Blocks/ Epidurals/ Pain Management Flashcards

Question

# Blocks/ Epidurals/ Pain Management What is local anesthesia CNS toxicity?

Answer 1

Can occur d/t accidental injection into blood vessel or overdose

Answer 2

Lightheadedness Tinnitus ****Circumoral numbness**** Metallic taste in mouth Slurred speech Muscle twitching Can progress to grand mal seizures and coma** | Compare these symptoms vs. symptoms of MH

Answer 3

! Apply oxygen at first signs. May administer versed, valium, or thiopental for seizure activity | Why versed, valium or thopental?

Answer 4

1. Early detection 2. Support circulation with fluids, vasopressors, antiarrhythmics 3. Oxygen, airway management 4. Control seizure activity

Answer 5

CPR/ ACLS if necessary Lipid infusion * 20% lipid emulsion for reversal of toxicity * IV Push - 1.5mL/kg over 1 minute * Infusion - 0.25mL/kg/min * Max dose 12mL/kg | Note that lipid infusion is weight based

Answer 6

Lipid emulsion binds to local anesthetic molecules which reduces the circulating amount of anesthetic that can bind to cardiovascular system. ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:321-322.

Answer 7

**most common with Bupivacaine** d/t blocking of sodium channels in the heart s/s includes hypertension leading to hypotension, PVCs, prolonged PR interval, CV collapse

Answer 8

Topical anesthesia Field block/ local infiltration IV injection Peripheral nerve block Sympathetic nerve blocks Neuraxial blocks (spinal, epidural)

Answer 9

Topical - Applied directly to Skin, Mucus Membranes, Urethra, Nose, Pharynx Local Infiltration - Direct tissue injection, Blocks transmission of sensory impulses, Epinephrine can be injected into confined spaces

Answer 10

unaided **head lift** sustained while supine and strong **hand grips**, indicate approximately 50% of neuromuscular receptors returned to baseline ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:306.

Answer 11

Never use Bupivacaine for Bier Block ! d/t can cause cardiovascular collapse Tourniquet applied to occlude circulation of arm or leg Large doses of local anesthetic injected and stays in area d/t tourniquet Risk of toxicity when tourniquet released d/t anesthetic can travel to systemic circulation Common application: ganglion cyst removal, carpal tunnel release, tendon release

Answer 12

a. cardiovascular depression

Answer 13

Anesthetic injected to specific site to block conduction of nerve impulses

Answer 14

1. Cervical plexus – common for carotid endarterectomy 2. Brachial plexus – 4 approaches Interscalene for shoulder surgery Supraclavicular Axillary Infraclavicular 3. Intercoastal block

Answer 15

Used to block areas around neck Commonly used for **carotid endarterectomy**, superficial neck procedures

Answer 16

Complications: Injury to vertebral artery Paralysis of diaphragm d/t phrenic nerve block Hoarseness for laryngeal nerve block Inadvertent subarachnoid or epidural block

Answer 17

Blocks arm from shoulder down (usually upper extremity surgery)

Answer 18

Interscalene Supraventricular Axillary Infraclavicular

Answer 19

**Horner syndrome** (hoarseness of voice, ptosis, miosis-constriction of pupil, decreased sweating, nasal congestion on the affected side) d/t blockade of stellage ganglion Unilateral phrenic + laryngeal nerve block Vertebral artery injection Possible high spinal or epidural Pneumothorax (check breath sounds)

Answer 20

Reassure the patient that the experience is self limiting. The complication will resove as soon as the local anesthetic wears off.

Answer 21

Excessive spread of local anesthetic during spinal or epidural anesthesia. s/s include high sensory block resulting in **upper extremity sensory and motor changes**, nausea and vomiting, loss of consciousness, anxiety, hypotension, bradycardia or asystole, respiratory distress, or apnea. ## Footnote Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO: Saunders; 2013:267.

Answer 22

Most popular, easy and safe Commonly used for forearm, wrist and hand procedures

Answer 23

IV injection Hematoma if axillary artery is punctured Contraindicated if patient with infected glands or the arm can not be abducted to 90 degrees at the shoulder

Answer 24

Useful for post op pain s/p thoracic or abdominal surgery, chest tube insertion Also for rib fractures and neurolytic block for cancer

Answer 25

Pneumothorax IV injection !Toxicity d/t rapid uptake by intercoastal

Answer 26

Local anesthetic injected to plane between internal oblique and transversus abdominis muscles Interrupts innervation to abdominal skin, muscles, parietal peritoneum

Answer 27

bowel resections, ventral hernia repair, cholecystectomy, kidney transplant, total abdominal hysterectomy, C-sections

Answer 28

Indicated for procedures at or below knee Lumbar plexus (psoas compartment block) Femoral nerve block Popliteal sciatic nerve block Saphenous nerve block Ankle block

Answer 29

IV injection Inadvertent arterial puncture Neural trauma

Answer 30

Spinal anesthesia Epidural anesthesia

Answer 31

Paravertebral block (mastectomy) Retrobulbar/ Peribulbar block (intraocular lens implant, posterior chamber/ retinal surgery, corneal implant, cataract surgery) Airway block (difficult intubation, upper airway trauma, cervical spine fracture or radiculopathy, airway malignancy or abscess)

