Regional/Neuraxial Flashcards
(306 cards)
1
Q
What forms the anterior portion of the vertebral arch
A
Vertebral body.
2
Q
What part of the vertebrae is palpated during spinal assessment
A
Spinous process
3
Q
Which type of cartilage covers the articular surface of the facet joints and permits a gliding motion between cartilage
A
Hyaline cartilage
4
Q
The cervical and thoracic spinous process project in which direction to provide stabilization and protection to the spinal column
A
Caudal
5
Q
The lumbar spinous process project in which direction allowing for easier access for needle placement
A
Posterior
6
Q
Caudal anesthetics are accomplished through the palpation of what
A
Sacral cornua
7
Q
What three ligaments aid in the placement of spinal and epidural anesthetics
A
Spinous ligament, intraspinous ligament, ligamentum flavum
8
Q
Which spinal ligament connects the apices of the spinous process. It is thick and serves as the major ligament in the cervical and upper thoracic regions
A
Supraspinous ligament
9
Q
Which spinal ligament runs between spinous processes
A
Intraspinous ligament
10
Q
Which ligaments are the strongest, they join the vertebral arches through vertical extensions of adjacent lamina. They run caudad from the inferior border of one lamina to the upper border of the lower lamina
A
Ligamentum flavum
11
Q
Which ligament is responsible for upright posture
A
Ligamentum flavum
12
Q
What are the support tissues that provide a protective covering for the cord and nerve roots from the foramen magnum to the base of the cauda equina
A
Meninges
13
Q
What are the layers of the meninges called from internal to most external
A
Pia, arachnoid, dura mater
14
Q
Spinal cord nerve roots exit through what
A
Intervertebral foramen
15
Q
Which meningeal space is filled with CSF
A
Subarachnoid
16
Q
Which meningeal layer is in contact with the outer layer of the spinal cord
A
Pia
17
Q
What is the potential space outside the dural sac but inside the vertebral canal and is continuous from the base of the cranium to the base of the sacrum at the sacrococcygeal membrane
A
Epidural space
18
Q
Which space contains fat that acts as a pad and lubricant for movement of neural structures
A
Epidural space
19
Q
What is the average distance from skin to lumbar epidural space using a midline approach
A
5cm (2.5-8cm)
20
Q
Where is the epidural space the largest
A
Midline of the midlumbar region at 5-6cm
21
Q
The epidural space in what region is only 1.5-2mm
A
Cervical
22
Q
The epidural veins are most prominent in the _____ portion, making ____ needle approach more safe
A
Lateral, midline
23
Q
The potential for injury or accidental cannulation of epidural veins is more common in obese and pregnant women due to what physiological alterations
A
Engorged and swollen epidural veins from increased abdominal pressure
24
Q
Which segments of the vertebral column have posterior (concave) curvatures
A
Thoracic and sacral
25
Which segments of the vertebral column have anterior (convex) curvatures
Cervical and lumbar
26
In the supine position, the apex of the lumbar curve occurs where
L3-L4
27
Lateral curvature of the spine
Scoliosis
28
Excessive posterior curvature or hump
Kyphosis
29
Hollowing of the back in obesity and pregnancy
Lordosis
30
Level of dermatomal sensory block can be determined by what methods
Scratch or temperature sensation
31
What is the primary site of action of local anesthetics
Nerve roots within the spinal cord
32
LA's affect nerve transmission by inhibiting what type of ion channel
Sodium
33
Do LA's inhibit neural transmission to the brain
No, there is neuronal transmission but no sensory perception
34
What is a differential block
Blockade of autonomic transmission, but not sensory or motor.
35
How does LA injected into the epidural space travel to get to the site of action
Bulk flow, NOT DIFFUSION, noncircumferential spread
36
What is considered the more dense neuraxial anesthetic
SAB
37
How can we make epidural a more dense block
Allow time, increase volume, increase concentration
38
What is selective anesthesia
Injecting small amount of LA into the subarachnoid space that directly supply nerve roots to the surgical site.
39
Which LA can produce single lower limb anesthesia
Hyperbaric bupivicaine
40
What level block is required for TURP
T10
41
Spinal anesthesia for TURP decreases the risk of what
Bladder overdistension and rupture
42
What type of LA should be used for patients in the jackknife or prone position for perianal procedures
hypobaric (LA will rise to the upright sacrum and coccyx
43
What two adjuncts can be added to spinal anesthesia to increase the duration
Opioids, A-2 agonists like clonidine
44
What preoperative findings are contraindications to spinals
Increased ICP, coagulopathy skin infection at the site, hypovolemia, spinal cord disease, hypertropic cardiomyopathy, aortic stenosis, long surgical time.
