Peripheral Nerve Blocks

Question 1

What class of drug includes bupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine?

Answer 1

Amides

Question 2

What is the maximum dose and duration for bupivacaine?

Answer 2

Max dose = 3 mg/kg

duration = 1.5 to 8 hours

Question 3

What is the maximum dose and duration for lidocaine?

Answer 3

Max dose = 4.5 mg/kg (7 w epi)

duration = 0.75 to 2 hours

Question 4

What is the maximum dose and duration for mepivacaine?

Answer 4

Max dose = 4.5 mg/kg ( 7 w epi)

duration = 1 to 2 hours

Question 5

What is the maximum dose and duration for ropivacaine?

Answer 5

Max dose = 3 mg/kg

duration = 1.5 to 8 hours

Question 6

What drug can be added to lidocaine in mepivacaine to prolong their action?

Answer 6

Epinephrine

Question 7

Benzocaine, chloroprocaine, cocaine, procaine, and tetracaine all fall into what category of drugs?

Answer 7

Esters

Question 8

It is more common to have an allergic reaction to amides or esters? why?

Answer 8

Esters

PABA

Question 9

A toxic dose of benzocaine can cause what?

Answer 9

Met hemoglobinemia

Question 10

How is met hemoglobinemia treated?

Answer 10

Methyline blue

Question 11

Why is epinephrine added to local anesthetics?

Answer 11

Intravascular marker
improves quality of block
decreases absorption (prolong action)
vasoconstriction on surgical field

Question 12

What are the three major risks of nerve blocks?

Answer 12

Systemic toxicity
infection
peripheral nerve damage

Question 13

What is LAST?

Answer 13

Local anesthetic systemic toxicity

Question 14

Which CNS symptoms come first C&S excitation or CNS depression?

Answer 14

CNS excitation

Question 15

What are the cardiovascular effects of LAST?

Answer 15

Depression of myocardial conduction and contractility

production of arterial vasodilatation

Question 16

How can LAST be prevented?

Answer 16

Incremental injection
Frequent aspiration
Adding a marker
Limiting local anesthetic dose and concentration
Communication with the patient

Question 17

How is LAST treated?

Answer 17

Seizures: Versed, propofol, thiopental
Cardio/pulmonary symptoms: airway management
ACLS/BLS
Intralipid infusion
CP Bypass

Question 18

How is Intralipid administered?

Answer 18

1.5 mL/kg as an initial bolus followed by .25 mL/kg/min for 30 to 60 minutes

Question 19

Name three techniques for placement of blocks

Answer 19

Ultrasound technique
Peripheral nerve stimulator
Paresthesia technique

Question 20

The brachial plexus stems from what roots?

Answer 20

C5-8, T1

Question 21

Name the five main branches of the brachial plexus?

Answer 21

Musculocutaneous 
axillary 
Radial 
 median 
Ulnar

Question 22

Name the three main nerves or groups of nerves that are in Close proximity to the brachial plexus

Answer 22

Superficial cervical plexus
Phrenic nerve
Intercostal brachial nerve

Question 23

What are the main approaches to the brachial plexus?

Answer 23

Interscalene
Supraclavicular
Infraclavicular
Axillary

Question 24

What type of block is most commonly done for shoulder, humorous and clavicle procedures?

Answer 24

Interscalene block

Question 25

What area is commonly missed by an interscalene block?

Answer 25

C8-T1 ulnar nerve

Question 26

In what patients would you be most concerned with the possibility of phrenic nerve palsy?

Answer 26

``` Ascites Pregnant COPD Respiratory depression Oxygen dependent Obese ```

Question 27

What type of block would you perform for surgeries for the entire arm below the level of the shoulder?

Answer 27

Supraclavicular block

Question 28

Supraclavicular blocks are performed at what level of the brachial plexus?

Answer 28

At the level of the divisions

Question 29

What type of block is performed at the level of the cords and is indicated for elbow forearm and hand surgery?

Answer 29

Infraclavicular

Question 30

What type of block is performed at the level of the terminal branches for elbow forearm and hand surgery?

Answer 30

Axillary

Question 31

How is a bier block performed?

Answer 31

By inserting IV catheter distally, inflating a double pneumatic tourniquet, wrapping the arm in eschmark elastic bandages and injecting 50mL of 0.5% lidocaine

Question 32

What type of block would be performed for surgery on the hip anterior thigh and knee?

Answer 32

Lumbar plexus block

Question 33

What nerves does the lumbar plexus block cover?

Answer 33

Femoral nerve Lateral femoral cutaneous nerve Obturator nerve

Question 34

The femoral nerve is medial or lateral to the artery?

Answer 34

Lateral

Question 35

Femoral nerve blocks are performed for what types of surgeries?

Answer 35

Knee surgeries Femoral ORIF Surgery involving the medial aspect of the leg

Question 36

What is the largest sensory branch of the femoral nerve?

Answer 36

Saphenous nerve

Question 37

What is the largest nerve of the leg?

Answer 37

Sciatic nerve

Question 38

The sciatic nerve is composed of what 2 nerves?

Answer 38

Tibial nerve and common peroneal nerve

Question 39

What are the two common approaches to a sciatic nerve block?

Answer 39

Popliteal fossa and subgluteal

Question 40

What type of block is performed for foot and toe surgeries?

Answer 40

Ankle block

Question 41

Which nerves are blocked in the ankle block?

Answer 41

``` Deep peroneal Superficial peroneal Posterior tibial Sural Saphenous ```