Answer 32

Anesthesia on subarachnoid space Anesthetize nerve root + part of spinal cord Spinal - blocks nerve conduction in the region of body Toxicity is rare d/t small doses given !Baracity (heaviness of solution) 5-10% glucose added to anesthetic solution makes medication heavier than CSF Helps sink solution in CSF, thus affected by gravity + patient's position

Answer 33

Web like Contains CSF, arteries, veins

Answer 34

Injected into epidural space Can be single, bolus, or continuous infusion (PCEA) Higher chance of systemic toxicity d/t large dose req More absorption to systemic circulation Higher incidence of post Dural puncture headache

Answer 35

Potential space only Must be created when accessed for injection of anesthetic

Answer 36

!Spinal - Nerve roots blocked as they pass through CSF !Epidural - Nerve roots blocked outside CSF

Answer 37

!Spinal - Lower lumbar below termination of spinal !Epidural - Lumbar or thoracic region

Answer 38

!Spinal - small !Epidural - large

Answer 39

!Spinal - needle !Epidural - needle or catheter

Answer 40

!Spinal - no !Epidural - yes

Answer 41

!Spinal - rapid, intense blockade, may lead to hypotension !Epidural - gradual, may have less intense blockade, BP decline is usually slower

Answer 42

hypotension

Answer 43

Assess dermatomes to evaluate evolution, extent of anesthesia Progress of block affected by many factors like Dose + volume administered Patient's position s/p administration Obesity, hormonal influence, pregnancy

Answer 44

!Loss of temperature sensation first sign of sensory block Feet affected first, then moves upward body

Answer 45

Surgical procedure involving lower extremity, perineum, abdomen Treatment of acute and chronic pain Obstetric procedure and labor analgesia

Answer 46

Preexisting neural disease Musculoskeletal abnormalities History of back surgery Untreated hypertension

Answer 47

Patient refusal CVD - severe AS, mitral stenosis, asymmetrical septal hypertrophy Severe uncorrected hypovolemia Allergy to anesthetic agent Increased ICP Infection at injection site Sepsis or bacteremia Coagulopathy

Answer 48

Patients on anticoagulant can experience catastrophic complications

Answer 49

Each dermatome correspond to specific nerve root Neck - C3 Clavicles - C5 Nipples - T4 - Cesarean section, upper abdomen, uterine Xiphoid - T6/T7 - Lower abdomen Navel - T10 - Hip and **genitourinary** Groin - L1 to L3 - Lower extremities Knee - L4 Dorsum of foot - L5 Lateral ankles - S1

Answer 50

Autonomic + Sympathetic Function > sense of temperature > pain > touch > movement > proprioception (sense that lets us perceive the location and movements of our body parts - https://www.sciencedirect.com/topics/neuroscience/proprioception) !Return of function is in the order of reversal of loss

Answer 51

Chest, abdomen, lower extremities, perineum

Answer 52

!Inpatient - T10 level (navel) indicates that the spinal/ epidural is resolving !Outpatient - S3 level ( ) indicates fully resolved per facility policy consider ability to void

Answer 53

!Blocks higher than T6 but less than T3 HYPOTENSION more likely Sympathetic output from the spinal cord is blocked HR may increase in response

Answer 54

!Blocks higher than T3 BRADYCARDIA more likely Function of SA node can be affected (vagus nerve is unrestrained)

Answer 55

!Blocks higher than T1 Cardiopulmonary collapse

Answer 56

starting dopamine infusion

Answer 57

Elevate patient's legs (but can worsen block). AVOID elevating head/ HOB. AVOID trendelenburg d/t increased risk of respiratory compromise, upward spread of anesthesia. IV fluid bolus Vasopressors for BP support (i.e. phenylephrine) IV atropine if pronounced bradycardia !High sensory block can lead to neurogenic shock

Answer 58

Postdural puncture headache d/t CSF leak in dura mater: More common in spinal anesthesia More likely if large needle/ hole used More likely occurs in younger people More likely if sharp needles than blunt needles

Answer 59

Symptoms appear 24-48 hours after dura puncture: HA worsened by sitting/ standing Nuchal rigidity Neck ache Nausea Visual and auditory disturbances

Answer 60

Hydration Caffeine Blood patch

Answer 61

Adhesive arachnoiditis: chronic inflammation of arachnoid progressive weakness/ sensory loss on lower limbs leads to paraplegia

Answer 62

Cauda equine syndrome: leg numbness, bowel/ bladder dysfunction usually permanent effects

Answer 63

Septic meningitis (symptoms appear within 24 hours of injection): fever, ha, neck rigidity, + Kernig's sign (chin can't touch chest) good outcome with early antibiotic treatment

Answer 64

Complete loss of chest wall sensation and c/o increasing difficulty breathing (suspect phrenic nerve paralysis - needs emergent intubation)

Answer 65

Epidural hematoma - for patients with coagulopathies S/S include sudden lower back pain, motor and sensory changes, bowel and bladder deficits Treatment - emergent MRI/ CT/ spinal decompression

Answer 66

Nausea and vomiting caused by hypotension

Answer 67

Patient refusal Coagulation deficiency Infection at block site

Blocks/ Epidurals/ Pain Management Flashcards

(91 cards)