45
Epidural placement in a patient with increased inter cranial pressure increases the risk of what
Herniation
46
What are some spinal anatomy relative contraindications to spinal anesthesia
Kyposcoliosis, arthritis, osteoporosis, fusion and scaring of the vertebrae.
47
What is the most prevalent cause of peripheral polyneuropathy
DM
48
What are potential causes of the double crush phenomenon
Epi in the LA, needle trauma, toxic reaction from the LA
49
If the patient has a normal coagulation profile preop this medication is safe to give as a continuous infusion intraop after receiving a spinal anesthetic
Heparin
50
What is the median time to onset of neurologic dysfunction after initiation of LMWH
3 days
51
What is the most common causative organism in epidural abscess
staph. Aureus
52
Irritation to the meninges by foreign substances causes what two complications
Arachnoiditis and aseptic meningitis
53
What are the names of the cutting needles
Quincke, Greene, and Pitkin
54
What are the names of the non-cutting needles
Sprottle, Whitacre, and Pencan
55
What is the size range of spinal needles
22-29 gauge
56
What is the most popular spinal needle gauge and length
25-27G gauge, 3.5 inch long
57
To minimize the risk of PDPH, the bevel of the needle should be inserted _____ to the longitudinal dural tissue fibers to minimize risk of PDPH
Parallel
58
The line formed between the tops of the iliac crests
Tuffiers or intercristal line
59
Spinal anesthetic skin prep should be in contact with the skin for at least how long before dried residue can be wiped off
1 minute
60
Wiping excess skin prep off the patients skin reduces the risk of what
Chemical arachnoiditis
61
Removing excess iodine with what solution reduces the iodines antiseptic effect
Alcohol
62
An introducer should not be inserted to the depth of what spinal tissue layer
Subarachnoid
63
The average depth to the epidural space and dura is typically how much
4-5cm, rarely up to 9cm
64
If an introducer is inserted into the subarachnoid space it is likely to cause what
PDPH
65
After breaching the subarachnoid space, and return of CSF, the needle can be rotated how much to confirm the needle is in the subarachnoid space
360 degrees in 90 degree increments
66
Bracing the spinal needle against the patient back with the non dominant hand is called what
Bromage grip
67
Which approach to neuraxial anesthetic is often easier in arthritic and elderly patients
Paramedian, to avoid calcified interspinous ligaments
68
Which interspace has the largest interlaminar space
L5
69
Which approach to neuraxial is best for pelvic and perineal surgical procedures
Taylor approach
70
The specific gravity of CSF is affected by what two things
Protein level, glucose levels, uremia, temperature,
71
What decreases CSF specific gravity
Liver disease and jaundice (due to bilirubin in the CSF), warm temperature,
72
An increase of 1 degree Celsius, changes the specific gravity of CSF by how much
0.001 decrease
73
What is the resting position of two fluids with different specific gravities called
baracity
74
When the ratio of specific gravity to local anesthetic to patient CSF equals 1, the Local anesthetic is considered
Isobaric
75
When the ratio of specific gravity to local anesthetic to patient CSF is less than 1, the Local anesthetic is considered
Hypobaric
76
When the ratio of specific gravity to local anesthetic to patient CSF is more than 1, the Local anesthetic is considered
Hyperbaric
77
What direction to hypobaric and hyperbaric LA's travel in the CSF
Hyperbaric sinks, Hypobaric rises
78
What solution are hypobaric and hyperbaric solutions mixed in
Hyperbaric dextrose, Hypobaric water, Isobaric saline
79
What factors related to spread of LA in the CSF can we control (4)
