Upper and Lower PNBs

Question 1

Blocking this nerve may help allow you to place a tourniquet on the arm of an awake patient

Answer 1

Intercostobrachial nerve (Arises from T2 and is blocked with a field block)

Question 2

Inter scalene targets these roots

Answer 2

C5, 6, and 7 (the stoplight)

Question 3

What does inter scalene block?

Answer 3

Blocks the upper trunk! So it’s good for shoulder and upper arm procedures. Not great for lower arm procedures because it blocks the lower roots that innervate the hand and forearm.

Question 4

The cupola of the lung is higher on which side?

Answer 4

Right side

Question 5

S/S of Horner’s syndrome?

Answer 5

Horny Pam!

Ptosis, anhidrosis, and miosis.

Question 6

As little as ___mL in the vertebral artery can result in sz activity

Answer 6

1mL

Question 7

Horner’s syndrome occurs as a result of what?

Answer 7

Blockade of the stellate ganglion (located at C7). Indicates successful block.

Question 8

Pneumothorax may have occurred if pt complains of

Answer 8

Coughing or chest pain during needle insertion or manipulation

Question 9

Complications of inter scalene block

Answer 9

Horner's syndrome
Phrenic Nerve Paralysis
RLN Injury
Pneumothorax
Epidural/Spinal injection
Seizure
Bezold jarisch reflex

Question 10

What is the Bezold Garish Reflex?

Answer 10

Will see bradycardia and hypotension!

Venous pooling results in a profoundly undefiled ventricle. The heart slows to improve diastolic filling.

Question 11

Doing this pre-op and decrease the risk of BJR

Answer 11

Pre-op beta blockade

Question 12

Supraclavicular is good for

Answer 12

Surgeries at or below the elbow

Question 13

Complications of supraclavicular block

Answer 13

Pneumo
Horner’s Syndrome
Subclavian artery injection

Question 14

Infraclavicular block is good for

Answer 14

surgeries below the elbow

Question 15

Infraclavicular block will block this part of the plexus

Answer 15

Cords

Question 16

Acceptable motor response for infraclavicular block

Answer 16

Triceps or anything below the elbow

Question 17

Complications of infraclavicular block

Answer 17

• Vascular puncture (SA and SV are right around the cords here)
• Pneumo (though lower risk here compared to inter scalene and supraclavicular)
• More painful to perform because you’re going through pec major and pec minor

Question 18

This block often misses the ulnar nerve

Answer 18

Interscalene

Question 19

This block often misses the musculocutaneous nerve

Answer 19

Axillary

Question 20

Axillary nerve block is good for

Answer 20

surgeries below the elbow

But misses the MC! Make sure you hit that shit up too!

Question 21

Nerves that come from the lumbar, sacral, and coccygeal plexuses

Answer 21

Lumber Plexus (Anterior):

• Femoral
• Obturator
• LFC
• Iliohypogastric
• Ilioinguinal
• Genitofemoral

Sacral Plexus (Posterior)

• Sciatic
• Posterior femoral, BIIIITTCHHHH

Coccygeal
- Pundendal

Question 22

Lumbar and Sacral Plexus nerve roots

Answer 22

Lumbar = L1-4 and sometimes T12

Sacral = L4-S4

Question 23

Sensory and motor innervation of the LFC

Answer 23

Sensory: Lateral thigh

Motor: None

Question 24

Sensory and motor innervation of the femoral nerve

Answer 24

Sensory: Anterior thigh

Motor:

• Anterior = Sartorius
• Posterior = Quads

Question 25

Sensory to the posterior aspect of the thigh is provided by

Answer 25

The posterior femoral nerve

Question 26

The sural nerve is composed of branches from these two nerves

Answer 26

Tibial and common peroneal (the two major branches of the sciatic)

Question 27

Borders of the femoral triangle

Answer 27

It’s a triangle like the SAIL of a ship!

S = Sartorius
A = Adductor longus
IL = Inguinal ligament

Question 28

This branch of the femoral nerve gives rise to the saphenous nerve

Answer 28

Posterior branch of the femoral nerve

Question 29

Stimulation of the tibial nerve will cause this motor response

Answer 29

Plantar flexion and inversion of the foot

Question 30

What is has more influence on spread in subarachnoid blocks? Volume or dose?

Answer 30

Dose.

For epidurals, both volume AND dose matter.

Question 31

What spinal nerve roots are most resistant to LAs?

Answer 31

L5 and S1
These are the largest and most resistant spinal nerves.
L5-S1 interspace is the largest interspace in the vertebral column