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Flashcards in US Regional Anesthesia Final Exam Deck (60)
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1

What type of block is utilized for post-op Cesarean Section?

TAP block--->postoperative analgesia/not sole anesthetic

2

What structures need to be identified in a TAP block?

SubQ(potential)
superior fascia of external oblique
External Oblique
inferior fascia of EOM/superior fascia of IOM
Internal Oblique
inferior fascia of IOM/superior fascia of TAM
Transversus Abdominus Muscle(TAM)
transversus fascia
Peritoneium
Intestines

3

Identify the proper positioning for a TAP block as related to the patient, transducer, depth, needling and approach.

POSITIONING:
Patient: Supine
Transducer: Linear
Depth: 3-4 cm
Needle: In-plane, long axis (out-of-plane for obese)
Approach: Transverse on the abdomen, at the anterior axillary line, between the costal margin and the iliac crest
(called the Triangle of Petit)

4

Identify the LA to use and the dose/amount to use with a TAP block was well as how to inject.

INJECTION:
1) Insert needle just slightly past the anterior fascia of TAM
2) Aspirate; then inject slowly retract needle as you inject
slowly
3) Once you see the two fascia layers separating, stop and
inject LA
20mL of 0.25% Ropivacaine (per side)
(0.4mL/kg per side for children)

5

Does a TAP block provide motor or sensory anesthesia?

Sensory only

6

What type of block is utilized to provide pain control for an Exploratory Laparotomy?

TAP block----->postoperative analgesia only/not a sole anesthetic

7

What regional nerve blocks should be utilized for a Closed Reduction for Dislocated Right Shoulder?

-Supraclavicular Block
-Interscalene Brachial Plexus Block

8

What are the structures to know when performing a Supraclavicular Block?

STRUCTURES TO KNOW:
• Clavicle (superior to)
• Prevertebral fascia (around the SA, MSM, & BP)
• Subclavian Artery (SA)
• Middle scalene muscle (MSM)
• Brachial plexus (between the SA & MSM)

9

What is the positioning as related to a Supraclavicular Block in regards to the patient, the transducer, the depth, needle and the approach.

POSITIONING:
Patient: Supine, semi-sitting
Transducer: Linear; transverse on neck, just superior to
the clavicle at midpoint
*** To achieve the best view, the transducer must be
tilted slightly inferiorly, rather than perpendicular to the
skin.
Depth: 2-4 cm(Brian 3cm)
Needle: In-plane, short axis
Approach: Lateral approach

10

Where LA should be used and how much should be used with a Supraclavicular Block? Where should the LA be deposited?

-15-30 mls of 0.5% Ropivacaine
-2 injections(above and below the plexus)

11

What parts of the Brachial Plexus are anethesized by a Supraclavicular Block?

-distal trunks
-proximal divisions

12

What are the structures to know when performing a Interscalene Brachial Plexus Block?

STRUCTURES TO KNOW:
• Sternocleidomastoid muscle (SCM)
• Prevertebral fascia (posterior to the SCM, covers the MSM and ASM)
• Middle scalene muscle (MSM)
• Brachial plexus (stoplight or honeycomb structure in the
interscalene groove between the MSM & ASM)
• Anterior scalene muscle (ASM)
• Carotid artery (CA)

13

What is the positioning as related to a Interscalene Block in regards to the patient, the transducer, the depth, needle and the approach.

POSITIONING:
Patient: Supine, semi-sitting, with head turned away
Transducer: transverse on neck, 3-4 cm superior to clavicle, over external jugular vein
Depth: 1-3 cm(Brian 3cm)
Needle: In-plane, short axis
Approach: Lateral approach; start in the “supraclavicular
approach” location and move cephalad until the scalene
muscles and BP is found

14

What LA should be used and how much should be used with a Interscalene Block? Where should the LA be deposited?

-15-30 mls of 0.5% Ropivacaine
-inject around the plexus

15

What parts of the Brachial Plexus are anethesized by a Interscalene Block?

PLEXUS &/or NERVE COVERAGE:
DISTAL ROOTS/ PROXIMAL TRUNKS
The interscalene approach to brachial plexus blockade results
in anesthesia of the shoulder and upper arm. Inferior trunk for
more distal anesthesia can also be blocked by additional,
selective injection, deeper in the plexus. This is accomplished
either by controlled needle redirection inferiorly or by
additional scanning to visualize the inferior trunk and another
needle insertion and targeted injection.