Dose, injection site, baracity, position of the patient
80
What determines the duration of the spinal anesthetic
LA chosen, and total dose
81
Highly ___ bound LA's have a long duration of action
Protein bound
82
Which LA's are highly protein bound leading to long duration of action
Tetracaine, bupivicaine, ropivicaine
83
Which LA's are less protein bound, leading to a shorter duration of action
Lidocaine and mepivicaine
84
What medication increase the duration of action of LAs
Epi, 0.1-0.2mL of 1:1000 (1mg/mL)
85
How does epi increase the duration of action of LA's
Causing vasoconstriction and preventing washout or uptake into the circulation
86
The addition of epinephrine is most appreciated with which LA
Tetracaine, less with lidocaine, and minimal with bupivicaine
87
What is the dose of fentanyl added to LA
25-50mcg
88
What is the dose of sufentanil added to LA
2.5-10mcg
89
What is the dose of morphine added to LA
250mcg
90
What is the dose of clonidine added to LA
150mcg
91
Fentanyl, sufentanil, morphine and clonidine act at which receptors
Opioid and a-2 adrenergic receptors
92
Increasing the dose of hyperbaric bupivicaine from 10mg to 15mg prolongs the duration of the sensory block by how much
50%
93
Hyperbaric solution injected while in the sitting position during and after block will cause what
Saddle block
94
Continuous spinal anesthetic catheters should be inserted to what depth into the subarachnoid space
2-3cm
95
What are symptoms of cauda equina syndrome
LE weakness, bowel and bladder dysfunction, persistent paralysis
96
Which LA is the most common culprit of cauda equina syndrome and transient neurologic syndrome
5% lidocaine
97
Pain the radiates to both legs originating in the gluteal region is called what
Transient neurologic syndrome
98
What is the onset and duration of transient neurologic syndrome
Onset within 24 hours, duration of 10 days
99
What is the treatment of transient neurologic syndrome
NSAID's and sometimes opioids
100
What explains differential blockage of spinal anesthetics
Neurons having different levels of susceptibility to LAs.
101
Order proprioception, pinprick, and temperature in the correct differential blockage
Proprioception, light touch, cold sensation, pinprick
102
Describe differential blockage height for autonomic, sensory and motor block
Autonomic is 2-7 dermatomes higher then sensory, and sensory is 2 dermatomes higher than motor block.
103
Somnolence from neuraxial anesthesia is caused by decreased sensory input to which area of the brain
Reticular activating system
104
What are the effects of sympathetic blockade
Arterial vasodilation, decreased SVR, venous pooling, reduced venous return
105
What is the fluid bolus dose, pre-neuraxial anesthetic to prevent hypotension
15mL/kg, 15 minutes before neuraxial placement
106
Which medication can block the reflexive decrease in heart rate caused by sympathetectomy, blocking bradycardia and hypotension
5-HT3 antagonist ondansetron 4-8mg
107
What medication should be used to treat symptomatic bradycardia caused by neuraxial anesthesia
Ephedrine 5-10mg
108
Which respiratory dynamics are not affected by neuraxial (4)
Tidal volume, rate, minute ventilation, ABG tensions
109
Neuraxial anesthesia affects which muscles of respiration
Intercostals and abdominal muscles
110
How does neuraxial affect the GI system
Increased peristalsis, decreased sphincter tone, increased intraluminal pressure, increased GI blood flow, increase PNS tone
111
GI hyperperistalsis and parasympathetic dominance causes what
Increased risk of Nausea and vomiting
112
What causes PDPH
Leak in the CSF from neuraxial catheter placement, there is loss f hydraulic pressure causing the brain to drop into the foramen magnum and create tension on the meninges and tentorium.
