Truncal blocks 2

Question 1

Advantages of a thoracic paravertebral block include the ability to: (select 2)
a. produce unilateral epidural anesthesia
b. achieve segmental blockade
c. provide spinal anesthesia
d. eliminate the risk of LAST

Answer 1

a. produce unilateral epidural anesthesia
b. achieve segmental blockade

Question 2

The objective of the paravertebral block is to

Answer 2

target the spinal nerves as they exit the vertebral foramen

Question 3

The paravertebral block can be thought of as

Answer 3

a “unilateral epidural”

Question 4

Indications for the paravertebral block include

Answer 4

segmental anesthesia or pain management of surgical procedures of the chest and abdomen when a neuraxial technique is contraindicated or refused

Question 5

Unlike the intercostal blocks, the paravertebral block

Answer 5

anesthetizes multiple dermatomal levels, reducing the number of injections reuqired

Question 6

For the paravertebral block, you can achieve bilateral blockade by

Answer 6

using a larger volume of local anesthetic

Question 7

Complications of the paravertebral block include

Answer 7

LAST, pneumothorax, intrathecal injection, & post-dural puncture headache

Question 8

List the borders of the paravertebral space

Answer 8

anterior–> parietal pleura
medial–> vertebral body and intravertebral foramen
posterior–> transvers process and superior costotransverse ligament

Question 9

The paravertebral block can be used for the following surgical procedures:

Answer 9

thoracic
breast
cholecystectomy
herniorraphy
appendectomy

Question 10

The paravertebral block can be used for pain management of

Answer 10

rib fractures
flail chest
blunt abdominal trauma
osteoporotic vertebral fractures
herpes zoster

Question 11

You can perform the PVB block at any level (thoracic or lumbar), however the _________ approach may be difficult due to ________–

Answer 11

lumbar; increased depth of the PVS

Question 12

What is the hemodynamic status of patients who get a PVB?

Answer 12

although sympathetic nerves are blocked, there’s less hemodynamic instability vs. neuraxial anesthesia

Question 13

The PVS also contains the ________________ which increases the risk of LAST

Answer 13

intercostal vessels

Question 14

Select the BEST regional anesthesia techniques that provide analgesia to a patient with rib fractures. (Select 3)
a. intercostal
b. transverse abdominus plane
c. iPACK
d. erector spinae
e. paravertebral
f. fascia iliaca

Answer 14

a. intercostal
d. erector spinae
e. paravertebral

Question 15

What is the objective of the erector spinae block?

Answer 15

fascial plane technique that targets the dorsal and ventral rami of the thoracolumbar nerves at the level of injection

Question 16

What are indications for the erector spinae block?

Answer 16

neuropathic pain
rib fractures
lumbar spine surgery
thoracic surgery
cardiac surgery
breast surgery
bariatric surgery
& numerous abdominal procedures

Question 17

What are complications of the erector spinae block?

Answer 17

pneumothorax, LAST

Question 18

The erector spinae consists of three paired muscles that extend from the sacrum to the skull base:

Answer 18

iliocostalis
longissimus
spinalis
(I Like Standing)

Question 19

What contributes to a failed ESP block?

Answer 19

at the lumbar level, the facet joints align with the transverse processes which makes it easy to mistake the facet joint for the transverse process

Question 20

Bilateral injections are required for an ESP block for

Answer 20

midline or transverse procedures

Question 21

A single injection for the ESP block at the thoracic level covers approximately

Answer 21

8-11 dermatome levels

Question 22

A single injection at the lumbar level for the ESP block covers approximately

Answer 22

3-4 dermatome levels

Question 23

When performing a thoracic ESB, the trapezius muscle is often

Answer 23

superficial to the erector spinae muscles

Question 24

The objective of the TAP block is to anesthetize the

Answer 24

thoracolumbar nerves as they travel in the fascial plane between the internal oblique and transversus abdominus muscles

Question 25

Indications for a TAP block include

Answer 25

procedures on the abdomen

Question 26

What are the TAP block approaches?

Answer 26

subcostal approach
lateral approach
posterior approach

Question 27

Where on the abdomen do the three approaches cover?

Answer 27

subcostal approach- procedures above the umbilicus
lateral & posterior approach–> procedures below the umbilicus

Question 28

Complications of the TAP block include

Answer 28

LAST, peritoneal injury

Question 29

What are the four paired muscles that form the anterolateral abdominal wall?

Answer 29

rectus abdominis
transverse abdominis
external oblique
internal oblique

Question 30

What is the triangle of Petit?

Answer 30

it is the inferior lumbar triangle and it provides a key anatomic reference point for performing a TAP block with a landmark technique

Question 31

What is the posterior border of the lumbar triangle?

Answer 31

latissimus dorsi

Question 32

What is the anterior border of the lumbar triangle?

Answer 32

external oblique

Question 33

What is the inferior border of the lumbar triangle?

Answer 33

iliac crest

Question 34

What is the inside of the triangle of the lumbar triangle?

Answer 34

internal oblique

Question 35

The thoracolumbar nerves arise from __________-

Answer 35

T6 to L1 to innervate the IO & TA muscles

Question 36

Indications for TAP block includes

Answer 36

hernia repair, open appendectomy, laparoscopic abdominal procedures, radical prostatectomy, gynecologic surgeries, and C-sections

Question 37

The TAP block provides analgesia to the

Answer 37

abdominal wall (skin & muscle) and the parietal peritoneum

Question 38

What kind of needles are better for TAP blocks?

Answer 38

blunt tip needles because the y increase tactile feel and reduce the risk of visceral injury

Question 39

With the TAP block to ensure the lateral cutaneous branches of the thoracolumbar nerves are blocked, guide the needle

Answer 39

tip to the midaxillary line

Question 40

Describe the landmark technique of the TAP block.

Answer 40

identify the anterior superior iliac spine and follow the iliac crest posteriorly to the point where it moves slightly inward
advance the needle over the crest until you feel a pop, this is inside the triangle of petit and means the needle is between the IO & TA

Question 41

Factors that contribute to LAST with a TAP block include:

Answer 41

a large volume of LA at each site
accidental intravascular injection into a thoracic intercostal artery or deep circumflex iliac artery
increased rate of LA absorption due to the compact area of the fascia