Regional Flashcards
(38 cards)
Superficial Cervical Plexus block
5 - 15 mL
Stellate Ganglion Block
5 mL
Interscalene Block
Supine, head turned contralateral
Depth 1 - 4 cm
22 G 50 mm needle
10 mL 0.2% for analgesia, 15 -20 mL 0.5% for anaesthesia
Ulnar sparing
Stellate Ganglion cross section
Supraclavicular BP
20 - 25 mL
Infraclav BP
Supine, head contralateral, Shoulder abduction elbow flexion
20 - 30 mL
Axillary BP
Supine, arm abducted + elbow flexed
22 G 50 - 100 mm needle
15 - 25 mL
ESPB
T5 for thoracic/breast surgery, T10 for abdominal, L3 for L-spine surgery
NB Lumbar level- much thicker ES muscle
30 mL ~8 thoracic or 4 lumbar levels
Midaxillary TAP
Block nerves prior to lateral cutaneous lateral cutaneous branch origin
Ensure LA reaches point where TA muscle ends
25 - 30 mL each side
SEnsory block below umbilicus to pubis
Subcostal TAP
Not very useful- doesn’t cover lateral cutaneous branches of intercostal nerves. Only get midline strip of anaesthesia- not useful e.g. Chevron, nephrectomy
PECS I and II
PECS 1: Muscle implants or tissue expanders, Pec muscle surgery, minimally invasive cardiac surgery
PECS II: breast surgery T2 -T6
Arm abducted 90 deg
Probe oblique parasaggital over 3rd and 4rth ribs
10 mL in PECS I, 20 mL PECS II. Do PECS II first
Serratus Anterior Plane
Block lateral cutanous branches T2-9 intercostal nerves, LTN (winged scapula), TDN, ICBN
Anterior cutaneous branches spared
Supine, shoulder abducted. Probe transverse, 5th and 6th ribs Mid axillary line at nipple level. Needle anterior to posterior, inject beetween LD and SA muscles (Shallow) or deep to serratus. No evidence for one vs other
Up to 40 mL LA
Paravertebral Block
Combined USS and LORS technique
Out of plane easier with hydrodissection
Breast surgical anaesthesia do every level T2-6 4 - 5 mL. Analgesia: T4 25 mL 0.5% ropi
Catheter 3 -4 cm max
Rectus Sheath block
avoid inferior and superior epigastric arteries. Posterior sheath
In plane lateral to medial
20 mL each side 2 at level of umbilicus, 2 at midpoint between umbilicus and xiphoid
Arcuate line- posterior rectus sheath terminates- . 1/3 below umbi.
Quadratus Lumborum Block
30 mL each side should block most of anterolateral abdominal wall
Curvilinear probe transverse just cephalad to iliac crest
Hip flexed
Needle medial to lateral
QL approaches
Lateral similar to TAP
Posterior: fascial plane posterior to QL (hope local spreads anteromedially)
Anterior: LA between QL and PM. Most effective/best spread cephalad
Lumbar plexus
Suprainguinal FIB
probe parasagital just medial to ASIS, slide inferomedially along ligamient
AIIS forms back ponbe of recturs fermoris- bow tie
avoid DCIA
Needle below Ingional ligmaent (IL)
FIB/FNB
Obturator block
Subgluteal Sciatic nerve
PCFN block not guaranteed but can block in same region
Inferior gluteal artery good landmark for plane
Hip flex
Popliteal Sciatic nerve
20 mL
Save 5 -10 for saphenous
Ankle block
PT- Posterior to MM, TDANH, inject from post to ant
Saphenous- field block above MM
SPN- Field block over dorsum of foot
DPN- Lateral to DPA
Sural- by short saphenous
Wrist block
- 25 G needle
- Median: mid forearm volar between deep and superficial flexors, trace down to wrist. 3 mL. Or needle 1 cm deep between FCR and PL
- Ulnar nerve: Mid forerarm where separates from Ulnar artery just medial to ulnar artery, 3 mL LA. Below FCU
- Superficial radial nerve- immediately superficial to styloid process (just lateral to radial artery) (NB deep branch motor). Radial styloid process palpated , 5 mL LA SC from dorsum of wrist
- Ulnar dorsal cutaneous branc- in SC tissue between Ulnar styloid and FCU- infiltrate SC on way out of ulnar. block
- Lateral cutaneous nerve of forearm- may cross into thenar emininece- SC infiltration across lateral wrist crease
Nerve injury - main concern
Motor blcok minimial as most muscles are innervated higher
