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Pain/Regional Flashcards

(93 cards)

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1
Q

A-delta

A

myelinated, sharp, well localized pain, temp, touch (somatic)

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2
Q

C fibers

A

unmyelinated, poorly localized mechanical, thermal, chemical (visceral)

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3
Q

pain course

A

a-delta/c fibers send signal to doral horn (near substantia gelatinosa), travel up spinal cord to the thalamus via ipsilateral spinoreticulothalamic tract or contralateral spinothalamic tract, some travel to somatosensory cortex and some to anterior cingulated gyrus (limbic forebrain) for emotional processing

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4
Q

allodynia

A

pain due to non painful stim

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5
Q

hyperalgesia

A

increased response to pain

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6
Q

hyperesthesia

A

exaggerated pain to noxious stimuli

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7
Q

hypoalgesia

A

decreased pain to painful stimuli

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8
Q

dyesthesia

A

unpleasant, abnormal sensation (spon/evoked)

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9
Q

how many nodes of ranvier need to be blocked

A

3

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10
Q

CRPS 1 vs CRPS 2

A

no known insult, gradual onset vs known major nerve damage and distal to central spread, both don’t follow dermatomes

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11
Q

CRPS acute

A

(first stage) 1-4 weeks; red, hot, dry skin

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12
Q

CRPS dystrophic

A

(second stage) 4 weeks - 4 months; cold, clammy, white

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13
Q

CRPS atrophic

A

(third stage) after 4 months; muscle wasting, joint destruction, bone demineralization, hair loss, nail changes, thinning of skin

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14
Q

CRPS triad

A
  1. sensory (pain, allodynia, hyoeralgesia) 2. autonomic (edema, skin color, skin temp) 3. motor (muscle weakness, spasm, decreased ROM)
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15
Q

phantom limb pain

A

all amputees get over time, no difference traumatic or not, worse with more proximal amputation, can reactivate with spinal/epidural

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16
Q

phantom treatment

A

carbamazepine or calcitonin, TENS, narcotics (epidural/PO), peripheral/central neurolysis or nerve blocks, trigger point injections

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17
Q

TENS

A

transcutaneous electrical nerve stimulation - low intensity electrical stim releases endogenous endorphins that are inhibitory at spinal cord

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18
Q

spinal cord stim placement technique

A

needle into epidural space via paramedian using fluoro

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19
Q

myofascial pain syndrome

A

widespread aching, stiffness, erythema, fluctuations in pain intensity, 3rd/4th decade of life, can have trigger points

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20
Q

myofascial treatment

A

exercise, PT, massage, LA injections

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21
Q

Post herpetic neuralgia treatment

A

4-6 weeks post outbreak; TCAs, anticonvulsants, oral analgesics, sympathetic nerve blocks, topical LA, capsaician

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22
Q

ethyl alcohol

A

painful, immediate and profound neurolysis, hypobaric, long duration, high incidence of post neurolysis neuralgia, pure - somatic blocks, diluted - sympathetic

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23
Q

phenol

A

painless, delayed and less intense neurolysis, hyperbaric, short duration, LA properties, used for peripheral nerve blocks

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24
Q

methgb susceptible

A

benzocaine, prilocaine (build up o-toluidine), NO, G6P deficiency, methbg reductase deficiency (<4 months have this), nitrites/nitrates, anti-malaria meds, phenytoin

