Flashcards in Peripheral Nerve Blocks Deck (41):
1
What class of drug includes bupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine?
Amides
2
What is the maximum dose and duration for bupivacaine?
Max dose = 3 mg/kg
duration = 1.5 to 8 hours
3
What is the maximum dose and duration for lidocaine?
Max dose = 4.5 mg/kg (7 w epi)
duration = 0.75 to 2 hours
4
What is the maximum dose and duration for mepivacaine?
Max dose = 4.5 mg/kg ( 7 w epi)
duration = 1 to 2 hours
5
What is the maximum dose and duration for ropivacaine?
Max dose = 3 mg/kg
duration = 1.5 to 8 hours
6
What drug can be added to lidocaine in mepivacaine to prolong their action?
Epinephrine
7
Benzocaine, chloroprocaine, cocaine, procaine, and tetracaine all fall into what category of drugs?
Esters
8
It is more common to have an allergic reaction to amides or esters? why?
Esters
PABA
9
A toxic dose of benzocaine can cause what?
Met hemoglobinemia
10
How is met hemoglobinemia treated?
Methyline blue
11
Why is epinephrine added to local anesthetics?
Intravascular marker
improves quality of block
decreases absorption (prolong action)
vasoconstriction on surgical field
12
What are the three major risks of nerve blocks?
Systemic toxicity
infection
peripheral nerve damage
13
What is LAST?
Local anesthetic systemic toxicity
14
Which CNS symptoms come first C&S excitation or CNS depression?
CNS excitation
15
What are the cardiovascular effects of LAST?
Depression of myocardial conduction and contractility
production of arterial vasodilatation
16
How can LAST be prevented?
Incremental injection
Frequent aspiration
Adding a marker
Limiting local anesthetic dose and concentration
Communication with the patient
17
How is LAST treated?
Seizures: Versed, propofol, thiopental
Cardio/pulmonary symptoms: airway management
ACLS/BLS
Intralipid infusion
CP Bypass
18
How is Intralipid administered?
1.5 mL/kg as an initial bolus followed by .25 mL/kg/min for 30 to 60 minutes
19
Name three techniques for placement of blocks
Ultrasound technique
Peripheral nerve stimulator
Paresthesia technique
20
The brachial plexus stems from what roots?
C5-8, T1
21
Name the five main branches of the brachial plexus?
Musculocutaneous
axillary
Radial
median
Ulnar
22
Name the three main nerves or groups of nerves that are in Close proximity to the brachial plexus
Superficial cervical plexus
Phrenic nerve
Intercostal brachial nerve
23
What are the main approaches to the brachial plexus?
Interscalene
Supraclavicular
Infraclavicular
Axillary
24
What type of block is most commonly done for shoulder, humorous and clavicle procedures?
Interscalene block
25
What area is commonly missed by an interscalene block?
C8-T1 ulnar nerve
26
In what patients would you be most concerned with the possibility of phrenic nerve palsy?
Ascites
Pregnant
COPD
Respiratory depression
Oxygen dependent
Obese
27
What type of block would you perform for surgeries for the entire arm below the level of the shoulder?
Supraclavicular block
28
Supraclavicular blocks are performed at what level of the brachial plexus?
At the level of the divisions
29
What type of block is performed at the level of the cords and is indicated for elbow forearm and hand surgery?
Infraclavicular
30
What type of block is performed at the level of the terminal branches for elbow forearm and hand surgery?
Axillary
31
How is a bier block performed?
By inserting IV catheter distally, inflating a double pneumatic tourniquet, wrapping the arm in eschmark elastic bandages and injecting 50mL of 0.5% lidocaine
32
What type of block would be performed for surgery on the hip anterior thigh and knee?
Lumbar plexus block
33
What nerves does the lumbar plexus block cover?
Femoral nerve
Lateral femoral cutaneous nerve
Obturator nerve
34
The femoral nerve is medial or lateral to the artery?
Lateral
35
Femoral nerve blocks are performed for what types of surgeries?
Knee surgeries
Femoral ORIF
Surgery involving the medial aspect of the leg
36
What is the largest sensory branch of the femoral nerve?
Saphenous nerve
37
What is the largest nerve of the leg?
Sciatic nerve
38
The sciatic nerve is composed of what 2 nerves?
Tibial nerve and common peroneal nerve
39
What are the two common approaches to a sciatic nerve block?
Popliteal fossa and subgluteal
40
What type of block is performed for foot and toe surgeries?
Ankle block
41