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apex review > Truncal blocks > Flashcards

Truncal blocks Flashcards

1
Q

A pectoralis 2 nerve block targets the fascial plane between the:
a. pectoralis major and pectoralis minor muscles
b. medial pectoralis and lateral pectoralis nerves
c. pectoralis minor and serratus anterior muscles
d. serratus anterior and latissimus dorsi muscles

A

a. pec major & pec minor & c. pec minor and serratus anterior muscles

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2
Q

What is the objective of the serratus anterior plane block.

A

targets the axillary region (not the chest)

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3
Q

What is the objective of the PECS 1 & PECS 2 block?

A

Pecs blocks are interfascial plane blocks that provide anesthesia and/or analgesia to the anterior chest wall without the risks of paravertebral or intercostal blockade

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4
Q

Indications for performing the PECs blocks include

A

breast surgery, thoracotomy, and insertion of a port-a-cath, AICD, or subpectoral prosthesis

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5
Q

Indications for performing the serratus anterior block is

A

breast reconstruction with latissimus dorsi flap

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6
Q

The local anesthetic volume for the PECS 1 block is

A

10-15 mL

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7
Q

The local anesthetic volume for the PECS 2 block is

A

10-15 mL

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8
Q

The local anesthetic volume for the serratus anterior block is

A

20 mL

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9
Q

Complications of the pecs 1 & pecs 2 blocks include

A

failure to appreciate the thoracoacromial artery may lead to inadvertent puncture, vessel injury, hematoma, and LAST

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10
Q

Key nerves that innervate the chest include

A

thoracic intercostal nerve
lateral pectoral nerve
medial pectoral nerve
long thoracic nerve
thoracodorsal nerve

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11
Q

The origin of the thoracic intercostal nerve is the

A

ventral rami of spinal nerves (T1-T6)

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12
Q

The regions innervated by the thoracic intercostal nerve include

A

the intercostal muscles
cutaneous regions of the chest & breast

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13
Q

The origin of the lateral pectoral nerve is the

A

brachial plexus (C5-C7)

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14
Q

The regions innervated by the lateral pectoral nerve include

A

pectoralis major

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15
Q

The origin of the medial pectoral nerve is the

A

brachial plexus (C8-T1)

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16
Q

The regions innervated by the medial pectoral nerve include

A

pectoralis minor
lower region of pectoralis major

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17
Q

The origin of the long thoracic nerve is the

A

brachial plexus (C5-C7)

18
Q

The regions innervated by the long thoracic nerve include

A

the chest wall superficial to the serratus anterior

19
Q

The origin of the thoracodorsal nerve is the

A

brachial plexus (C6-C8)

20
Q

The regions innervated by the thoracodorsal nerve include the

A

latissimus dorsi

21
Q

The serratus anterior plane block affords greater coverage of the

A

intercostal nerves of the axillary region (it does not cover the medial chest)

22
Q

What are the nerves anesthetized with the PECS 1 block?

A

medial pectoral
lateral pectoral

23
Q

What is the injection site of the PECs 1 block?

A

fascial plane between the pec major and pec minor

24
Q

What is the injection site of the PECS 2 block?

A

fascial plane between the pec major & pec minor & fascial plane between the pec minor & serratus anterior

25
Q

What are the nerves anesthetized in the PECS 2 block?

A

medial pectoral
lateral pectoral
thoracic intercostals
long thoracic

26
Q

Why is a PECS 2 block indicated?

A

everything covered by PECS 1 & also require analgesia of the axilla such as mastectomy, sentinel node biopsy, tumor resection

27
Q

What is the site of injection of the serratus anterior block?

A

fascial plane between the latissimus dorsi & serratus anterior

28
Q

What nerves are anesthetized with the serratus anterior block?

A

thoracic intercostals (increased coverage vs. PECs 2)
long thoracic
thoracodorsal

29
Q

The recommended maximal local anesthetic dose for PECs blocks is

A

0.2 mg/kg

30
Q

The recommended maximum dose for SAP blocks is

A

0.4 mg/kg

31
Q

PECS blocks & SAP blocks may result in ____________ due to the proximity of the needle

A

pneumothorax; to the pleural space

32
Q

Benefits of an intercostal nerve blockade include: (select 2)
a. multi-level coverage after a single injection
b. decreased risk of opioid-induced respiratory depression
c. hemodynamic stability
d. low risk of local anesthetic toxicity

A

b. decreased risk of opioid-induced respiratory depression
c. hemodynamic stability

33
Q

What is the objective of an intercostal nerve block?

A

provide motor and sensory anesthesia of the trunk from the xiphoid to the pubis (single dermatome level)

34
Q

Indications of an intercostal nerve block include

A

acute and chronic pain syndromes of the chest and upper abdomen, including rib fractures, herpes zoster, cholecystectomy, and chest tube insertion

35
Q

Select complications of an intercostal nerve block include

A

pneumothorax, LAST

36
Q

The local anesthetic volume needed for an intercostal nerve block is

A

3-5 mL per dermatome level

37
Q

The intercostal nerves originate from the

A

ventral rami of the thoracic spinal nerves (T1-T11)

38
Q

The risk of LAST with an intercostal nerve block is increased because

A

the rapid rate of local anesthetic uptake due to high vascularity

39
Q

Respiratory insufficiency may occur in patients with

A

severe COPD who depend on their intercostal muscles for ventilation

40
Q

Blocking ______________ can be difficult due to the thickness of the paraspinal muscles and proximity of the scapula

A

T1-T5; you should use a paravertebral block instead

41
Q

Describe the landmark technique for an intercostal block

A

place patient in sitting, lateral or prone position
locate the site using the sharp posterior angulation of the rib and slide laterally to the lateral border of the sacrospinalis muscle
advance needle until it hits bone and slowly walk off

apex review (224 decks)

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