Regional Final Flashcards by Jenn Weinschenk

Indications for Intercostal Block

thoracic or upper abdominal surgery
rib fractures
breast surgery

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Overview of Intercostal nerve blocks

need to perform blockade of two dermatomes above incision and two levels below
does not block visceral pain
does not provide adequate coverage for intraoperative anesthesia

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Landmarks for Intercostal block

angle of rib

(6-8 cm lateral to the spinous process)

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Risks of Intercostal block

Pneumothorax
local anesthetic toxicity
hematoma
nerve damage
epidural anesthesia

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Technique for Paravertebral

2.5 cm lateral to midline

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longest lumbar transverse process

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Trigeminal Nerve

[overview]

5th CN providing sensory innervation to face

preganglionic fibers exit brainstem and synapse with trigemincal (gasserian) ganglion
post-ganglionic fibers exit to form:
- V1 - opthalmic
- V2 - maxillary
- V3 - Mandibular

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most common trigeminal nerves to have pain

V2 (maxillary) and V3 (mandibular)

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carbamezapine

treats seizures and nerve pain

(especially trigeminal neuralgia)

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Complications of Trigeminal Nerve Block

intravascular injection (carotid)
persistent paresthesias
total spinal
profound facial numbness

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indications for Supraorbital block

lower forehead or upper eyelid

(blepheroplasty)

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amount of local anesthetic in Supraorbital block

2 - 3 mL

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injection of LA inside the cone of the eye provides anesthesia and akinesia of ___ and ____

globe and extraocular muscles

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Oculocardiac Reflex

[afferent]

trigeminal

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oculocardiac reflex

[efferent]

vagus nerve

increase in parasympathetic tone

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steps in oculocardiac reflex

pressure on eyeball

ciliary nerves and ciliary ganglion

gasserian ganglion

trigeminal sensory nucleus in 4th ventricle

vagus nerve

increase parasympathetic tone and bradycardia

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highest incidence of oculocardiac reflex

children

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Treatment of oculocardiac reflex

removal of stimulus

anti-cholinergics

check depth of anesthesia

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sensory anterior 2/3 of tongue

trigeminal

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sensory above vocal cords

internal branch of superior laryngeal nerve

(vagus)

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sensory posterior 1/3 of tongue

glossopharyngeal

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sensory below vocal cords

recurrent laryngeal nerve

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The recurrent laryngeal nerve innervates all muscles of the pharynx except _____

cricothyroid muscle

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innervation of cricothyroid muscle

external branch of the superior laryngeal nerve

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Transtracheal block indication

blunts gag reflex

nerves involved in gag reflex

afferent (CN IX) and efferent (CN X)

nerves in lumbar plexus

T-12 to L-4

nerves in femoral branch

L2 - L4

1= Femoral Artery 2= Femoral Nerve 3= Femoral Vein 4= Anterior Superior Iliac Spine 5= Inguinal Ligament 6=Sartorius

}In the PACU your patient complains of knee pain after a Total Knee Arthroplasty. A continuous femoral nerve block has already been placed. What do you do?

adductor canal block

Boundaries of Adductor canal block

sartorius vastus medialis adductur longus and magnus

Advantage of adductor canal block over femoral

sensory block only no motor fibers involved; good for athletes that need to recover quickly

Adductor canal block

Indications for Saphenous nerve block

saphenous vein harvesting or supplementation for medial foot/ankle surgery in combination with sciatic nerve block

saphenous nerve block

nerves in sciatic branch

L4 - S3

largest nerve in the body

sciatic

landmarks for sciatic nerve block

ischial tuberosity and greater trochanter

sciatic nerve block needle insertion

4cm distal to midpoint between ischial tuberosity and greater trochanter

branches of sciatic nerve

tibial and common peroneal

which nerve causes dorsiflexion?

common peroneal

which nerve causes plantarflexion?

tibial nerve

boundaries of popiiteal fossa

bicep femoris semi-tendenosis and semi-membranosus

Popliteal block if two nerves are seen (common peroneal and tibial) move caudally

Which is most appropriate combination of nerve blocks for knee arthroscopy with a tourniquet:

transgluteal sciatic nerve block and lumbar plexus block

(5) nerves in ankle block

* deep peroneal * posterior tibial * saphenous * superficial peroneal * sural

1. Saphenous 2. Deep Peroneal 3. Superficial Peroneal 4. Medial plantar Branch of Tibial 5. Lateral Plantar branch of tibial 6. Tibial 7. Sural

TAP

transversus abdominis plane

"triangle" in TAP block

latissimus dorsi external oblique iliac crest

indications for T.A.P.

large bowel resection appendectomy or cholecystectomy C-section renal transplant

TAP ultrasound

indications for fascia iliaca block

anterior thigh and knee surgery

TEG

Thromboelastogram

R parameter on TEG

clotting time | (reaction time)

reasons for elongated R parameter

slow enzymatic reaction factor deficiency or dysfunction residual heparin

The R value represents which of the following phases of hemostasis?

Activation of coagulation pathways and initial fibrin formation

alpha parameter

kinetics of clot formation

Which TEG parameters will best demonstrate the need for coagulation factors?

Maximum amplitude in TEG

represents clot strength

what do you give for a low MA?

platelets

pain assessment in children

oucher

dose of oral acetaminophen

10 - 15 mg/kg

dose of oral ibuprofen

5 - 10 mg/kg

dose of naproxen

5 mg/kg

IV dose of fentanyl

0.5 - 1 mg/kg

IV dose of morphine

0.1 mg/kg

EMLA

lidocaine and prilocaine cream * may cause methemoglobinemia in children \< 3 months of age

most commonly used anesthetic especially in children

bupivacaine

cardiotoxicity is ____ common than neurotoxicity in children

signs of cardiotoxicity

increased HR and NP increased amplitude of T-waves on EKG

infants spinal cords end at \_\_\_\_

neuropraxia

blunt injury to nerve * myelin damage * conduction slowing

axonotmesis

loss of axonal continuity * endoneuriu intact * no conduction

neurotmesis

complete interruption of the entire nerve * loss of axonal and endoneurial continuity

delay between neuraxial block and heparin

1 hour remove epidural 2 hours after last heparin dose

Lovenox

low-molecular weight heparin * activates anti-thrombin accelerating interaction with factor Xa and thrombin

difference between Type I and II CRPS

type II has a defined nerve injury

TENS

transcutaneous electrical nerve stimulation

which nerve is spared in a 3-1 block?

obturator

nerves in obturator block

L2 - L4

Myasthenia Gravis {overview}

resistant to Sux * may be on pyridostigmine therapy * destroy ACh receptors at neuromuscular junctions

Multiple Sclerosis [overview]

demyelinating disease of the CNS * do **_NOT_** perform spinal/epidural

Regional Final Flashcards

(84 cards)