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25
methgb treatment
methylene blue 1-2 mg/kg over 5-10 min to avoid toxicity (restlessness, tremor, precordial pain), reduction in 30-60 min or ascorbic acid 2mg/kg
26
Methgb percentage
70% death
27
signs of total spinal in infant
apnea --> hypoxemia --> bradycardia
28
cervical plexus superficial block
C1-4, posterior lateral border of SCM from inferior surface of mandible to clavicle
29
cervical plexus deep block
C1-4, 10 ml at level of C4 transverse process or 3 injections at levels C2, 3, 4 transverse processes
30
cervical plexus block complications
horner's, RLN block, epidural/intrathecal injection, phrenic or SLN block, intravascular injection
31
interscalene block
C6 between anterior and middle scalene, blocks roots, spares lower trunk (supplemental block for ulnar)
32
supraclavicular block
lateral SCM and clavicle, block trunks
33
infraclavicular block
blocks at cords
34
axillary block
blocks at branches (distal to elbow), need sup for musculocutaneous at coracobrachialis, intercostobrachial (posterior medial arm) and medial cutaneous nerve (medial forearm) by arm cuff
35
push, pull, pinch, pinch
push radial, pull musculocutaneous, pinch (thumb to pinky) median, pinch (pinky to thumb) ulnar
36
radial injury
wrist drop
37
ulnar injury
can't adduct thumb or abduct pinky
38
median injury
can't oppose thumb and pinky
39
radial wrist block
anatomic snuff box (btw extensor pollicus longus & brevis)
40
ulnar wrist block
medial to ulnar artery(btw flexor carpi ulnaris & ulnar art)
41
median wrist block
btw palmaris longus & flexor carpi radialus tendons (injured at AC fossa with drug extravasation or needle injury
42
Intercostal nerve blocks
8-10 cm from back midline
43
TAP block location
between internal oblique and transverse abdominus fascia
44
femoral nerve block
L2-4, sensory to ant thigh & knee, medial aspect of leg
45
saphenous nerve block
only branch of femoral that innervates below the knee, block near saphenous vein at level of tibial tuberosity
46
ilioinguinal/iliohypogastric block
T12/L1, 2 cm medial and 2 cm superior to ASIS
47
lateral femoral cutaneous block
2 cm medial and 2 cm inferior to ASIS
48
obturator block
1-2cm distal and lateral to pubic tubercle, hit pubic bone then redirect cephalad to obturator canal
49
sciatic nerve injury
(innervateds hamstrings and muscles of leg and foot, sensory to outer leg and whole foot except instep and medial malleolus) weakness to all muscles below knee, L4-S3
50
tourniquet contraindications
sickle cell, infection, ischemic vascular disease
51
which LA associated with thrombophlebitis and bier block
chloroprocaine
52
bier block doses
prilocaine 3-4, lidocaine 1.5-3, ropivicaine 1.2-1.8
53
tourniquet inflation guidelines
250-275 of 100 mm Hg > SBP
54
tourniquet times
minimum of 25 minutes before deflation, if before --> deflate then re-inflate immediately, wait 1 minute then deflate
55
physio changes after tourniquet deflation
1-8 mm HG CO2 increase, 10-15% increase in HR, 5-10% potassium increase, ass with cerebral embolism
56
describe symptoms from nerve impingement in vertebral foramina and treatment
unilateral numbness/parethesias, in UE with movement (extension); treat with NSAIDs, steroids, surgery
57
common peroneal damage
no dorsal flexion of toes, no eversion of foot
58
lumbar sympathetic block
7cm lateral and 2 cm inferior to L2 vertebral body, success leads to vasodilation of LE, elevated skin temp, decreased skin resistance
59
lumbar/celiac sympathetic block complications
aorta/IVC puncture, perforation of renal pelvis/other organs, subarachnoid injection, somatic spread,bretroperitoneal hemorrhage, pneumo (celiac)
60
celiac plexus block and success
T5-12 in retroperitoneal space anterior to L1, posterior to aorta and IVC; hypotension, diarrhea
61
intraspinal narcotic symptoms
pruritis>n/v>urinary retention
62
spinal additions
alpha agonists and neostigmine have some analgesic properties
63
block succession
sensory then sympathetic then motor
64
block lag spinal
sensory lags 2 dermatomal segments behind sympathetic
65
spinal segment anesthetic requirements
1-2 ml per spinal segment in 20-40 yo, 2/3 blocked above, 1/3 blocked below (increase in age 0.75-1.5 ml)
66
large dose of intrathecal LA
pupil dilation
67
caudal landmarks
PSIS and sacral hiatus (between sacral cornua)
68
spinal/subarachnoid space block factors
baricity and patient position most important for sensory level
69
epidural block factors
increased dose (mass) more effective at faster onset and longer duration
70
Taylor approach
L5-S1 interspace epidural injection, find PSIS and use paramedian approach
71
neuraxial contraindications
coagulopathy, increased ICP, local/systemic infection, hypovolemic, R-L cardiac shunt, fixed cardiac lesions (AS, MS, IHSS), multiple sclerosis, spina bifida occulta
72
cutting needles
quinke, pitkin
73
conical needles
whitacre, sprotte, greene
74
epidural hematoma
rapid onset of backache, b/l muscle weakness, sensory deficit, urinary retention, paraplegia, treatment within 8 hours
75
epidural abscess
slow (5 days) onset of backache and loss of function, stage1: back pain→stage 2: radicular pain→stage 3: motor/sensory deficits→stage 4: paraplegia, dx w/MRI
76
anterior spinal artery thrombosis
rapid, painless, flaccid paralysis 2/2 to arteria radicularis magna damage
77
spinal cord blood supply
1 anterior spinal artery (vertebral aa at base of skull) supplies anterior 2/3, 2 posterior spinal aa (cerebellar aa) supplies posterior 1/3
78
spinal cord blood supply feeders
intercostal arteries T9-12 (75%), lumbar arteries L1-2 (10%), artery of adamkiewitz arises from aorta on left (T9-L2/T5) --> major blood supply for anterior spinal a and lower 2/3 of spinal cord
79
cauda equine syndrome
low back pain, BLE weakness, saddle anesthesia, loss of blowel/bladder control, assoc w/large micro catheters for cont spinal
80
transient neurologic syndrome
pain/dyesthesia in back, buttock & LE w/IT LA esp lido (w/o sensory/motor loss or bowel/bladder dysfunction), ↑risk w/lithotomy, ambulatory, obesity, onset of sx 12-24 hours, resolves in 3 days, tx: NSAIDs
81
total spinal
LOC 2/2 ischemic paralysis of medullary ventilatory centers b/c profound ↓BP or penetration of local thru foramen magnum, Pupilary dilation & loss of light reflex
82
neuraxial pruritits treatment
opioid ant, mixed opioid ag-ant, diphenhydramine and hydroxyzine, propofol
83
intralipid therapy
20% lipid emulsion, 1mk/kg bolus (can repeat), then followed by 0.25ml/kg/min after stable
84
LMWH catheter placement
12 hours after prophylaxis, 24 hours after treatment
85
Heparin catheter placement
4 hours after dose
86
clopidogrel neuraxial
7 days
87
ticlid neuraxial
14 days
88
abciximab neuraxial
2 days
89
tirofiban neuraxial
8 hours
90
eptifibatide neuraxial
8 hours
91
streptokinase/urokinase neuraxial
avoid
92
transdermal fentanyl mechanism of action
fentanyl depot in the upper layer of skin, takes about 1 hour before seen in serum and continues to circulate for about 24 hours after patch removed
93
lumbar plexus
ventral rami L1-4, variable contribution from T12 and L5

Anesthesia (16 decks)

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