Truncal blocks 3

Question 1

When performing a rectus sheath block, the needle is inserted into the fascial plane between the (select 2):
a. external oblique muscle
b. anterior rectus sheath
c. rectus abdominis muscle
d. posterior rectus sheath

Answer 1

c. rectus abdominis muscle
d. posterior rectus sheath

Question 2

What is the objective of a rectus sheath block?

Answer 2

a fascial plane block that targets the thoracolumbar nerves and the anterior cutaneous branches as they travel in the fascial plane between the rectus abdominis muscle and posterior rectus sheath

Question 3

What are indications for a rectus sheath block?

Answer 3

procedures with a midline abdominal incision (umbilical hernia repair)

Question 4

What arteries travel within the rectus sheath that could potentially lead to a LAST event?

Answer 4

inferior epigastric arteries

Question 5

________- is a thickened region of the anterior rectus sheath that extends vertically from the xiphoid process to the pubic symphysis.

Answer 5

Linea alba

Question 6

The _________- runs vertically along the lateral edges of the rectus abdominis.

Answer 6

linea semilunaris

Question 7

___________– runs horizontally across the rectus abdominis

Answer 7

Tendinous intersections

Question 8

With a rectus sheath block, the posterior rectus sheath is ______________________- below the level of the umbilicus and may ____________

Answer 8

absent (or very thin); and may not be appreciated

Question 9

Match each quadratus lumborum block with its target area for depositing local anesthetic.
QL 1, QL2, QL 3
lateral to the quadratus lumborum muscle
anterior to the quadratus lumborum muscle
posterior to the quadratus lumborum muscle

Answer 9

QL 1- lateral to the quadratus lumborum muscle
QL 2- posterior to the quadratus lumborum muscle
QL 3- anterior to the quadratus lumborum muscle

Question 10

What is the objective of the QL block?

Answer 10

quadratus lumborum muscle is a key anatomic landmark and the thoracolumbar fascia is the target area for depositing local anesthetic

Question 11

Indications for the QL block include

Answer 11

analgesia for procedures of the anterolateral abdominal wall

Question 12

Implications of the QL block include

Answer 12

inadvertent peritoneal puncture & visceral injury (kidney, liver, and spleen)

Question 13

The thoracolumbar fascia consists of 3 layers:

Answer 13

anterior, middle & posterior

Question 14

The quadratus lumborum muscle resides between the

Answer 14

anterior to the middle layers of the thoracolumbar fascia

Question 15

The QL 1 block provides coverage for

Answer 15

abdominal surgery below the umbilicus

Question 16

The QL 2 & 3 provides coverage for

Answer 16

abdominal surgery below or above the umbilicus (up to T6)

Question 17

QL blocks require

Answer 17

ultrasound

Question 18

Which QL block looks for the shamrock sign under ultrasound

Answer 18

QL 3

Question 19

The shamrock sign is made up of

Answer 19

The stem of the shamrock is formed by the L4 transverse process. The three leaves of the clover include the erector spinae muscle group, QL muscle, and psoas muscle