Module 17 Regional Anesthesia Flashcards by Megan Manasco

Highest points of spinal column

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Lowest points of spinal column

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Spinal cord extends from foramen magnum to what level in adults

Newborn

L1 adult

L3 newborn

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Widest area of epidural space

Narrowest

L2 widest

C5 narrowest

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Principle site of action for neuraxial is

Nerve root of spinal cord

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Total amount of CSF

150ml

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Amount of CSF produced and absorbed daily

500ml/day

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Apnea with neuraxial occurs due to

Hypoperfusion of respiratory centers in medulla 2/2 severe hypotension

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Midline approach for spinal pass through what structures

Skin
SQ
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater

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For lateral approach will not pass through what structures

Supraspinous ligament

Interspinous ligament

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Volume calculation for epidural

1-2ml of LA per segment to be blocked

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Order in which nerves are blocked with neuraxial

B
C and A-delta
A-gamma
A-beta
A-alpha

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Average distance from skin to epidural space in adult

4-6cm

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Volume of LA for caudal block

1ml/kg to get to T10-12

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Typical US frequency for clinical imaging

2-12 MHz

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Pneumonic for nerves supplied by each cord of brachial plexus

MUM

PAR

LMM

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Nerve responsible for

Extension of elbow
Supination of forearm
Extension of wrist and fingers

Radial

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Nerve responsible for

Pronation of forearm
Flexion of wrist
Opposition of middle, forefinger and thumb
Flexion of lateral 3 fingers

Median

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Nerve responsible for

Flexion of wrist
Adduction of all fingers
Flexion and opposition of medial two fingers to thumb

Ulnar

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Nerve responsible for

Flexion at elbow

Musculocutaneous

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Cervical plexus block

Volume

4ml per level

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Block for shoulder surgery

Interscalene

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Interscalene block frequently misses what nerve

Ulnar

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Volume for interscalene block

40ml

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Block known as spinal of arm

Supraclavicular

Greatest risk of supraclavicular block

Pneumothorax

Volume for supraclavicular block

20-30ml

Block for forearm and hand procedures

Infraclavicular

Volume for infraclavicular

20-30ml

Block for surgery at or below the elbow

Axillary block

Volume of axillary block

40ml

Nerve blocks at elbow (ulnar, median, and radial) what volume

4ml

Which block at elbow has high incidence of neuritis

Ulnar

Volume for ulnar and median wrist block

3ml

Radial nerve block at wrist what volume

6ml

Digit block volume

2ml per side of finger

Block to provide anesthesia for anterior thigh, knee, medial foot

Femoral “3 in one”

Volume for femoral

30ml

Sensation to heel and medial sole of foot

Posterior tibial

Sensation to dorsum of foot and toes 2-5

Superficial peroneal

Sensory or medial legs angle and upper foot

Saphenous

Supplies posterolateral calf and lateral foot. 5th toe

Dural

Supplied toe Elenor’s and sensation to medial dorsal for toe 1 and 2

Deep peroneal

For a procedure requiring a tourniquet on the leg, a minimum sensory level of what is required for block?

Landmarks for caudal block

Sacral Cornu and sacra hiatus

For caudal block in children what is LA dose

0.5ml/kg

Damage to what nerve causes inability to adduct thumb

Ulnar

Damage to what nerve causes inability to abduct thumb

Radial

Which nerve can be damaged by AC IV

Median

What nerves are anesthetized in popliteal block

Tibial and common peroneal (branches of sciatic)

Sural nerve is branch of what nerve

Tibial nerve (branch of sciatic)

Ankle block placed laterally between lateral malleolus and Achilles blocks which nerve

Sural

infiltration on dorsal foot from medial malleolus to extensor digitorum longus blocks which nerve

Saphenous and superficial peroneal

Block placed at intermalleolar line between extensor difitorum longus and extensor hallucis longus blocks which nerve

Deep peroneal

Block placed posterior to medial malleolus blocks which nerve

Posterior tibial nerve

Dose for intralipid in LAST treatment

20% intralipid 1.5 ml/kg over 1 minute Infusion 0.25 ml/kg/min

What are medication adjustments for ACLS with LAST

Decrease epi dose Avoid calcium channel blockers and beta blockers Avoid LA Amiodarone preferred for ventricular dysrhythmias

Diplopipa following spinal results from palsy of what nerve

CN VI abducens

Most common complication of neuraxial

Backache

Early opioid induced depression of ventilation occurs when? Is due to what

Within 2 hours Due to systemic absorption of opioid

Late (delayed) opioid induced ventilatory depression occurs when? Is due to what?

6-12 hours after injection Due to cephalad spread in CSF to respiratory centers in medulla MORHPINE

Most common side effect of spinal opioids

Puritis

Pain initiated or caused by primary lesion, dysfunction, or transitory perturbation in PNS or CNS

Neurogenic pain

Pain initiated or caused by primary lesion or dysfunction in nervous system

Neuropathic pain

Pain due to a stimulus which does not normally provoke pain

Allodynia

Increased response to stimulus which is normally painful

Hyperalgesia

Disturbance of function or pathological change in a nerve

Neuropathy

Signs of dysfunction including numbness, weakness, or loss of DTR referable to a specific spinal nerve

Radiculopathy