Regional- epidural neural blockade Flashcards Preview

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Flashcards in Regional- epidural neural blockade Deck (16):
1

in adults you need ___ to __ mL of LA per segment being blocked

1-2 mLs per segment

2

Name 2 curved needles

Touhy (30 degree curve)

Husteab (15 degree curve)

3

Name a cutting needle

crawford (straight)

4

the use of catheters w/ epidurals have a lower incidence of what?

inadequate analgesia

5

place the Following in order of onset (fast to slowest)

Prilocaine

Mepivacaine

Bupivacaine

Chloroprocaine

Ropivacaine

Lidocaine

 

Chloroprocaine fast

Prilocaine Fast

Lidocaine Intermediate

Mepivacaine Intermediate

Bupivacaine slow

Ropivacaine Slow

 

6

place the following in order of duration from shortest to longest (for a bonus name how long about each last)

Prilocaine

Mepivacaine

Bupivacaine

Chloroprocaine

Ropivacaine

Lidocaine

Chloroprocaine 50-90 min

Prilocaine 90-130 min

Lidocaine 90-150 min

Mepivacaine 120-160 min

Bupivacaine 200-260 min

Ropivacaine 300-600 min

The faster the onset the shorter the duration

7

epidural relies on _____, thats why it is dependent on Volume

Diffusion

8

For intrathecal or epidural anesthesia LA's work on what 3 things

 

nerve rootlets

Nerve roots

Spinal cord

 

9

name the nerve fibers 6 total

  • B fibers
  • C fibers
  • A-delta
  • A- Gamma
  • A- beta
  • A- alpha

10

place the nerve fibers in order of blockade following epidural (also state if they are mylinated or unmylinated)

 

 

  1. B fibers (small mylinated)
  2. C and A-delta fibers (c-unmylinated)
  3. A- gamma (Large Mylinated)
  4. A-beta (Large Mylinated)
  5. A-alpha (Large Mylinated)

remember is by

S M

U M

L M

11

see picture to clearify the last slide on which nerves are blocked first and why

Surrounding thr outside of the root are B fibers (SM), immediatly interior to the B fibers (SM) are the C and A-delta fibers. The larger fibers A-gamma, A-beta, A-alpha (LM) are located at the core of the nerve bundle, Thus the LA first encounters the B fibers (SM), then the C and A-Delta fibers then the Large mylinated A fibers (A-delta, A-beta, A-alpha). 

 

12

what is the order of SENSITIVITY of the nerve fibers from most to least sensitive

 

  • LM (A-delta, A-beta, A-aplha)
  • Small mylinated (B-fibers)
  • Unmylinated (C-fibers)

 

Remember

L M

S M

U M

13

Name the structures the needle passes through for an epidural block

  1. Skin
  2. Subcutaneous
  3. Supraspinous ligament
  4. Intraspinous ligament
  5. Ligamentum flavum
  6. epidural space

14

what is the most sensitive indicator of initial onset of sensory block

loss of temp sensation

15

what is the most accurate assessment of overall sensory block

Pinprick

16

why do you perform a test dose after satisfatory placement of the epidural catheter?

a test dose is designed to detect both SA and IV injection