Upper Extremity Nerve Blocks
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| show | Volume...more volume better spread
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| show | Proximal areas will be blocked first as they are on the outer surface of the nerve sheath
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| Brachial plexus anatomy | show 🗑
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| How do you test a brachial plexus block | show 🗑
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| show | Push tests the radial nerve which innervates the triceps muscle
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| show | Pull tests the musculocutaneous nerve which innervates the biceps muscle.
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| What does "pinch, pinch" test for in a brachial plexus block. | show 🗑
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| show | Radial nerve.
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| show | There is a high risk for phrenic nerve block (unilateral). This is usually of little consequence in healthy patients but can lead to respiratory distress in patients who already have a comprimised resp status.
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| What type of surgeries is an interscaline block good for? | show 🗑
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| Duration of a interscalene block. | show 🗑
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| What level of the brachial plexus does an interscalene block work on? | show 🗑
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| show | The cricoid cartilage is at the level of C6, which serves as a guide when preforming an interscalene block.
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| show | Never direct the needle cephalad and never insert the needle more than 2.5cm (even in obese patients) as this is a superficial block
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| Needle insertion site for interscalene block. | show 🗑
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| show | IV injection, neuraxial block, phrenic nerve block(50%++), PNA, infection, hematoma, paresthesia, Horner's syndrome (30-40%), recurrent laryngeal nerve block (30-50%), total spinal anesthesia, nerve injury.
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| How do you prevent total spinal anesthesia during a interscalene block? | show 🗑
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| show | This can happen with a interscalene block as result of block spread to the stelate ganglion. Will result in ptosis, miosis, anhydrosis, increased skin temp, nasal congestion. This occurs less commonly with low interscalene block.
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| show | 22g short needle (never insert greater than 2.5 cm)
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| show | Ulnar nerve
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| show | 6-8 hours of surgical anesthesia and up to 24 hours of postop analgesia
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| Goal of nerve stim during interscalene block | show 🗑
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| LA injection for interscalene block | show 🗑
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| show | 30-40min of soak time
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| show | Supraclavicular block, works at the level of the divisions, the nerve bundle is more tightly together at this level than at the level of the trunks for and interscalene block.
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| Complications of supraclavicular block | show 🗑
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| show | Musculocutaneous nerve will not be blocked by an axillary block and must be blocked seperately.
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| How is a musculocutaneous block performed. | show 🗑
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| show | 34-40ml
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| show | Paresthesia, transarterial, nerve stimulator
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| Intercostal block contraindications | show 🗑
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| show | Ride rib down to its inferior border to block nerve which lies on inferior border, just below the artery, which is just below the vein (Vein, Artery, Nerve)
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| Needle size for intercostal block | show 🗑
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| show | 3-5 ml of LA at eachh level
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| show | Usually 12 hours +/- 6 hours with bupivicaine 0.25-0.5%, Ropivicaine 0.5-0.75%, lidocaine with epi 1-2%. Adding epi to ropivicaine or bupivicaine does not significantly prolong the block.
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| Digital nerve block of hand | show 🗑
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| show | GANGREEN-No vasoconstrictors, limit volume to 2ml. NERVE INJURY-awake pt, no inject if pt c/o pain or there is increased pressure when injecting. INFXN. HEMATOMA-avoid multiple needle insertions, use 25g needle. VASCULAR PUNCTURE-Intermittent aspiration.
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| show | Lies lateral to the flexor carpi ulnaris tendon & medial to the ulnar artery. Small gauge short-bevel needle is inserted perpindicular to wrist- causing paresthesia, inject 3-5ml of LA. If no paresth. inject in fan like fashion between two landmarks.
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| Median Nerve Block at the wrist | show 🗑
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| Radial Nerve Block at the wrist | show 🗑
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| show | Requires supplemental systemic analgesia, requires technical expertise, risk of pneumo, LA toxicity with multiple levels of blockade
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| show | Superior analgesia, opioid sparing, improved pulm mechanics, reduced CNS depression, Avoid urinary retention
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| Ax block nerve stimulator settings | show 🗑
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| show | 0.25% bupivicaine or 0.2% ropivicaine run at 4-10ml/hr
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Created by:
mandyrosern
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