Regional Anesthesia Flashcards
(58 cards)
What are the 5 components of brachial plexus?
5/3/6/3/5
What are the five terminal branches of the brachial plexus
Musculocutaneous (C5 - C7)
Axillary (C5 - C6)
Median (C5 - T1)
Radial (C5 - T1)
Ulnar (C8 - T1)
Where do the roots turn into trunks?
Just beyond the lateral border of the scalene muscles
Where do trunks turn into divisons
Under the clavicle and over the first rib
Where do divisions turn into cords
Pectoralis minor muscle
Where do cords turn into terminal branches
Axilla
Describe the sensory innervation of the upper extremity
The ventral portion is supplied by median, ulnar, musculocutaneous nerves = lateral and median cords
The dorsal portion is supplied by the radial and axillary nerves = posterior cord
How do you assess each branch of the brachial plexus?
PushER = radial nerve, triceps
PushEM= musculocutaneous, biceps
Pinch Em = median nerve, middle finger
Pinch U = ulnar nerve, pinky
What types of surgical procedures are well suited for a supraclavicular block?
upper arm, elbow, wrist, hand
not ideal for shoulder procedures b/c it does not reliably anesthetize the suprascapular nerve which arises from the proximal upper trunk
Describe the relationship between the terminal branches relative to the axillary artery
Musculocutaneous - anterior & lateral
Median - anterior & medial
Radial - posterior & lateral
Ulnar - posterior & medial
How do you block the radial nerve in the forearm?
LA btw biceps tendon and brachioradialis (3 - 4 mL)
How do you block the ulnar nerve at the elbow?
Flex elbow 90 degrees
Inject LA btw olecranon and medial epicondyle of the humerus (3 - 5 mL)
How do you block the median nerve at the forearm?
In the AC, inject LA mediaal to brachial artery. Brachial artery is medial to biceps tendon.
How do you block the ulnar nerve at the wrist
inject 3 - 5 mL medial to and below flexor carpi ulnaris tendon.
How do you block median nerve at wrist
5 mL btw flexor carpi radialis and flexor palmaris longuss
Bier block how much LA?
50 mL of 0.5% lidocaine
How long before tourniquet pain w/Bier Block?
25 mins (some texts say 45 - 60 mins)
2 hours max inflation time
When can you deflate the tourniquet?
20 mins
Name the 6 terminal branches of the lumbar plexus
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral Femoral Cutaneous
Obturator
Femoral
i invariably get lazy on fridays
Which nerve roots give rise to each nerve of lumbar plexus
2 from 1 - I, I, both L1
2 from 2 - G = L1, L2, L = L2, L3
2 from 3 = O & F L2 - L4
What nerves are covered with the psoas compartment block?
AKA lumbar plexus block
LFC, obturator, and femoral are covered
Describe the femoral triangle
SAIL
Sartorius
Adductor Longus
Inguinal Ligament
thoracic intercostal n.
ventral rami of spinal n T1 - T6
-innervates breast, chest, IC muscles
lateral pectoral n
C5 - C7
pec major
