5. Performing Brachial Plexus Blocks

Question 1

interscalene block needle insertion no u/s

Answer 1

interscalene groove at level of cricoid (C6)

Question 2

interscalene block head positioning

Answer 2

30 degree to contralateral side

Question 3

interscalene block probe placement

Answer 3

parallel to clavicle
over the lateral head of the sternocleidomastoid
at level of cricoid/thyroid cartilage

Question 4

where does the brachial plexus lie in the interscalene block

Answer 4

in the interscalene groove

Question 5

what direction is the needle inserted for interscalene block?

Answer 5

lateral to medial
in-plane approach

Question 6

landmark for supraclavicular block

Answer 6

subclavian artery

Question 7

probe placement for supraclavicular block

Answer 7

in the supraclavicular fossa
parallel to the superior border of the clavicle
angle toward thorax

Question 8

what is pulsatile in supraclavicular block

Answer 8

subclavian rtery

Question 9

where is the brachial plexus in relation to the subclavian artery for supraclavicular approach

Answer 9

lateral

Question 10

what moves when the pt is breathing in supraclav block

Answer 10

pleura

Question 11

what should you avoid in supraclav block

Answer 11

subclavian artery injection
going below rib

Question 12

where should you inject in supraclav block

Answer 12

lateral to subclavian artery
superior to first rib

Question 13

how much do you inject supraclav

Answer 13

20-30 mL

Question 14

probe placement infraclav block

Answer 14

perpendicular to clavicle
medial to coracoid process

Question 15

landmarks infraclav

Answer 15

axillary artery
axillary vein

Question 16

needle insertion point infraclav

Answer 16

inferior to clavicle
in plane from cephalad aspect

Question 17

what is the needle inserted through for infraclav?

Answer 17

pectoralis major
pectoralis minor

Question 18

which block requires a more steep needle angle

Answer 18

infraclav

Question 19

where do you inject LA in infraclav

Answer 19

U-shape around the axillary artery because its difficult to identify all 3 cords

Question 20

which block has highest risk of pneumothorax

Answer 20

supraclav

Question 21

which block has highest incidence of phrenic nerve palsy

Answer 21

supraclav

Question 22

which block is best with indwelling catheter

Answer 22

infraclav due to pectoralis stabilization

Question 23

why is supraclav difficult in obese pts?

Answer 23

supraclavicular fat pads

Question 24

why is infraclav difficult in obese pts?

Answer 24

deeper nerves

Question 25

which block is best for COPD?

Answer 25

infraclav

Question 26

which block has fastest onset?

Answer 26

infraclav

Question 27

which block has best visualization

Answer 27

supraclav (more superficial)

Question 28

which block has worse visualization

Answer 28

infraclav (deeper)

Question 29

which block has higher risk of hematoma with accidental vascular puncture?

Answer 29

infraclav (difficult to apply pressure)

Question 30

landmark for axillary block

Answer 30

axillary pulse

Question 31

axillary pulse location

Answer 31

between biceps/coracobrachialis and triceps muscle

Question 32

axillary block pt positioning

Answer 32

supine with arm abducted 90 degrees head turned toward contralateral side

Question 33

median nerve location

Answer 33

median n is superior to pulse

Question 34

ulnar nerve location

Answer 34

inferior above the pulse

Question 35

radial nerve location

Answer 35

inferior-posterior just behind pulse

Question 36

neurovascular bundle

Answer 36

median, radial, ulnar arteries that lie around the axillary artery

Question 37

which nerve lies outside the neurovascular bundle

Answer 37

musculocutaneous

Question 38

musculocutaneous location

Answer 38

between biceps and coracobrachialis

Question 39

which nerve do you need u/s for in axillary block

Answer 39

musculocutaneous nerve

Question 40

transarterial axillary needle ga

Answer 40

22 ga

Question 41

transarterial volume

Answer 41

30-40 mL

Question 42

trasarterial axillary injection location

Answer 42

posteriorly or anteriorly

Question 43

why is an u/s good for axillary blcok

Answer 43

decr volume of LA musculocutaneous can be done

Question 44

probe placement axillary block

Answer 44

immediately distal to point where pectoralis major inserts onto humerus

Question 45

landmarks axillary

Answer 45

radial, ulnar, median nerves around axillary artery musculocutaneous nerve between biceps and coracobrachialis

Question 46

where do you inject for axillary

Answer 46

injection around each nerve

Question 47

axillary volume

Answer 47

5-7mL per injection == 20 mL total

Question 48

which nerve do you inject first

Answer 48

radial nerve

Question 49

why do you inject that nerve first?

Answer 49

to avoid displacing structures deepeer, inject posterior to the artery first

Question 50

which nerve is posterior to axillary artery?

Answer 50

radial nerve

Question 51

axillary block advantage

Answer 51

lower complication rate

Question 52

axillary block disadvantag

Answer 52

higher LAST risk does not block axillary nerve reqs extra injection for musculocutaneous nerve