You can block that?
The brachial plexus terminates in these branches that innervate the hand.
What is the median, ulnar, and radial nerves.
You should send your patients to me after you suspect a nerve injury.
What is a neurologist
A common complaint from patients with nerve block catheters, this can result in dislodgement of the block if not addressed.
What is leaking?
"Just block the patient when they're asleep!"
What is... higher risk of nerve damage due to inability to communicate paresthesias
This piece of equipment revolutionized the safety and efficiency of performing nerve blocks
What is an ultrasoound?
These are the terminal branches of the sciatic nerve, at the level of the ankle.
Saphenous, Deep Peroneal, Superficial Peroneal, Sural, Tibial
These studies will be performed by a neurologist when investigating the etiology of a nerve injury
EMG, nerve conduction studies, MRI
A patient complains of 10/10 pain. They have a catheter.
What is...
Ask specifics!
Inspect dressing/catheter/pump.
Can try bolus.
May be outside of nerve distribution!
"Just get their block done so they're ready to go, talk to them when it's done!"
What is informed consent
These are the "deep" (non-compressible) nerve blocks
What is...
Infraclavicular
Paravertebral/erector spinae/thoracic epidural
Subgluteal sciatic
When blocking a patient's shoulder with the most common approach, you may inadvertently block these nerves, too.
Phrenic - manifests as dyspnea
Cervical plexus - manifests as Horner's
Recurrent laryngeal nerve - manifests as hoarseness
The name for when a preexisting nerve deficit increases the chances for subsequent nerve injury
What is "double-crush" phenomenon
My nerve block worked initially, but now everything hurts!
What is "step-off"
"Of course that nerve block damaged your nerves! This certainly wasn't my fault!" (Common causes of nerve injury)
What is...
Pneumatic tourniquet
Positioning
Surgical trespass
Initial injury
Preexisting nerve injury/neuropathy
RARELY nerve block (intraneural injection increases risk)
This is class of local anesthetic that people are most commonly allergic to
Ester local anesthetics
This block is necessary in addition to an interscalene block to cover the proximal clavicle.
What is the superficial cervical plexus
Your patient fell and broke her humerus. Your surgeon requests a post-operative block because of this concern.
What is radial nerve injury
This is why you can't keep that catheter in forever.
What is... risk of infection rises with prolonged catheter use
Major risk factors: >48 hour use, absence of antibiotic prophylaxis, stay in ICU, frequent catheter dressing changes, and axillary or femoral location of the catheter.
"We have a heparin infusion running on the amputation patient. How long do you need us to hold it so you can do a block?"
If your stimulator current is set below this number and you're eliciting a twitch, then you're probably intraneural.
What is 0.5mA?
This block is necessary in order to block the axilla for an upper arm incision.
What is an intercostobrachial block (lateral cutaneous branch of second intercostal nerve, arising anterior to the long thoracic nerve)
During this period after a nerve injury, nerve conduction studies or EMG may be falsely reassuring.
What are the first 2 weeks
This is the maximum mg/kg dose of local anesthetics to avoid toxicity.
(Lidocaine, Lidocaine with epi, Ropivacaine, Bupivacaine)
What is...
Lidocaine: 5mg/kg
Lidocaine with epi: 7mg/kg
Ropivacaine: 3mg/kg
Bupivacaine: 2.5mg/kg (lipophilic, cardiotoxic!)
"My tibial plateau fracture patient can't have a block! I need to know if they're having pain so we don't miss ________!"
What is compartment syndrome
You should make these adjustments to ACLS if you suspect LAST
What is...
- Small doses of epinephrine (less than 1 microgram/kg)
- Vasopressin should be avoided, as it can result in pulmonary hemorrhage.
- Calcium-channel blockers and B-adrenergic-receptor blockers are not recommended.
- If ventricular arrhythmias do occur, amiodarone is the preferred pharmacotherapy, as local anesthetics and procainamide can exacerbate the existing toxicity.