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73 Cards in this Set

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Nerve roots of the brachial plexus
C5-8 and T1 (minimal if any contribution from C4 and T2)
What are the three trunks of the brachial plexus and what are their nerve roots?
Superior (C5 and C6); Middle (C7); Inferior (C8 and T1)
How many divisions from the trunks are there in the brachial plexus?
Six divisions
How many cords are there in the brachial plexus and where do they emerge?
There are 3 cords; they emerge below the clavicle
What are the contributions of the lateral cord?
C5,6,7
What are the contributions of the posterior cord?
C5,6,7,8 and T1
What are the contributors to the medial cord?
C8 and T1
How many Roots? Trunks? Divisions? Cords? Branches?
5-3-6-3-5
What is the lateral cord and what does it terminate as?
The lateral cord is the lateral branch of the median nerve; terminates as the musculocutaneous nerve
What is the medial cord and what does it terminate as?
The medial cord is the medial branch of the median nerve; terminates as the ulnar nerve
What is the posterior cord and what does it terminate as?
Gives off the axillary nerve and terminates as the radial nerve
Which nerve roots contribute to the musculocutaneous nerve?
C5,6,7
Which nerve roots contribute to the axillary nerve?
C5 and C6
Which nerve roots contribute to the radial nerve?
C5,6,7,8, and T1
Which nerve roots contribute to the median nerve?
C6,7, 8 and T1
Which nerve roots contribute to the ulnar nerve?
C8 and T1
What is the motor innervation of the musculocutaneous nerve?
biceps muscle (flex forearm)
What is the sensory innervation of the musculocutaneous nerve?
lateral mid-forearm
What is the motor innervation of the axillary nerve?
deltoid muscle (wing upper arm)
What is the sensory innervation of the axillary nerve?
upper lateral arm
What is the motor innervation of the radial nerve?
triceps (extend forearm), supinator and extensors of the forearm
What is the sensory innervation of the radial nerve?
posterior arm & forearm, thumb and dorsal surface of hand
What is the motor innervation of the median nerve?
flexors and pronator muscles of forearm (flexion of wrist)
What is the sensory innervation of the median nerve?
palmar surface of hand, index and middle fingers
What is the motor innervation of the ulnar nerve?
flexor carpi ulnaris (abduct fingers)
What is the sensory innervation of the ulnar nerve?
little finger and medial ring finger
What kind of needle should be used when doing a peripheral nerve block?
B-bevel
Name 5 desirable features of nerve stimulators
(1) Constant current output; (2) Current meter; (3) Current intensity control; (4) Short pulse width; (5) Disconnect indicator
Which color wire goes to the grounding pad? Which to the needle?
Red (positive) is the grounding pad; Black (negative) attaches to the needle
Anatomic landmarks for interscalene approach to brachial plexus block?
With pts head turned towards opposite side, at level of cricoid cartilage (C6), palpate posterior border of SCM; roll fingers posterior and palpate interscalene groove between anterior and middle scalene muscles
Milliamp setting of interscalene approach?
<1.0 milliamp
How much LA to inject for interscalene approach?
30-35 mL
Besides failed block and intravascular injection, name 5 complications of interscalene approach to brachial plexus block
Subarachnoid/epidural injection; pneumothorax; RLN block (60%); Horner’s syndrome, phrenic nerve block (>80%)
What do you see in Horner’s syndrome?
Droopy eye (ptosis), constricted pupil (miosis) due to spread into cervical ganglia (can also see enophthalmos and anhidrosis)
Which terminal nerve is most often missed in an axillary approach to brachial plexus block?
Musculocutaneous
What kind of needle should be used for an axillary approach?
22-25ga B-bevel needle
How much LA should be used for an axillary approach? What should be added?
40-50 mL of LA with 1:200,000 epi and bicarb
What else can be done to improve spread of anesthetic during axillary approach?
Apply distal pressure
When evaluating brachial plexus blockade, what does “push” evaluate?
Radial nerve function
When evaluating brachial plexus blockade, what does “pull” evaluate?
Musculocutaneous nerve function
When evaluating brachial plexus blockade, what does “extend” evaluate?
Distal radial nerve function
When evaluating brachial plexus blockade, what does “flex” evaluate?
median and ulnar nerve function
When evaluating brachial plexus blockade, what does “spread fingers” evaluate?
ulnar nerve function
What is the big concern when using a supraclavicular approach to the brachial plexus?
hitting the dome of the lung (PTX)
What is the benefit of the supraclavicular approach?
Increased success in blocking the inferior trunk (ulnar, radial)
What kind of brachial plexus block is uniquely well suited for hand, wrist, elbow and distal arm surgery?
Infraclavicular block
How do you do a “touch-up” block of the median nerve?
inject LA at the elbow, just above flexion crease and medial to the brachial artery
How do you do a “touch-up” block of the musculocutaneous nerve?
inject LA deep in the body of the coracobrachialis muscle
How do you do a “touch-up” block of the radial nerve?
Inject LA at the elbow, just above flexion crease, laterally
Nerve roots of the lateral femoral cutaneous nerve?
L2-3
Nerve roots of the femoral nerve?
L2-3-4
Nerve roots of the obturator nerve?
L2-3-4
Nerve roots of the sciatic nerve?
L4-5, S1-2-3
The femoral nerve becomes the ____ nerve
Saphenous
The Sciatic nerve splits into the ___ and the ___ nerves
common peroneal and tibial
The common peroneal nerve splits into the ___ and the ___ nerves
superficial peroneal and deep peroneal
Lateral femoral cutaneous nerve: sensory innervation? Motor innervation?
Sensory: anterolateral aspect of thigh; Motor: none
Femoral nerve: sensory innervation? Motor? Terminates as ___ nerve, which innervates ___.
Sensory: anterior thigh and knee; terminates as saphenous nerve, innervating the medial side of the calf down to the ankle
Obturator nerve: sensory innervation? motor?
sensory: lower portion of the inner thigh; motor: adductor muscles
the “medial” sciatic nerve is functionally the ____ nerve, while the “lateral” sciatic nerve is functionally the ___ nerve
tibial; peroneal
Sciatic nerve: sensory innervation? motor?
sensory: posterior aspect of thigh and entire foot; motor: posterior aspect of thigh and entire foot
How do you evaluate motor block of the femoral nerve?
extension of the knee with the leg flexed at the hip
How do you evaluate motor blockade of the obturator nerve?
Abduct the leg and ask the patient to move it toward the midline
What nerve is represented by A?
the musculocutaneous nerve
How do you evaluate motor blockade of the sciatic nerve?
Have the patient plantar flex (tibial) and dorsiflex (peroneal) the foot
How do you evaluate a popliteal fossa block?
Similar to evaluating a sciatic nerve block
Which nerve is represented by B?
the median nerve
Landmark for popliteal fossa block?
5 cm above the crease behind the knee; elicit a foot twitch
Amount of LA for popliteal fossa block?
30 mL
Which five nerves are blocked with an ankle block? Which of these isn’t really necessary?
Tibial, Sural, Superficial peroneal, Deep peroneal, and saphenous. Saphenous block rarely necessary
Which nerve is represented by the lines marked D?
the medial cutaneous nerve of the arm
Which nerve is represented by C?
the ulnar nerve
Which nerve is represented by E?
the radial nerve