Regional- Epidural Neural Blockade Flashcards Preview

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

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

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

 

Epidural

 

2

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

midline lunbar region

b/c spinal cord ends @ L1 in adlt

3

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

 

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

where can epidurals be placed (anatomically)

Cervical

Thoracic

Lumbar

Sacral

5

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

1) it will "bounce" odd the dura (less chance of PDPH)

2) guides catheter upward (cephalad)

6

What is a disatvantage of the Crawford (cutting) needle

Increased chance of PDPH

7

what type of epidural is the crawford good for

thoracic

8

what is special about the weiss needle

winged tiped

9

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

Inadequate analgesia

10

Multi orfice catheters have a higher incidence of what complication

IV cannulation

11

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

  • Prilocaine
  • Mepivacaine
  • Bupivacaine
  • Chloroprocaine
  • Ropivacaine
  • Lidocaine

 

 

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

 

 

12

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

 

13

onset

duration of action

14

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

Diffusion

15

advantages of spinal over epidual

Less time to perform

Rapid onset

Sensort and motor block quality better

Less pain during sx

16

Advantages of epidural over Spinal

Less risk of PDPH

less hypotension

Can prolong block with catheter

Cath for post op pain

17

Name the structures the needle passes through for an epidural block

Skin
Subcutaneous
Supraspinous ligament
Intraspinous ligament
Ligamentum flavum
epidural space

18

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

4-6 cm

19

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

up to 8 cm

20

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

 

3 cm

21

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

loss on temp sensation

22

what is the best way to assess temp sensory loss

Alcohol swab

23

what is the most accurate assessment of overall sensosry block

pinprick

24

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

25

name complications of Epidural

  • 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

S/S of epidural hemotoma

Sharp back pain

Leg pain

Leg numbness

motor weakness

Sphincter dysfuntion

Classic sign- block wears off and come back

27

treatment for epidural hemotoma

Stat MRI

Neuro consult

Surgical decompression in 8-12 hours

28

Caudal Epidural:

needle insertion is through what?

the sacrococcygeal membrane

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