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Regional 1 > PNB Complications > Flashcards

PNB Complications Flashcards

1
Q

Higher incidence of neurologic injuries involve which blocks

A

Brachial plexus blocks

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2
Q

_______________ while doing a block is associated with high incidence of post op neurologic injury

A

Elicitation of paresthesia

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3
Q

What is more common with PNB

A

Transient neurologic dysfunction

Typically resolves with time

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4
Q

Most symptoms of PNB injury resolve when

A

Within 2-4 weeks

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5
Q

Surgeries associated with most complications r/t PNB

A

Rotator Cuff Repair

Carpal Tunnel Release

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6
Q

Patient characteristics associated with PNB injury

A

Preexisting neurologic disease**

DM **

Smoker

BMI extreme

Male

Elderly

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7
Q

Perioperative characteristics associated with PNB injury

A

Pain with injection***

Prolonged tourniquet time***

Positioning ***

Parenthesis with needle placement

Sedated during block

Hypothermia

Prolonged hospitalization

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8
Q

Barriers to PNI recognition

A

Sedation

Post op pain/analgesia

Regional anesthesia (failure to report, failure to peruse)

Patient periop naivety/uncertainty

Dressings,drains, casting ***

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9
Q

Types of neurologic injury

Mild

Recovery 2-3 weeks

A

Neuropraxia

Most common

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10
Q

Cause of neuropraxia

S/S

A

Hit nerve with needle- mild inflammation

No deficit in sensory or motor

Tingling or paresthesias

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11
Q

Types of neurologic injury

Severe

Regeneration 1mm/day

Recovery 6-12months

A

Axonotmesis

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12
Q

Causes of axonotmesis

A

Injury to nerve directly but not transected

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13
Q

Types of neurologic injury

Degeneration

Neuroma formation

Permanent and irreversible

A

Neurotmesis

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14
Q

Causes of neurotmesis

S/S

A

Complete disruption in axoplasmic flow

Sensory or motor in either direction disrupted

Aka Wallerian degeneration

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15
Q

Sunderland classification of nerve injury and prognosis

1
2
3
4
5
A

1- neuropraxia good

2- axonotmesis. Fair

3,4,5- neurotmesis poor

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16
Q

4 causes of neural injury

A

Mechanical

Ischemic

Chemical

Co-existing neurologic disease and comorbidities (obese, smoker, elderly)

17
Q

4 types of mechanical nerve injury

A

Needle contact

Intrafasicular injection

Compression

Stretch

18
Q

Needle angle to reduce intraneural injury

A

Tangential and long axis approach

19
Q

Does intraneural injection always cause neurologic dysfunction

A

No

20
Q

Chemical nerve injury MOA

A
  • all LA are neurotoxic
  • duration of nerve exposure to LA increases risk
  • pre-existing neural blood flow increases risk if low
  • adjuvants may have neurotoxic potential
21
Q

MOA for LA being causative agents for neurotoxic injury

A

Increase in cystolic Ca

Depletes ATP, mitochondrial injury, membrane dysfunction, cell death

22
Q

Which nerves more susceptible to neurotoxicity injury

A

Small diameter

Transmitting pain and temperature

23
Q

LA

Vasodilator to vasoconstrictor

A

Lidocaine(dilate)

Bupivacaine

Mepivacaine

Ropivacaine (constrict)

24
Q

All LA except______ have shown to reduce neural blood flow

A

Tetracaine

25
Q

Lidocaine 2% reduces neural blood flow by ______ when epi added

A

20-80%

26
Q

Doses of bupivacaine >0.5% have mild _______ action

A

Vasodilator

27
Q

Should always use __________ drugs for PNB

A

Preservative free drugs

28
Q

3 non LA drugs that have been shown to be neurotoxic at high doses

A

Ketamine

Midazolam

Dexamethasone (dose dependent)

29
Q

_____________ has been shown to be neuroprotective and may prolong block duration

A

Dexmedetomidine

30
Q

Which route of dexamethasone administration prolongs block more IV or PNB additive

A

Added to PNB

31
Q

Buprenorphine addition findings

A

Prolong by 8 hours

SIGNIFICANTLY INCREASES RISK OF PONV

32
Q

When doing PNB on diabetic pt you should

A

Reduce concentration and volume of LA in PNB

Eliminate adjuncts (especially epi)

33
Q

Pt undergoing chemo changes in PNB

A

Limit concentration, volume, and adjuncts

34
Q

Tips for performing PNB

A

Eval for pre-existing neurologic disease/disorder pre-op

Use lowest concentration and volume possible

Regional 1 (8 decks)

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