus and subclavian artery lie on top of the first rib
  2. Brachial plexus is located lateral and posterior to the subclavian artery
  3. Subclavian vein and anterior scalene muscle are found medial to the subclavian artery
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16
Q

Sciatic nerve ?

A
  1. Arises from L4/L5 & S1-S3
  2. Sensory and motor innervation to the LL
  3. Exits the pelvis via the greater sciatic foramen below the piriformis muscle
  4. Nerve is deep and anterior to the gluteus maximus and superficial - posterior to the inner muscle layer
  5. Course down the midline of the posterior thigh and branches into tibial and common peroneal nerves
17
Q

Oburator nerve ?

A
  1. Originates from L2-L4
  2. Descends towards the pelvis from the medial border of the psoas major muscle.
  3. Passes through the obturator foramen. The obturator nerve enters the medial aspect of the thigh
  4. Divides into anterior branch between adductor longus and brevis muscle and a posterior branch between the adductor brevis and magnus muscles.
  5. Posterior branch gives off an articular branch to the knee joint.
18
Q

Lateral cutaneous femoral nerve?

A
  1. Arises from the dorsal divison of L2/L3
  2. Arises from the lateral border of psoas major muscle - Courses inferiorly and laterally towards the anterior superior illiac spine.
  3. It passes under the inguinal ligament and over the sartorius muscle into the thigh where it divides into an anterior and posterior branch.
  4. Provides sensory innervation to the lateral thigh
19
Q

Ilioinguinal / iliohypogastric nerve?

A
  1. Both arise from L1
  2. Arise from the upper part of the lateral border fo the psoas major muscle
  3. Ilioingluinal nerve is small and courses caudad to the iliohypogastric nerve.
  4. Both nerves cross obliquely anterior to the quadratus lumborum and iliacus muscles and perforate the transversus abdominis near the anterior part of the illiac crest.
  5. In the anterior abdominal trunk, it travels between the transversus abdominis and the internal oblique.
20
Q

Psoas compartment block?

A
  1. Lumbar plexus is formed by the anterior division of L1-L4
  2. The L1 root often receives a branch from T12
  3. it is located in the posterior 1/3 of the psoas major muscle, anterior to the transverse processes of the lumbar vertebrae.
  4. The adult lumbar plexus lies deep within the psoas major muscle.
  5. Not visualised using ultrasound
21
Q

TAP block ?

A
  1. Anterior abdominal wall innervated by the anterior rami of the lower 6 thoracic nerve (T7-T12) and L1.
  2. Terminal branches courses between the IOM and TAM
  3. Provides unilateral analgesia to the skin, muscle and pareital peritonium.
22
Q

Terminal branch - C5

A

Dorsal scapular nerve

23
Q

Terminal branch C5 - C8

A

Longus colli & scelene muscle

24
Q

Terminal branch C5 - C7

A
  • Lateral pectoral nerve
  • Musculocutaneous nerve
  • Long thoracic nerve
25
Q

Terminal branch C5 - C6

A
  • Suprascapular
  • subclavius
  • Axillary nerve
26
Q

Terminal branch C5 - T1

A
  • Radial nerve

- Median nerve

27
Q

Terminal branch C7 - T1

A

Ulnar nerve

EDAIC Online course (BCSAC 2021) (35 decks)

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