25 Trunk blocks Flashcards
(28 cards)
Quais os 4 ramos dos nervos intercostais?
- Cinza comunicante - anterior ao gânglio simpatico
- Cutaneo posterior - pele e musculo na area paravertebral
- Cutaneo lateral - anterior a linha axilar media e envia ramos subcutâneos anterior e posteriormente
- Cutaneo anterior - terminacao do nervo
The intercostal nerves are the primary rami of T1 through T11.
T12 is technically the ___1___, and it can communicate with the iliohypogastric and ilioinguinal nerves. Fibers from T1 contribute to the ___2___; T2 and T3 provide a few fibers to the formation of the ___3___, which supplies the skin of the medial aspect of the upper arm.
- subcostal nerve
- brachial plexus
- intercostobrachial nerve
Few surgical procedures can be performed with an inter-costal block alone, and the application of these blocks in combination with other techniques has largely been sup- planted by ___1___.
- epidural blockade
Although surgical applica- tions are possible, the majority of indications are for post- operative analgesia. Intercostal blocks provide a viable alternative to epidural and paravertebral blocks, with a similar safety and efficacy profile.
Como é o posicionamento do paciente para o bloqueio de nervos intercostais?
Prono
(B) The index finger displaces the skin up over the rib. The needle is inserted at the tip of the finger and rests on the rib. The needle is walked off the lower rib edge and inserted 3 to 5 mm.
(C) An intercostal nerve and its branches.
The risk of systemic local anesthetic toxicity is present with multiple intercostal blocks because of the large vol- umes and rapid systemic absorption of the solutions. Use of ___1___ has been shown to decrease blood levels.
epinephrine
Four peripheral nerves primarily innervate the lower abdominal wall: (4)
- subcostal,
- ilioinguinal,
- iliohypogastric,
- genitofemoral
Posicionamento no TAP block
Onde é a injecao no TAP block?
- Fascia que separa os mm. OI e o TA
Injection is in the fascial layer that separates the inter- nal oblique and the transversus abdominis muscles. Direct visualization and proximity to the nerves is not critical if 15 to 20 mL of dilute local anesthetic is injected in this layer.
The respiratory motion of the peritoneal cavity and influence of muscle contraction makes general anesthesia an appealing option for performing this block. The transversus abdominis muscle is relatively thin; there- fore careful placement of the needle tip is necessary.
The ilioinguinal and iliohypogastric nerves arise from ___1___. They pierce the ___2___ muscle cephalad and medial to the anterior superior iliac spine to lie between the ___3___ and the ___4___.
After traveling a short distance caudally and medially, their ventral rami pierce the ___5___ before giving off branches, which then pierce the ___6___ and provide sensory fibers to the skin.
- the first lumbar spinal root
- transversus abdominis muscle
- transversus abdominis
- internal oblique muscles
- internal oblique muscle
- external oblique
The ___7___ nerve courses anteriorly and inferiorly to the inguinal ring, where it exits to supply the skin on the proximal, medial portion of the thigh. The ___8___ nerve supplies the skin of the inguinal region.
- ilioinguinal nerve
- ilio-hypogastric
Ilioinguinal and iliohypogastric blocks are used for analge- sia following ___1___ and for lower abdominal procedures utilizing a ___2___.
- inguinal hernia repair
- Pfannenstiel incision.
ILIOINGUINAL AND ILIOHYPOGASTRIC NERVE BLOCKS
These blocks can be performed using a loss-of-resistance technique. The local anesthetic should be injected between the ___1___ and between the ___2___.
- transversus abdominis and the internal oblique
- internal and external oblique muscles
Qual o bloqueio conforme a figura?
Quadrado Lombar
Identificar as estruturas conforme a imagem do bloqueio
Quais as diferenças praticas entre as opções de agulhamento do Quadrado Lombar?
- fraqueza na perna devido a dispersão para o plexo lombar
Qual o bloqueio conforme a figura?
TAP Block
- Mais seguro que o Quadrado Lombar
Identificar as estruturas conforme a imagem do TAP block
- Atentar para a imagem dos planos musculares se dividindo
Quais regiões afetadas pelo bloqueio TAP Block
Todos devem ser feitos bilateralmente, a nao ser que seja incisão de um lado, como numa reabordagem de colostomia)
- Subcostal: hernia incisional alta
- Anterior: analgesia supra-umbilical
- Lateral: incisao infra-umbilical (cesariana)
Qual o bloqueio conforme a figura?
Eretor da espinha
- coloca a imagem no centro e vai deslizando ate ver o processo transverso
- pode ser sentado ou em decubito lateral
Identificar as estruturas conforme a imagem do bloqueio Eretor da Espinha em T4
- Em T8 nao aparece o musculo romboide
- Mais seguro que o paravertebral
Quais regiões afetadas pelo bloqueio do Eretor da Espinha?
- Dermátomo e Osso também
Complicacoes do bloqueio Eretor da Espinha
Qual o bloqueio conforme a figura?
PECS
- USG em 45 graus