113
What vasconstrictor drugs help treat PDPH
Caffeine and theophylline
114
What type of spinal needle has the highest risk of PDPH
16 Touhy
115
Contributing factors for PDPH include
Anxiety, lack of sleep, hypoglycemia, lack of morning caffeine
116
Pain severity scores are not improved in PDPH with which of the following medications: Gabapentin, theophylline, hydrocortisone, sumatriptan
Sumatriptan
117
What is the definitive treatment for PDPH
Blood patch
118
Blood injected for a epidural blood patch will spread in which direction
Cephalad
119
What are some triggers for identifying when enough blood has been injected for a epidural blood patch
Pressure ***********, back or legs, about 12-15mL
120
Nausea during neuraxial anesthesia can be attributed to cerebral ischemia which activates which area of the brain
Medulla
121
Which medication added to spinal anesthetics increases the risk of PONV
Epinephrine, intrathecal morphine
122
Urinary retention after neuraxial is increased in patient who received what
Long acting LAs, adding epi, epidural analgesia
123
Cardiac arrest during spinal anesthetic is likely due to what
Decrease in preload leading to bradycardia
124
A decrease in preload during neuraxial activates which 3 reflex responses
Pacemaker stretch, baroreceptors, and Bezold-jarisch
125
Complications of neuraxial anesthesia in the head include
Horners syndrome and CN5 palsy
126
Before diffusing into the CSF and leak in to the paravertebral space, epidurals must first spread to which regions
Dural cuff
127
Initial blockade from epidural is likely due to blockade of what
Spinal roots within the dural sleeves
128
Epidural anesthesia is dependent on what
Diffusion
129
Which type of epidural catheters have higher incidence of IV cannulation, but lower incidence of inadequate analgesia
Multiport
130
To reduce the incidence of epidural catheter failure, they should be inserted to at least what depth
3cm, 3-5cm
131
The stylet of a epidural needle is removed when seated in which ligament
Ligamentum flavum
132
Aspiration of a hanging drop on the epidural needle signifies what
Needle entered the epidural space
133
What can persistent paresthesias after epidural potentially cause
Nerve root damage or death, and long-term morbidities
134
Which spinal needle is used for paramedic approach, or thoracic insertion
Crawford
135
What are the two most important factors for determining the extend of dermatome block
Dose and site of injection
136
What is the suggested volumes of LA per dermatome in the cervical and thoracic regions
0.7-1mL per dermatome
137
What is the suggested volumes of LA per dermatome in the lumbar region
1.25-1.5mL per dermatome
138
Rapid injection of LA in the epidural space can increase what pressures
CSF, headache, inter cranial
139
In order to better control level of anesthetic and sympathectomy, how should epidurals be given
3-5mL every 3 minutes
140
Opioids injected into the epidural space need to diffuse to their receptors located where
Substantia gelatinosa of rexed lamina 2 or 3
141
Do hydrophilic or lipophilic opioids have a faster onset
Lipophilic
142
What is the typical time to maximal spread of epidural
10-25 minutes
143
Redosing of epidural is indicated if the initial dermatome level has decreased by how many levels
1-2
144
Which LA are most likely to cause tachyphylaxis
Short acting amides - lidocaine or mepivacaine
145
Which form of loss of resistance more commonly causes missed dermatome spread
Air
146
What is the order of needle insertion to CSE two-level technique
Epidural needle first, then spinal 1-2 interspaces lower
147
How do you perform a single level CSE
Insert a epidural needle, then insert a spinal needle through the epidural needle
148
Trauma to interspinous ligaments is increase with which needle for CSE due to large needle size
Eldor
149
What are appropriate LAs for the spinal component of CSE
5% lidocaine (isobaric or hyperbaric), hyperbaric 0.75% bupivacaine, iso- or hyperbaric 1% tetracaine
150
What are appropriate LAs for the epidural component of CSE
2% lidocaine, 0.5% or 0.75% bupivacaine, 2 or 3% 3-chloroprocaine, 1% ropivacaine
151
A CSE is most appropriate in which surgical patient population
Obstetrics
152
How does epidural after spinal CSE affect spinal level of block
Epidural compresses the subarachnoid space - increasing the spread. Epidural leaks into the subarachnoid space via the dura puncture - increasing spread.
153
PDPH risk is increased or decreased with CSE
Decreased
154
Caudal anesthetics, after acting on the sacral area will act like what
An epidural
155
What procedures are caudal anesthetics used for
Perirectal, urologic, and LE
156
Can a 20 gauge IV needle can be used for caudal anesthesia
TRUE
157
What is the dose of caudal anesthetic to achieve a umbilicus block in peds
0.5-1mL/kg
158
What is the dose of clonidine added to caudal LA
1mcg/kg, same effect as opioids
159
What is the adult dose of caudal LA for sacral anesthesia? Up to T10?
