Regional- Epidural Neural Blockade Flashcards Preview

► Med Misc 44 > Regional- Epidural Neural Blockade > Flashcards

Flashcards in Regional- Epidural Neural Blockade Deck (28)
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1
Q

what type of block is a caudal? (spinal/epidural)

A

Epidural

2
Q

the safest point of entry into the epidural spae is where and why?

A

midline lunbar region

b/c spinal cord ends @ L1 in adlt

3
Q

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

A

1-2 mL

Ex if you want to block T4 from L4-5. this is 12 segments to reach T4. 12 x 1-2mL segment = 12-24mL of agenet

4
Q

where can epidurals be placed (anatomically)

A

Cervical

Thoracic

Lumbar

Sacral

5
Q

what are 2 advantages of the curved epidural needles (touhy and husteab)

A

1) it will “bounce” odd the dura (less chance of PDPH)
2) guides catheter upward (cephalad)

6
Q

What is a disatvantage of the Crawford (cutting) needle

A

Increased chance of PDPH

7
Q

what type of epidural is the crawford good for

A

thoracic

8
Q

what is special about the weiss needle

A

winged tiped

9
Q

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

A

Inadequate analgesia

10
Q

Multi orfice catheters have a higher incidence of what complication

A

IV cannulation

11
Q

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

  • Prilocaine
  • Mepivacaine
  • Bupivacaine
  • Chloroprocaine
  • Ropivacaine
  • Lidocaine
A
  1. Chloroprocaine fast
  2. Prilocaine Fast
  3. Lidocaine Intermediate
  4. Mepivacaine Intermediate
  5. Bupivacaine slow
  6. Ropivacaine Slow
12
Q

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

A
  • 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

13
Q

onset

A

duration of action

14
Q

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

A

Diffusion

15
Q

advantages of spinal over epidual

A

Less time to perform

Rapid onset

Sensort and motor block quality better

Less pain during sx

16
Q

Advantages of epidural over Spinal

A

Less risk of PDPH

less hypotension

Can prolong block with catheter

Cath for post op pain

17
Q

Name the structures the needle passes through for an epidural block

A

Skin
Subcutaneous
Supraspinous ligament
Intraspinous ligament
Ligamentum flavum
epidural space

18
Q

what is the avg distance from skin to epidural space in adult

A

4-6 cm

19
Q

what is the avg distance from skin to epidural space in obese

A

up to 8 cm

20
Q

what is the avg distance from skin to epidural space in thin person

A

3 cm

21
Q

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

A

loss on temp sensation

22
Q

what is the best way to assess temp sensory loss

A

Alcohol swab

23
Q

what is the most accurate assessment of overall sensosry block

A

pinprick

24
Q

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

A

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

25
Q

name complications of Epidural

A
  • Penetration of Blood vessel
  • Epidural Hemotoma
  • Dural puncture
  • Back pain
  • Neural trauma
  • Air embolism
  • Subdural cath
  • IV catheter
  • Infection
  • Headache
  • Hypotension
  • Respiratory depression
  • Horners sydrome
  • Total spinal
26
Q

S/S of epidural hemotoma

A

Sharp back pain

Leg pain

Leg numbness

motor weakness

Sphincter dysfuntion

Classic sign- block wears off and come back

27
Q

treatment for epidural hemotoma

A

Stat MRI

Neuro consult

Surgical decompression in 8-12 hours

28
Q

Caudal Epidural:

needle insertion is through what?

A

the sacrococcygeal membrane

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