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Travis > Extra Regional > Flashcards

Extra Regional Flashcards

1
Q

Intercostal nerves are…

A

T1-T11 (T12 is SUBcostal)

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2
Q

Intercostal blocks are useful in what procedures?

A

upper abdominal and thoracic superficial procedures like gastrostomy tube placement and minor breast surgery, ESWL, and pacemaker placement.

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3
Q

Extremely useful for what?

A

Pain control for fractured ribs

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4
Q

Intercostal nerves run where in relation to the artery and vein?

A

generally the most inferior to the vein and artery; ventral portion is what wraps around the rib and the dorsal portion provides sensation to paravertebral muscles.

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5
Q

Position for intercostal block

A

best placed prone with pillow under abdomen and arms dangling

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6
Q

What are landmarks for intercostal blocks?

A

12th and 7th ribs

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7
Q

Intercostal blocks are at an increased risk for?

A

LAST secondary to increased blood flow to the area

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8
Q

Which portion of the nerve is wrapped around the rib?

A

ventral

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9
Q

Which portion provides sensation to the paravertebral muscles?

A

dorsal

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10
Q

where are ribs marked after palpation?

A

lateral to the edge of the sacrospinous muscles where the ribs are most superficial

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11
Q

Distance from spine-posterior

A

6-8cm

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12
Q

What gauge needle is used for intercostal block?

A

22g

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13
Q

Where is needle inserted for intercostal block?

A

inferior to rib at a 20 degree cephelad angle until contact with bone is made (usually 1cm), walk the needle off inferiorly.

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14
Q

Where is contact with bone typically made?

A

1cm

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15
Q

After needle is walked off inferiorly, how far is the needle advanced?

A

3mm

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16
Q

How much local is injected to each desired level?

A

3-5mL

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17
Q

What should always be avoided when performing intercostal block?

A

Needle should never be disconnected from tubing or syringe

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18
Q

What could happen as a result of disconnecting needle from tubing or syringe?

A

inadvertent puncture of parietal pleura (pneumo) because it pulls air in through the needle

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19
Q

Who should not receive an intercostal block?

A

those in which a pneumo would have devastating consequences.

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20
Q

Paravertebral blocks should be performed for what procedures?

A

surgical or post op analgesia for involvement in thoracic or abdominal wall, VASTS, mastectomy, and in those with rib fractures

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21
Q

Where can paravertebral blocks be performed?

A

cervical, thoracic or lumbar levels

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22
Q

What are complications of paravertebral blocks?

A

sympathetic blockade in thoracolumbar region, pneumo, intrathecal/epidural injection

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23
Q

where is local injected in paravertebral blocks?

A

paraverterbal space where spinal nerves emerge from intervertebral foramina

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24
Q

How is patient positioned for paravertebral block?

A

sitting or lateral decubitus

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25
Q

what serves as landmarks for paravertebral blocks?

A

each spinous process - each is palpated and a mark is made 2.5cm lateral to the spinous process

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26
Q

How much local in injected in paravertebral block?

A

6-10mL (dilute local)

27
Q

Where is local injected in paravertebral block?

A

in subcutaneous tissue of paravertebral muscles

28
Q

What size needle should be utilized in paravertebral block?

A

18-20g Touhy

29
Q

Where is needle placement for paravertebral blocks?

A

inserted until contact with transgerse process is made then needle is direced caudal or cephelad and advanced 1-1.5cm

30
Q

When should the needle not be advanced more cephelad in paravertebral blocks?

A

if you are above T7 secondary to increased risk of pneumo

31
Q

What is the correct needle depth for lower lumbar paravertebral blocks?

A

3-8cm?

32
Q

What is the correct needle depth for high thoracic paravertebral blocks?

A

6-8cm

33
Q

What is the correct needle depth for lower thoracic paravertebral blocks?

A

3-4cm

34
Q

Pop or loss of resistance may be felt during paravertebral block when the needle penetrates what?

A

costotransverse ligament

35
Q

How much local should be administered during paravertebral block after negative aspiration?

A

5mL at each level blocked

36
Q

Why should midline angling be avoided during paravertebral block adminsitration?

A

SAB/epidural injection

37
Q

Alternative technique to paravertebral block?

A

marking distance to transverse process when withdrawing needle to skin and readvancing and additional 1cm caudad or cephelad

38
Q

Transverse adbominis plane blocks what nerves?

A

lower thoracic nerves T7-T11
subcostal T12
ilioinguinal L1
iliohypogastic L1

ipsilateral abdomen below the umbilicus

39
Q

Normally what does a TAP block cover?

A

T10 and below

40
Q

Where do most of the thoracic and lumbar nerves covered in a TAP block lie?

A

Between the internal oblique and transverse abdominus muscles

41
Q

TAP blocks should be performed for what procedures?

A

Superficial procedures on lower abdomen or post op for procedures below the abdomen.

42
Q

How are TAP blocks best performed?

A

With ultrasound

43
Q

What is the best position for TAP block performance?

A

Supine or lateral decubitus

44
Q

Which way is the ultrasound positioned for a TAP block?

A

Longitudinally

45
Q

Where is the ultrasound probe held for a TAP block?

A

In the flank between lower rib and iliac crest

46
Q

How do muscles appear under ultrasound?

A

Marbled and transverse

47
Q

What size need is utilized in a TAP block?

A

21g

48
Q

What direction is a needle inserted for a TAP block?

A

Medial to lateral using in plane technique

49
Q

Where is the pop felt for TAP block insertion?

A

Entering plane between two muscle layers

50
Q

How much LA is inserted during TAP block?

A

20 mL

51
Q

Where is LA injected for TAP block?

A

Between internal oblique and transverse abdominis

52
Q

A rectus sheath block covers what areas?

A

Intercostal nerves 9,10 and 11

53
Q

Where are the 9th,10th and 11th intercostal nerves located?

A

Between the rectus abdominus muscle and posterior rectus sheath

54
Q

What can a rectus sheath block be used for?

A

Intra and post op analgesia for abdominal surgery with midline incision

55
Q

Examples of procedures done with rectus sheath blocks

A

Incisional and umbilical hernia repair, tubal ligation, c section

56
Q

How is the ultrasound probe positioned in a rectus sheath block?

A

Transverse

57
Q

Where is the ultrasound probe placed for rectus sheath block?

A

Transverse immediately lateral and above umbilicus

58
Q

What direction is the needle advanced for a rectus sheath block?

A

Medial to lateral

59
Q

What position is a patient placed in for rectus sheath block?

A

Supine

60
Q

What size needle is utilized for a rectus sheath block?

A

22g

61
Q

Where is the needle passed through for a rectus sheath block?

A

Through skin and sub q tissue until it meets firm resistance of anterior rectus sheath.

62
Q

How is the penetration of the sheath and belly muscle performed?

A

Firm pressure

63
Q

How much local is injected in a rectus sheath block?

A

10-20 mL using the posterior sheath as the back board

64
Q

How does the sheath appear under ultrasound?

A

Bright hyperechoic structure surrounding the muscle

Travis (5 decks)

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