quiz 6

Question 1

Labs need to be what for regional block?

Answer 1

Platelets >100k

PT/INR, aPTT < 2x normal value

PT: 11 - 13.5
INR: 0.8 - 1.1
PTT: 25 - 35

Question 2

issue with pts who have preexisting nerve injuries?

Answer 2

can have prolonged or permanent block

Question 3

intrallipid dosing

Answer 3

1.5ml/kg/min bolus, max 8ml/kg

Question 4

which drug not a good motor blocker?

Answer 4

bupivicaine

Question 5

DOA of ropiv, bupiv, lido? with Epi?

Answer 5

Ropiv: 2-6h, N/A w/epi

Bupiv: 2-4, 3-4 w/epi

Lido: 30min-2h, up to 3h w/epi

Question 6

2% lido has how much per ml?

Answer 6

20mg per mL

just move decimal of percentage over 1 to get answer

Question 7

1:200,000 solution to Epi ratio?

Answer 7

take second number and divide 1 million into it so – 5 mcg/ml

Question 8

spraying local in an area to get the nerve, what technique?

Answer 8

field block technique

used for incision

Question 9

parasthesia technique?

Answer 9

Block needle is inserted in proximity of the target nerve or nerve plexus

When needle makes direct contact with a sensory nerve, a paresthesia is elicited and the LA is injected

Question 10

current and interval of nerve stimulator technique?

Answer 10

0-5 mA

1-2 Hz

Question 11

what implies intraneural needle placement?

what about close to nerve?

Answer 11

muscle contraction elicited at < 0.2 mA

less than 0.5 mA – close to nerve

Question 12

how much injected via nerve stimulator placement dose?

Answer 12

30-40 mL in divided doses with gentle aspiration

Question 13

Ultrasound uses high-frequency sound waves emitted from _____________ that travel at different rates through tissues of different densities, returning a signal to the transducer. Range?

Answer 13

piezoelectric crystals

1-20 MHz

Question 14

solid organs, deep structures have what echogenicity?

Answer 14

hypoechoic

Question 15

diaphragm, gallstones, bone, pericardium have what echogenicity?

Answer 15

hyperechoic

Question 16

fluid and blood filled structures have what echogenicity?

Answer 16

anechoic

Question 17

look at slide 18

Answer 17

.

Question 18

Nerves are best imaged in________ (_______)

Answer 18

cross-section

short axis

(seen as honeycomb appearance)

Question 19

The nerve appears as a single circular ________ structure with internal _________ circles

Answer 19

hyperechoic

hypoechoic

Question 20

preferred plane view?

Answer 20

longitudinal/in-plane alignment

Question 21

Advantages of Continuous PNB

Answer 21

Reduction in resting and dynamic pain
Reduction in supplemental analgesia requirements
Reduction in opioid related side effects
Reduction in sleep disturbance
Improved patient satisfaction
Improved patient ambulation
Accelerated resumption of passive joint range-of-motion
Reduced time to discharge

Question 22

Complications of Continuous PNB

Answer 22

Systemic local anesthetic toxicity
Catheter retention
Retroperitoneal hematoma
Infection
Increased risk of falling (femoral nerve catheter)
Nerve injury

Question 23

which LAs preferred for continuous and why?

Answer 23

Long acting

better effect on sensory and less effect on motor

Question 24

Brachial Plexus Blocks

Answer 24

Supraclavicular block
Interscalene block
Infraclavicular block
Axillary block

Question 25

Terminal Nerve Blocks

Answer 25

``` Digital nerve blocks Intercostobrachial nerve block Median nerve block Musculocutaneous nerve block Ulnar nerve block Radial nerve block ```

Question 26

intravenous regional anesthesia

Answer 26

Bier block

Question 27

interscalene block blocks what the most? good for what surgery? What area does injection happen?

Answer 27

c5-c7 involving the shoulder and the upper arm (not appropriate for surgery at or distal to the elbow) Roots

Question 28

what needs to be considered when doing a total shoulder and an interscalene block?

Answer 28

For complete surgical anesthesia of the shoulder, the C3-C4 cutaneous branches may need to be supplemented with a superficial cervical plexus block or local infiltration

Question 29

A properly performed interscalene block will invariably block the _______ ________ nerve – will block one side of diaphragm so don’t do double block

Answer 29

ipsilateral (same side) phrenic

Question 30

a condition marked by a contracted pupil, drooping upper eyelid, and local inability to sweat on one side of the face, caused by damage to sympathetic nerves on that side of the neck.

Answer 30

Horner's syndrome | myosis, ptosis, anhidrosis

Question 31

Other considerations with Interscalene block

Answer 31

- Horner's syndrome - RLN involvement - Vertebral artery involvment (immediate seizure) - Spinal or epidural injection (could get full spinal) - Pneumothorax

Question 32

where does brachial plexus come out b/w in neck?

Answer 32

B/w anterior and middle scalene muscle | interscalene triangle

Question 33

Supraclavicular block: Good for what surgeries? What is biggest risk? What area injected?

Answer 33

surgical procedures at or distal to the elbow Pneumothorax Divisions

Question 34

Complications of Supraclavicular block

Answer 34

- Horner’s syndrome - Ipsilateral phrenic nerve palsy in ~50% of patients - Pneumothorax - Subclavian artery puncture - Recurrent laryngeal nerve palsy

Question 35

Infraclavicular Block: What level blocked? What spared? What surgery?

Answer 35

Cords surgical procedures at or distal to the elbow The intercostobrachial nerve is spared (T2 dermatome)

Question 36

Axillary block: What nerves? What does it block? What level?

Answer 36

Median and Ulner entire arm distal to elbow distal portion of cords

Question 37

favored sites for terminal nerve blocks?

Answer 37

the elbow and the wrist

Question 38

Bier block: duration? Common surgery?

Answer 38

45-60 mins Carpel tunnel release

Question 39

look at slide 48

Answer 39

.

Question 40

Peripheral Nerve Blocks of the Trunk

Answer 40

Superficial Cervical Plexus Block Paravertebral Block Intercostal Block Transverse Abdominis Plane Block

Question 41

highest risk of toxicity?

Answer 41

Bier block d/t IV

Question 42

Horner’s syndrome - may result from proximal tracking of local anesthetic and blockade of sympathetic fibers to the ____________.

Answer 42

cervicothoracic ganglion

Question 43

For Axillary block: At the _______ border of the _________ muscle, the cords of the brachial plexus form large terminal branches

Answer 43

lateral pectoralis minor