12-15mL, 20-30mL
160
What is the preferred method of anesthesia for obstetrics
Regional
161
What are the absolute contraindications to regional
Patient refusal, uncorrected anticoagulation, infection at injection site
162
What are two relative contraindications to regional related to infection
Sepsis and systemic infection
163
Allergies to LAs is typically an allergy to what
Preservatives or metabolic products of LA hydrolysis
164
What are general complications of regional
LAST, nerve injury, vascular injury, hematoma, or infection
165
As you approach the nerve bundle, the amount of amplitude should increase or decrease
Decrease
166
Motor response with 0.2mA indicates what
Intraneural needle placement
167
Which area of negative electrode placement may cause a falsely elevated twitch response
Directly over the nerve path
168
What is the frequency of ultrasound wavelengths
2-13mHz
169
What type of probe should be used for structures less than 4cm deep to the skin
High frequency 10-13 MHz
170
What does the vertical axis on ultrasound represent
Distance from the ultrasound probe
171
What is the horizontal axis on ultrasound represent
Distance to the right or left of the center of the probe
172
What do hyperechoic tissues reflect
Large amount of waves coming back to the probe, appear white
173
What do hypoechoic tissues reflect
Small amount of waves coming back to the probe, appear grey
174
What do anechoic areas represent
Black, do not reflect ultrasound waves
175
What explains difference in ultrasound reflection during ultrasound
Acoustic impedance
176
Does bone or soft tissue have greater acoustic impedance
Bone
177
In a short axis view, how do nerves and vessels appear on ultrasound
Circles
178
In a long axis view, how do nerves and vessels appear on ultrasound
Linear view
179
What needle approach allows the entire length of the needle to be viewed on ultrasound
In-plane or axial/longitudinal
180
What needle approach shows the needle as a hyperechoic dot on ultrasound
Out of plane or tangential/short
181
What does ART stand for
Alignment, Rotation, Tilting
182
Where do roots turn to trunks
Lateral to the scalene muscles
183
Which roots form the superior trunk
C5, C6
184
Which roots form the middle trunk
C7
185
Which roots form the inferior trunk
C8, T1
186
What may be the cause of patchy blocks within shealths
Septa (they isolate nerves)
187
Where do the trunks divide into divisions
Under the clavicle and over the first rib
188
What divisions supply the ventral and dorsal portions of the arm
Anterior divisions supply the ventral (flexor) portion, posterior supply the dorsal (extensor) portion
189
Posterior divisions combine to form which cord
Posterior
190
Anterior divisions of the superior and middle trunks combine to form which cord
Lateral
191
Anterior divisions of the inferior trunk forms which cord
Medial
192
The lateral cord becomes which terminal branch
Musculocutaneous, and median
193
The medial cord becomes which terminal branch
Ulnar and median
194
The posterior cord becomes which terminal branch
Axillary and radial
195
Branches of which cords supply the ventral portion of the upper extremity
Lateral and medial
196
Branches of which cords supply the dorsal portion of the upper extremity
Posterior
197
Which nerves supply the ventral portion of the upper extremity
Median, ulnar, musculocutaneous
198
Which nerves supply the dorsal portion of the upper extremity
Radial and axillary
199
Which nerve is the major supply to the dorsal extensors muscles
Radial
200
Which nerve supplies sensory innervation to the extensor region of the arm forearm and hand
Radial
201
Which nerve supplies the flexor muscles such as the biceps, brachioradialis, and coracobrachialis
Musculocutaneous
202
Which nerve supplies sensory innervation to the lateral aspect of the forearm between the wrist and elbow
Musculocutaneous (lateral antebrachial cutaneous nerve)
203
Which nerves provide motor and sensory innervation to the forearm and hand
Median and ulnar
204
Which nerve supplies most of the flexor and pronator muscles of the forearm
Median
205
Which nerve supplies sensory innervation to the ventral portion of the thumb, 1st and 2nd fingers, palm, and lateral 3rd finger
Median
206
What nerve supplies motor innervation to most of the small flexor muscles of the hand
Ulnar
207
Sensation to the medial 3rd finger, 4th finger, and remaining palm is which nerve
Ulnar
208
Which block provides a lower likelihood of tourniquet pain and reliable block of the musculocutaneous and axillary nerves
Infraclavicular
209
The interscalene block spares which nerve
Ulnar
210
Where is Chassaignac's tubercle palpated
Cricoid cartilage ring just below the thyroid cartilage, C6
211
Which blood vessel overlies the interscalene groove at C6
External jugular vein
212
What type of motor response indicated the needle is within the brachial plexus sheath
Fade of the motor twitch
213
Which nerve is blocked during interscalene and results in ipsilateral diaphragmatic hemiparesis
Phrenic
214
The brachial plexus of the interscalene block is between which two muscles
Anterior and middle scalene muscles
215
What is the most important complication of supraclavicular block
Pneumothorax
216
What is Horner's Syndrome
Ptosis, Miosis, and Anhydrosis
217
What is the best needle position for ultrasound guided supraclavicular block
Junction of the first rib and the subclavian artery (corner pocket)
218
Which block is most efficient for procedures of the elbow, forearm and hand
infraclavicular
219
What is another name for the infraclavicular block
High axillary block
220
If the patient is unable to abduct their arm for the axillary block, which can be used
Infraclavicular
221
The infraclavicular block, blocks which nerves more effectively than the axillary
Musculocutaneous and axillary nerves
222
Which approach to infraclavicular block has reduced risk of pleural puncture and axillary artery injection
Lateral
223
The first twitch response during infraclavicular block is usually caused by which nerve and what is the response
Musculocutaneous, elbow flexion
224
What response during infraclavicular block is required to achieve full anesthesia of the hand
Hand flexion or extension
225
Stimulation of the lateral cord during infraclavicular block will result in what repose in the pinky
Lateral movement
226
Stimulation of the medial cord during infraclavicular block will result in what repose in the pinky
Flexion
227
Stimulation of the posterior cord during infraclavicular block will result in what repose in the pinky
Extension
228
Which muscle is used to locate the axillary artery for the axillary block
Pec major
229
What is the most frequent and concerning complication of axillary block
Systemic uptake and LA toxicity
230
What are symptoms of intravascular LA injection
Dizziness, tinnitus, metallic taste, circumoral numbness, visual disturbance, muscle twitching.
