Neuraxial blocks

Question 1

Vertebral column is formed by __ vertebrae?

Answer 1

33

Question 2

Describe how many cervical, thoracic, lumbar, sacral, & coccygeal vertebrae there are.

Answer 2

Cervical= 7
Thoracic= 12
Lumbar= 5
Sacral= 5-fused
Coccygeal= 4-fused

Question 3

Describe the types of curves that exist in the spine.

Answer 3

Cervical & lumbar= lordosis

Thoracic & sacral= kyphosis

Question 4

_____ & _______ join the anterior and posterior segments of the vertebra to form the vertebral foramen

Answer 4

Lamina & pedicles

Question 5

The vertebral foramen contains the

Answer 5

spinal cord, nerve roots, and epidural space

Question 6

Cervical and thoracic spinous processes angle in a ______ direction which requires more _________ approach with the needle

Answer 6

caudal; cephalad

Question 7

The lumbar spinous processes project in a posterior direction which is beneficial because

Answer 7

it increases ease of access for placement of neuraxial anesthesia

Question 8

The intervertebral disc separate ______ and act

Answer 8

each vertebra and act as shock absorbers

Question 9

Spinal nerves exit the vertebral column through

Answer 9

the intervertebral foramina

Question 10

_________ reduces the size of the intervertebral foramina

Answer 10

disc degeneration

Question 11

Disc degeneration can lead to

Answer 11

nerve compression and manifest as pain, parathesias, and/or motor deficits

Question 12

Surface landmark: vertebra prominens

Answer 12

C7

Question 13

Surface landmarks: spine of scapula

Answer 13

T3

Question 14

Surface landmarks: inferior angle of scapula

Answer 14

T7

Question 15

Surface landmarks: rib margin 10 cm from midline

Answer 15

L1

Question 16

Surface landmarks: superior aspect of iliac crest

Answer 16

L4

Question 17

Surface landmarks: posterior superior iliac spine

Answer 17

S2

Question 18

Tuffier’s line correlates with

Answer 18

L4

in infants up to 1 year it is L5-S1 interspace

Question 19

The facet joints are responsible for

Answer 19

guiding and restricting the movement of the vertebral column

Question 20

Injury to facet joint can

Answer 20

compress nerves leading to pain and muscle spasms

Question 21

What spinal level coincides with the conus medullaris in adults?

Answer 21

L1-L2

Question 22

What spinal level coincides to the conus medullaris in the infant?

Answer 22

L3

Question 23

What spinal level coincides with the dural sac in the adult?

Answer 23

S2

Question 24

What spinal level coincides with the dural sac in the infant?

Answer 24

S3

Question 25

What is the bundle of spinal nerves that extend from the conus medullaris to the dural sac?

Answer 25

cauda equina

Question 26

The filum terminale is fixated at which two points?

Answer 26

conus medullaris | coccyx

Question 27

Describe the significance of the sacral hiatus

Answer 27

provides an entry point to the epidural space- useful in pediatrics

Question 28

The sacral hiatus coincides with

Answer 28

S5

Question 29

The sacral hiatus is covered by the

Answer 29

sacroccocygeal ligament

Question 30

Bony nodules that flank the sacral hiatus are known as

Answer 30

sacral cornua | they are used as landmarks for caudal anesthesia

Question 31

Order the spinal ligaments from superficial to deep: anterior longitudinal ligament, posterior longitudinal ligament, interspinous ligament, ligamentum flavum, supraspinous ligament

Answer 31

1. supraspinous ligament 2. interspinous ligament 3. ligamentum flavum 4. posterior longitudinal ligament 5. anterior longitudinal ligament

Question 32

With either the midline or paramedian approach, the needle should NEVER pass through

Answer 32

the anterior longitudinal ligament and the posterior longitudinal ligament

Question 33

Ligaments transversed in the midline approach:

Answer 33

supraspinous ligament interspinous ligament ligamentum flavum

Question 34

Ligaments transversed in the paramedian or Taylor approach

Answer 34

ligamentum flavum

Question 35

The cranial border of the epidural space is

Answer 35

the foramen magnum

Question 36

The caudal border of the epidural space is the

Answer 36

sacrococcxygeal ligament

Question 37

The anterior border of the epidural space is the

Answer 37

posterior longitudinal ligament

Question 38

The lateral border of the epidural space is the

Answer 38

vertebral pedicles

Question 39

The posterior borders of the epidural space is the

Answer 39

ligamentum flavum and vertebral lamina

Question 40

The epidural space communicates with the _____ space by way of the

Answer 40

paravertebral space by way of the intervertebral foramina

Question 41

The epidural space contains

Answer 41

nerve roots, fat pads, and blood vessels

Question 42

Epidural fact acts as a sink for

Answer 42

liphophilic drugs, reducing their bioavailability | bupivacaine> lidocaine & fentanyl> morphine

Question 43

Epidural veins or Batson's plexus work to drain

Answer 43

venous blood from the spinal cord

Question 44

Obesity & pregnancy increase intraabdominal pressure leading to

Answer 44

engorgement of the plexus | associated with increased risk of needle injury or cannulation during neuraxial anesthesia

Question 45

Describe the 3 meningeal layers from outside to inside

Answer 45

``` dura mater subdural space arachnoid mater subarachnoid space pia mater ```

Question 46

This mater should never be punctured during spinal anesthesia

Answer 46

Pia mater

Question 47

The pia mater is the external covering of

Answer 47

the spinal cord

Question 48

The subarachnoid space contains

Answer 48

CSF, nerve roots, rootlets, and the spinal cord

Question 49

The target of spinal anesthesia is the

Answer 49

subarachnoid space

Question 50

Inadvertent local anesthetic injection into the subdural space will cause

Answer 50

a high spinal (if using epidural dosing) or a failed spinal (if using spinal dosing)