Brachial Plexus

Question 0

intensity of nerve stimulation

Answer 0

low intensity, up to 5 mA

Question 1

blocks of the brachial plexus

Answer 1

interscalene, supraclavicular, infraclavicular, axillary

roots-trunks-divisions-cords-terminal branches

Question 2

duration of nerve stimulation

Answer 2

0.05-0.1 ms

Question 3

nerve stimulation helps avoid…

Answer 3

intraneural intrafascicular injection and subsequent nerve injury

Question 4

C5, C6

Answer 4

axillary, upper and lower subscapular, suprascapular

Question 5

C5, C6, C7

Answer 5

musculocutaneous, long thoracic, lateral pectoral

Question 6

C5

Answer 6

dorsal scapular, to subclavious muscle

Question 7

C5, C6, C7, C8

Answer 7

to longus colli and scalene muscles

Question 8

C5, C6, C7, C8, T1

Answer 8

radial, median

Question 9

C8, T1

Answer 9

ulnar, medial pectoral, medial cutaneous nerve of forearm

Question 10

T1

Answer 10

medial cutaneous nerve of arm

Question 11

C6, C7, C8

Answer 11

thoracodorsal (middle subscapular)

Question 12

acceptable twitches

Answer 12

pectoralis major, deltoid, biceps, triceps, forearm , hand

Question 13

advantages of ISB

Answer 13

landmarks easy to find in obese patients, shoulder surgery, small risk of pneumothorax

Question 14

ISB disadvantages

Answer 14

paresthesias usually elicited
ulnar nerve frequently spared
not appropriate for the pulmonarily compromised
phrenic nerve blockade typically ensues (only 10%)

Question 15

ISB complications

Answer 15

unintentional spinal/epidural anesthesia
vertebral artery puncture
phrenic nerve block
LAST

Question 16

ISB technique

Answer 16

head contralateral, HOB slightly elevated
sternocleidomastoid palpated
roll fingers off posteriorly
intersection at C6

Question 17

ISB insertion

Answer 17

22/23g needle almost perpendicular to the floor
45 degrees caudad, posterior, and medial
watch out for EJ
paresthesias are elicited and injection performed (30 ml)

Question 18

drugs and dosages for ISB

Answer 18

lidocaine 20-30ml
mepivacaine 20-30ml
bupivacaine 20-30ml
ropivacaine 20-30ml

Question 19

advantages SCB

Answer 19

3 trunks of the brachial plexus (most compact here)
arm can be in any position
most homogenous block of brachial plexus (ulnar nerve not spared)

Question 20

disadvantages of SCB

Answer 20

difficult to teach
considerable experience required
major risk of pneumo

Question 21

SCB complications

Answer 21

puncture of subclavian artery
pneumo
phrenic nerve block
LAST

Question 22

SCB dosages

Answer 22

Lidocaine 30ml
Bupivacaine 30ml
Ropivacaine 30ml
Mepivacaine 30ml

Question 23

ICB advantages

Answer 23

nerves frequently missed with axillary approach are blocked
musculocutaneous nerve blocked
does not require positioning of the arm like axillary approach
phrenic nerve blockade not a possibility

Question 24

ICB disadvantages

Answer 24

no pulse to assist in blocking bundle if injection too far proximal to clavicle, musculocutaneous and axillary nerves will be missed needle insertion too medial can result in pneumothorax

Question 25

ICB dosages

Answer 25

Lidocaine 30 ml Bupivacaine 30 ml Mepivacaine 30 ml Ropivacaine 30 ml

Question 26

Median nerve in quadrants...

Answer 26

1 & 8 in 56% of subjects

Question 27

ulnar nerve in quadrants...

Answer 27

2 in 59% of subjects

Question 28

radial nerve in quadrant...

Answer 28

3 in 38% of subjects

Question 29

advantages of AxB

Answer 29

surgery on forearm and wrist fewer complications than SCB safest and most reliable for the patient

Question 30

AxB disadvantages

Answer 30

arm abducted for surgery not for shoulder or upper arm surgery musculocutaneous nerve lies outside of perivascular sheath, need separate block

Question 31

AxB technique

Answer 31

supine head contralateral arm abducted 90 degrees forearm flexed 90 degrees palpate brachial artery as far proximal

Question 32

Dosages AxB

Answer 32

Lidocaine 20-30ml Bupivacaine 20-30ml Ropivacaine 20-30ml Mepivacaine 20-30ml

Question 33

elbow blocks technique

Answer 33

flex elbow 90 degrees ID medial condyle of humerus insertion point is between medial condyle of humerus and olecranon process of ulna Inject 4 ml LA (3-5 ml)

Question 34

median nerve block

Answer 34

draw a line from the medial to lateral condyles of the humerus on anterior surface insert B bevel needle slightly medial to the brachial artery inject 4 ml (3-5 ml)

Question 35

radial nerve block

Answer 35

elbow extended locate brachioradialis muscle and biceps brachii insertion (tendon) radial nerve is in the groove between the muscles mentioned above inject 4 ml (3-5 ml)

Question 36

movements in response to radial nerve stimulation

Answer 36

extension at elbow supination of forearm extension of wrist and fingers

Question 37

movement in response to ulnar nerve stimulation

Answer 37

flexion of wrist adduction of all fingers flexion and opposition of medial two fingers towards thumb

Question 38

movement in response to median nerve stimulation

Answer 38

pronation of forearm flexion of wrist opposition of middle, forefinger, and thumb flexion of the lateral three fingers

Question 39

movement in response to musculocutaneous stimulation

Answer 39

flexion at elbow