16

What blocks can be utilized to facilitate regional anesthesia for a Fractured Left Femur(mid shaft)?

o Fascia Iliaca Compartment Block
o Femoral Nerve Block

17

What are the structures to know when performing a Fascia Iliaca Block?

-internal oblique
-sartorius
-fascia iliaca
-iliopsoas Muscle
-Ilium
-bowel

18

What is the positioning as related to a Fascia Iliaca Block in regards to the patient, the transducer, the depth, needle and the approach.

Patient: supine
Transducer: parasagittal
Depth: 2-4 cm(Brian 4cm)
Approach: inferior to superior
Needle: in plane

palpate ASIS first--->place probe over ASIS--->ID ASIS spine then move superiorly and inferiorly to identify the "bow tie"

19

What LA should be used and how much should be used with a Fascia Iliaca Block? Where should the LA be deposited?

40-60 ml of 0.2 % Ropivacaine

Ideally the solution will lift the fascia iliac off the superficial layer and spread superior towards the lumbar plexus

20

What plexus is anethesized by the Fascia Iliaca Block?

Ideally the solution will lift the fascia iliac off the superficial layer and spread superior towards the lumbar plexus

21

What are the structures to know when performing a Femoral Block?

-Illiopsoas muscle
-Fascia lata
-Fascia iliaca
-Femoral artery
-Femoral vein

22

What is the positioning as related to a Femoral Block in regards to the patient, the transducer, the depth, needle and the approach.

Patient: supine
Transducer: transverse(near inguinal crease)
Depth: 2-4 cm
Approach: lateral to medial
Needle: in plane, short axis

23

What LA should be used and how much should be used with a Femoral Block? Where should the LA be deposited?

Ropivacaine 0.5% 20-30 ml
Must pierce both fascia lata and fascia iliac

24

What plexus is anethesized by the Femoral Block?

Lumbar plexus

25

What regional blockade is utilized for a Left Basilic Vein Transposition?

o Axillary Brachial Plexus Block
o Infraclavicular Brachial Plexus Block
o Supraclavicular Brachial Plexus Block

26

What regional blockade is utilized for a Right Hip Pinning?

o Fascia Iliaca Compartment Block (adjunct not sole anesthetic)
o Lateral Femoral Cutaneous Nerve Block (postoperative analgesia/ not sole anesthetic)

27

What blocks are utilized for a Left Total Knee Arthroplasty?

o Adductor Canal Block (saphenous nerve)
o Fascia Iliaca Compartment Block
o Femoral Nerve Block
o (+/ −) Sciatic Nerve Block

28

What are the structures to know when performing a Saphenous Nerve Block?

STRUCTURES TO KNOW:
ABOVE THE KNEE (AK)
• mid-thigh
• Fascia lata
• Saphenous n. (SN)
o SN pierces the fascia lata between the tendons of the sartorius and gracilis muscle before becoming a subcutaneous n.
o May also surface between sartorius and vastus medialis muscles
• Vastus medialis muscle
• Femoral artery (FA)
BELOW THE KNEE (BK)
• Nerve passes along the tibial side of the leg, adjacent to the great saphenous vein subcutaneously
• At the ankle, a branch of the nerve is located medially next to the subQ positioned saph vein

29

What is the positioning as related to a Saphenous Nerve Block in regards to the patient, the transducer, the depth, needle and the approach.

POSITIONING:
Patient: Supine position, with the thigh abducted and externally rotated to allow access to the medial thigh
Transducer: Linear; Transverse on anteromedial thigh approx. at the level of mid-thigh
Depth: 2-4 cm(Brian 4.5 cm)
Needle: In-plane, short axis
Approach: Lateral (AK); medial (BK)

****Find femoral Artery--->lies under it*****

30

What LA should be used and how much should be used with a Saphenous Nerve Block? Where should the LA be deposited?

INJECTION:
1) After identification of the FA or SN; advance the needle in-plane toward FA
2) Place needle tip medial to artery in adductor canal, underneath sartorius muscle
3) Aspirate; inject 1-2mL of LA to confirm proper needle position
4) Inject a total of 10-20 mL of 0.5% Ropivacaine