231
How can you prevent retrograde flow of LA during injection
Pressure behind the needle
232
During axillary block, which nerves require a field block
Musculocutaneous, medial brachial cutaneous, and intercostobrachial
233
The musculocutaneous nerve can be independently blocked by injecting LA into the body of which muscle
Coracobrachialis
234
The coracobrachialis is located ___ to the axillary artery and ____ to the biceps brachialis muscle
Superior, inferior
235
Which nerves are blocked to prevent UE tourniquet pain
Intercostobrachial and medial brachial cutaneous
236
During axillary block ultrasound, which nerve is located close to the axillary artery
Median
237
Which nerve is located medial to the axillary artery in the axillary block
Ulnar
238
Which nerve is located just below the axillary artery in the axillary block
Radial
239
Are blocks at the elbow and wrist primary sensory or motor
Sensory
240
Anesthesia of the cutaneous portions of the lower forearm, hand, 2,3,4 fingers can be achieved with which blocks
Median and ulnar
241
If the patient has carpal tunnel which nerve should we avoid blocking
Median
242
Which muscles and tendons are used to help placing a radial block at the elbow
Brachioradialis muscle, biceps tendon
243
Epinephrine is not used in blocks below the ______
Elbow
244
Which block at the wrist is the least tolerated of the supplemental blocks and has limited success
Proximal approach to the radial nerve under the brachioradialis muscle
245
What is the preferred location for IV placement for Bier Block
Dorsum of the hand
246
An IV placed in the forearm or hand for a Bier block increase the risk for what
Partial or complete block failure
247
What tourniquet pressure should be used for a Bier Block of the UE
250mmHg or 100 above SBP
248
What kind of local anesthetic should be used for Bier Block
Free of preservatives or vasoconstrictors, 50mL 0.5% lidocaine
249
What is the minimum time for tourniquet inflation during bier block
20 minutes
250
Faster onset and a denser block can be accomplished with which alternate Bier Block technique
Inflate the distal cuff, place a IV tourniquet, inject half the LA, remove the IV tourniquet, inject the other half of LA
251
What additive for Bier Block seems to be the only one with significant benefits
Ketorolac, 15-30 mg
252
What tourniquet pressure should be used for a Bier Block of the LE
350-400mHg
253
What are the most common complications of intercostal block
Pneumo and LA toxicity
254
Intercostal nerve fibers provide sensory and motor innervation to which muscles
Superior rectus in the upper abdomen
255
Which position for placement has more complications with intercostal block
Anterior
256
Which LA's can be used for intercostal block
Bupivicaine, tetracaine, procaine, and lidocaine
257
Epi added to which two LA's prevents their rapid absorption and increases duration
Tetracaine or lidocaine
258
What needle size reduces the risk of pneumothorax during intercostal block
22G
259
Where do TAP blocks provide anesthesia for
Skin, muscles, parietal perineum of the anterior abdominal wall
260
Which muscle layer is LA injected between for the TAP block
Internal oblique and transverse abdominal
261
What nerves are blocked in a TAP block
T9-12 and L1
262
What are the roots of the lumbar plexus
L1-4
263
Where is the lumbar plexus in relation to the quadrates lumborum and psoas
Anterior to the QL and posterior to the psoas major
264
Which nerve is the first to leave the lumbar plexus
Lateral femoral cutaneous
265
Where does the lateral femoral cutaneous nerve supply sensory innervation
Lateral aspect of the thigh
266
What are the nerves of the lumbar plexus
Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, femoral
267
Due to its close proximity to vessels which nerve can be injured during pelvic surgery
obturator
268
The obturator is a motor nerve to which muscles
Adductor to the upper leg
