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VMS4001 SEM 2 > Local Blocks > Flashcards

Local Blocks Flashcards

1
Q

MOA for local anaesthetics?

A
  • Reversible block of voltage gated Na+
    channels
  • No membrane depolarisation
  • Sensory & Motor blockade
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2
Q

What different properties of Locals?

A
  • Dissociation constant (pKA) -> Determines onset
  • Lipid solubility determines potency (more lipid soluble more potent)
  • Protein Binding (duration)
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3
Q

WHy do we use loco-regional anaesthesia?

A
  • Reduced GA dose (also reduce AEs & quicker recovery)
  • Improved peri-operative analgesia -> preemtive & multimodal ; prevention of central sensitization & chronic pain
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4
Q

COMPARE different locals

A
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5
Q

What different adjuncts can we use ?

A
  • Adrenaline (vasoconstriction)
  • ALpha2 (vasoC & more analgesia)
  • Opioids (enhanced & prolonged analgesia
  • Steroids (epidural)
  • NaHCO2 (sodium bicarb) -> changes pH therefore onset/ duration
  • Dexamethasone -> anti-inf
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6
Q

What adverse effects seen with increasing doses of lidocaine?

A
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7
Q

Suppotive tx for toxicity?

A

 Intubation, 02
therapy, ventilation, benzodiazepines, propofol….
 CPR (adrenaline, defibrillation, amiodarone…)
 20% Lipid emulsion (intralipid)

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8
Q

T/F with bupivicaine cardiac & CNS signs with be seen at same time ?

A

True

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9
Q

What other adverse effects might we see?

A
  • Nerve & local tissue injury
  • Local haemorrhage
  • Infections
  • Allergic reactions
  • Chondrotoxicity
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10
Q

How can we avoid these?

A
  • Calculate the local anaesthetic volume before, staying below toxic dose!
  • If multiple local anaesthetic used: keep individual dose below toxic dose
  • Aspirate before injection, confirm absence of blood
  • Aseptic techniques
  • Beware of coagulopathies
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11
Q

What different ways can we PERFORM a loco-regional block?

A
  • ANATOMICAL LANDMARKS (“BLIND APPROACH”)
  • ELECTRICAL NERVE STIMULATION
  • Insulated needles
  • Peripheral nerve stimulator
  • ULTRASOUND GUIDED
  • Direct visualisation
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12
Q

Indications for infra-orbital or rostral maxillary blocks?

A
  • Nose
  • Upper lip
  • Gengiva & teeth up to 2nd premolar
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13
Q

Landmarks for infra-orbital or rostral maxillary ?

A
  • Infraorbital foramen
  • 3
    rd premolar tooth (maxilla)
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14
Q

Indications for Caudal (maxillary) block?

A
  • Nose
  • Upper lip
  • Hard/soft palate
  • Upper dental arch
  • Maxilla
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15
Q

What different approaches & respective landmarks of maxillary nerve blocks?

A
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16
Q

Mental N block Indications & landmarks?

A

INDICATIONS: bone, teeth?, Lower lip/chin rostral to the block

LANDMARKS: Middle mental foramen (ventral to 2nd premolar)

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17
Q

Indications for Mandibular N Block (inferior alveolar) ?

A

bone, teeth, intra-oral tissues from the molars to the mandibular symphysis

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18
Q

Landmarks for mandibular block?

A

Mandibular foramen
(medial side of mandible)

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19
Q

What should we be careful about with mandibular N Block?

A

: risk of lingual nerve desensitization & self-trauma, do NOT block bilaterally (or use lido)

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20
Q

Indications for greater auricular & auricolo-temporal N.block?

A

Procedures of ear canal, pinna
Acute & chronic ear pain

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21
Q

Landmarks for GREATER AURICULAR & AURICOLO-TEMPORAL N. BLOCKS

A
  • Zygomatic arch
  • Vertical ear canal
  • Vertebral Atlas transverse processes (wings)
22
Q

Risk with Auricular block?

A

Risk of Facial nerve paralysis: EYE LUBE

23
Q

What are all the thoracic limb blocks?

24
Q

Cervical paravertebral nerve blck - blocks what?

A

From shoulder joint to entire limb: (C5),C6, C7, C8 & T1,(T2) nerves

25
What does brachial plexus block block?
from distal humerus/elbow (C6, C7,C8, T1)
26
Potential complications of Cervical paravertebral nerve block & brachial plexus block?
* Pneumothorax * Phrenic nerve blockade (C5, C6, C7) * Haemorrhage
27
What is RUMM?
(RADIAL-ULNAR-MEDIAN & MUSCULOCUTANEOUS N. BLOCK
28
Area blocked with RUMM?
* Area blocked: distal thoracic limb (carpus, manus & digits) * Blind, nerve stim, US guided
29
How to block thorax?
Intercostal nerve block
30
Indications for Intercostal nerve block?
 Thoracotomy  Rib fractures  Chest drainage insertion
31
Additional potential complications of intercostal nerve block?
* Pneumothorax * Haemothorax * Lung damage
32
What gets blocked by intercostal nerve block?
Block site + 3 spaces cranially & caudally
33
Describe Epidural block?
* Administration of drugs in the epidural space (space between vertebral canal and dura mater) * Usually at lumbo-sacral (L7-S1) or sacro-coccygeal space
34
Indications for epidural?
pelvis, pelvic limbs, tail, perineal and abdominal procedures, (thorax)
35
How to check epidural needle in right place?
* “Pop sensation” * Loss of resistance * Hanging drop * Running drip (Baraka method)
36
What can we use in epidural?
* Lidocaine/Bupivacaine/ Ropivacaine* +/- Preservative free morphine
37
Epidural contraindications?
* Infection/inflammation/ neoplasia @ injection site * Coagulation disorders * Hypotension/Hypovolemia (sepsis…) * Pre-existing neurological deficits * Anatomical abnormalities? (RTA) * Obesity?
38
Adverse events of epidural?
* Motor blockade: pelvic limb ataxia * Vasodilation/Hypotension * Respiratory depression * Nerve damage * Lack of hair growth * Pruritus (opioids) * Urinary retention (especially with opioids)
39
What are the Hindlimb blocks?
40
Femoral nerve block?
 Blind?, nerve stimulator, US guided * Contraction quadriceps femoris * Extension of stifle
41
Femoral N Block approach?
INGUINAL -> blind, nerve stim ,Us guided
42
When to use Femoral N Block? (what does it block)
* Contraction quadriceps femoris * Extension of stifle * Stifle not completely blocked (OBTURATOR n.)?
43
Landmarks for Sciatic B Block?
* Greater trochanter of femur * Ischiatic tuberosity
44
What does sciatic N block stop?
extension/flexion of the tarsus
45
When to use epidural vs unilateral block (femoral & sciatic ) ?
* Patient ability to walk * Post-op care (Is the patient aggressive?, size of patient) * Does your patient have other comorbidities (i.e. osteoarthritis, patella luxation, recent surgery on other leg) ? * Anaesthetist/surgeon Preference * Schedule 3 procedure ( Femoral & Sciatic n. block)
46
Indications for intra-peritoneal lavage?
abdominal surgeries (e.g. ovario-hysterectomies)
47
How to do intra-peritoneal lavage ?
* Local anaesthetic instilled in the peritoneal cavity after incision or before closure of the incision  Bupivacaine/ropivacaine
48
Describe an infiltration (incisional) block?
* Instillation of local anaesthetic around or directly into the incision or wound ‘field’ * Simple, safe, and inexpensive
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VMS4001 SEM 2 (28 decks)

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