Truncal blocks

Question 1

A pectoralis 2 nerve block targets the fascial plane between the:
a. pectoralis major and pectoralis minor muscles
b. medial pectoralis and lateral pectoralis nerves
c. pectoralis minor and serratus anterior muscles
d. serratus anterior and latissimus dorsi muscles

Answer 1

a. pec major & pec minor & c. pec minor and serratus anterior muscles

Question 2

What is the objective of the serratus anterior plane block.

Answer 2

targets the axillary region (not the chest)

Question 3

What is the objective of the PECS 1 & PECS 2 block?

Answer 3

Pecs blocks are interfascial plane blocks that provide anesthesia and/or analgesia to the anterior chest wall without the risks of paravertebral or intercostal blockade

Question 4

Indications for performing the PECs blocks include

Answer 4

breast surgery, thoracotomy, and insertion of a port-a-cath, AICD, or subpectoral prosthesis

Question 5

Indications for performing the serratus anterior block is

Answer 5

breast reconstruction with latissimus dorsi flap

Question 6

The local anesthetic volume for the PECS 1 block is

Answer 6

10-15 mL

Question 7

The local anesthetic volume for the PECS 2 block is

Answer 7

10-15 mL

Question 8

The local anesthetic volume for the serratus anterior block is

Answer 8

20 mL

Question 9

Complications of the pecs 1 & pecs 2 blocks include

Answer 9

failure to appreciate the thoracoacromial artery may lead to inadvertent puncture, vessel injury, hematoma, and LAST

Question 10

Key nerves that innervate the chest include

Answer 10

thoracic intercostal nerve
lateral pectoral nerve
medial pectoral nerve
long thoracic nerve
thoracodorsal nerve

Question 11

The origin of the thoracic intercostal nerve is the

Answer 11

ventral rami of spinal nerves (T1-T6)

Question 12

The regions innervated by the thoracic intercostal nerve include

Answer 12

the intercostal muscles
cutaneous regions of the chest & breast

Question 13

The origin of the lateral pectoral nerve is the

Answer 13

brachial plexus (C5-C7)

Question 14

The regions innervated by the lateral pectoral nerve include

Answer 14

pectoralis major

Question 15

The origin of the medial pectoral nerve is the

Answer 15

brachial plexus (C8-T1)

Question 16

The regions innervated by the medial pectoral nerve include

Answer 16

pectoralis minor
lower region of pectoralis major

Question 17

The origin of the long thoracic nerve is the

Answer 17

brachial plexus (C5-C7)

Question 18

The regions innervated by the long thoracic nerve include

Answer 18

the chest wall superficial to the serratus anterior

Question 19

The origin of the thoracodorsal nerve is the

Answer 19

brachial plexus (C6-C8)

Question 20

The regions innervated by the thoracodorsal nerve include the

Answer 20

latissimus dorsi

Question 21

The serratus anterior plane block affords greater coverage of the

Answer 21

intercostal nerves of the axillary region (it does not cover the medial chest)

Question 22

What are the nerves anesthetized with the PECS 1 block?

Answer 22

medial pectoral
lateral pectoral

Question 23

What is the injection site of the PECs 1 block?

Answer 23

fascial plane between the pec major and pec minor

Question 24

What is the injection site of the PECS 2 block?

Answer 24

fascial plane between the pec major & pec minor & fascial plane between the pec minor & serratus anterior

Question 25

What are the nerves anesthetized in the PECS 2 block?

Answer 25

medial pectoral lateral pectoral thoracic intercostals long thoracic

Question 26

Why is a PECS 2 block indicated?

Answer 26

everything covered by PECS 1 & also require analgesia of the axilla such as mastectomy, sentinel node biopsy, tumor resection

Question 27

What is the site of injection of the serratus anterior block?

Answer 27

fascial plane between the latissimus dorsi & serratus anterior

Question 28

What nerves are anesthetized with the serratus anterior block?

Answer 28

thoracic intercostals (increased coverage vs. PECs 2) long thoracic thoracodorsal

Question 29

The recommended maximal local anesthetic dose for PECs blocks is

Answer 29

0.2 mg/kg

Question 30

The recommended maximum dose for SAP blocks is

Answer 30

0.4 mg/kg

Question 31

PECS blocks & SAP blocks may result in ____________ due to the proximity of the needle

Answer 31

pneumothorax; to the pleural space

Question 32

Benefits of an intercostal nerve blockade include: (select 2) a. multi-level coverage after a single injection b. decreased risk of opioid-induced respiratory depression c. hemodynamic stability d. low risk of local anesthetic toxicity

Answer 32

b. decreased risk of opioid-induced respiratory depression c. hemodynamic stability

Question 33

What is the objective of an intercostal nerve block?

Answer 33

provide motor and sensory anesthesia of the trunk from the xiphoid to the pubis (single dermatome level)

Question 34

Indications of an intercostal nerve block include

Answer 34

acute and chronic pain syndromes of the chest and upper abdomen, including rib fractures, herpes zoster, cholecystectomy, and chest tube insertion

Question 35

Select complications of an intercostal nerve block include

Answer 35

pneumothorax, LAST

Question 36

The local anesthetic volume needed for an intercostal nerve block is

Answer 36

3-5 mL per dermatome level

Question 37

The intercostal nerves originate from the

Answer 37

ventral rami of the thoracic spinal nerves (T1-T11)

Question 38

The risk of LAST with an intercostal nerve block is increased because

Answer 38

the rapid rate of local anesthetic uptake due to high vascularity

Question 39

Respiratory insufficiency may occur in patients with

Answer 39

severe COPD who depend on their intercostal muscles for ventilation

Question 40

Blocking ______________ can be difficult due to the thickness of the paraspinal muscles and proximity of the scapula

Answer 40

T1-T5; you should use a paravertebral block instead

Question 41

Describe the landmark technique for an intercostal block

Answer 41

place patient in sitting, lateral or prone position locate the site using the sharp posterior angulation of the rib and slide laterally to the lateral border of the sacrospinalis muscle advance needle until it hits bone and slowly walk off