269
Which nerve provides innervation to the anterior surface of the thigh and sartorial muscle
Anterior femoral
270
Which nerve provides innervation to the quadriceps muscle, knee joint, and medial ligament of the knee
Posterior femoral
271
Which nerve gives rise to the saphenous nerve
Femoral
272
Which block, blocks the lumbar plexus by injecting into the fascial health surrounding the plexus
Psoas compartment block
273
Which lumbar plexus block is performed on the back and uses the vertebrae and intercostal line
Psoas compartment
274
Needle placement with a nerve stimulator during psoas compartment block is confirmed by stimulation of which muscles
quadriceps
275
When is a femoral nerve block most effective
Post-op pain control, not a sole anesthetic
276
What is the desired muscle stimulation during femoral nerve block with a peripheral nerve stimulator
Quadriceps twitch or patellar "snap"
277
Volume of LA for a femoral nerve block should be at least how much to prevent a spotty block
20 mL
278
A 3-in-1 block can be accomplished by added more volume to which block
Femoral
279
What nerves are anesthetizes in a 3-in-1 block
Femoral, obturator, lateral femoral cutaneous
280
A femoral block cannot cover which nerve
Sciatic
281
Describe the femoral nerve on ultrasound
Hyper echoic, lateral to the femoral artery
282
Which anesthetics are used for a continuous femoral nerve block
0.2% ropivacaine, 0.25% bupivicaine
283
Which block is an anterior approach to the lumbar plexus
Fascia iliaca
284
The fascia iliaca provides better anesthesia to which nerves compared to a 3-in-1
Lateral femoral cutaneous, and femoral nerves
285
Which two muscles are pierced by the needle during femoral and fascia iliaca
Fascia lata, fascia iliaca (deeper)
286
What is the largest nerve trunk in the body
Sciatic
287
What roots make up the sciatic nerve
L4-S3
288
What muscles does the sciatic nerve supply
Back of the thigh, skin of the leg, muscles of the lower leg and foot
289
What nerves does the sciatic divide into
Common perineal and tibial
290
What motor response is elicited by correct needle placement for sciatic nerve block
Plantar flexion, dorsal flexion
291
A sciatic nerve block at the level of the popliteal fossa will block what
The distal leg and foot
292
Sensation of the ankle, achilles, toes, tibia, fibula can be anesthetized with which block
Sciatic at the popliteal fossa
293
What are the landmarks of the popliteal fossa block
Popliteal crease, medial border of femoral biceps muscle, semitendinous muscle tendon
294
What are the five nerves at the ankle
Deep peroneal, Superficial peroneal, Sural, Tibial, Saphenous (clockwise)
295
What nerve in the ankle arrises from L4, L5, S1, S2, S3 roots
Tibial
296
What nerve in the ankle lies on the medial side of the achilles tendon
Tibial
297
What nerve in the ankle lies on the lateral side of the achilles tendon
Sural
298
Which nerves in the ankle are by arteries
Tibial and deep peroneal
299
Branches of which two nerves form the sural nerve
Tibial and common peroneal
300
Which nerve in the ankle provides sensory innervation to the posterior portion of the sole of the foot, posterior heel, achilles above the ankle
Sural
301
What nerve in the ankle arrises from L4, L5, S1, S2 roots
Superficial peroneal and deep peroneal
302
Which peroneal nerve remains in the anterior tibial muscle and long extensor muscle of the great toe
Deep peroneal
303
What nerve innervates the short extensors of the toes and sensory innervation to the skin on the lateral side of the hallux on the second digit
Deep peroneal
304
Which nerve is frequently missed during regional anesthesia to the ankle
Deep peroneal
305
What nerve provides sensory innervation to the medial side of the malleolus and the skin of the medial aspect of the lower leg
Saphenous
306
To tolerative a tourniquet above the ankle, which nerve needs to be blocked
Saphenous
