Unit 8 - Truncal Blocks

Question 1

where do intercostal nerves originate

Answer 1

from ventral rami of thoracic spinal nerves (T1-T11)

Question 2

distribution of anesthesia with paravertebral block

Answer 2

Intervertebral blocks provide coverage for only one dermatome level, the procedure must be performed at each level where anesthesia is desired

Question 3

boundaries of paravertebral space

Answer 3

1. Anterior - Parietal pleura
2. Medial - Vertebral body and intravertebral foramen
3. Posterior - Transverse process and superior costotransverse ligament

Question 4

indications for paravertebral blockade

Answer 4

Surgical procedures:
* Thoracic
* Breast
* Cholecystectomy
* Herniorraphy
* Appendectomy

Pain Management
* Rib fractures
* Flail chest
* Blunt abdominal trauma
* Osteoporotic vertebral fractures
* Herpes zoster where coverage of more than one dermatome is needed

Question 5

target of erector spinae plane block

Answer 5

dorsal and ventral rami of the thoracolumbar nerves at the level of injection

Question 6

borders of the triangle of Petit

Answer 6

• Posterior border = Latissimus dorsi
• Anterior border = External oblique
• Inferior border = Iliac crest
• Inside of the triangle (floor) = Internal oblique
• The transverse abdominis is deep to the 10

Question 7

the triangle of petit is used as an anatomic reference point for which block

Answer 7

TAP block

Question 8

where is LA injected in TAP block

Answer 8

in the fascial plane between the internal oblique (I0) and transverse abdominis (TA) muscles

Question 9

how are the IO and TA muscles innervated

Answer 9

thoracolumbar nerves arising from T6-L1

Question 10

TAP block approaches

Answer 10

• Subcostal approach - procedures above the umbilicus
• Lateral and posterior approach - procedures below the umbilicus

Question 11

indications of rectus sheath block

Answer 11

procedures that require a midline abdominal incision
ex- umbilical hernia repair in the pediatric population, cesarean section when a midline incision is required, and postpartum laparoscopic tubal ligation.

Question 12

where does the QL muscle reside

Answer 12

muscle resides between the anterior to the middle layers of the TLF

Question 13

where is LA injected for QL blocks

Answer 13

• QL 1 - LA is injected lateral to the QLM
• QL2 - LA is injected posterior to the QLM
• QL 3 - LA is injected anterior to the OLM

Question 14

LA target injection site in QL blocks

Answer 14

thoracolumbar fascia

Question 15

nerves anesthetized by TAP block

Answer 15

lower intercostal n.
iliohypogastric n.
inguinal n.

Question 16

a PECS2 block targets the fascial plane between:

Answer 16

Pec major & pec minor
pec minor & serratus anterior

Question 17

where is LA injected for PECS1 block

Answer 17

Fascial plane = Between
pectoralis major and pectoralis minor

Question 18

where is LA injected for serratus anterior plane block

Answer 18

Fascial plane = Between
latissimus dorsi and serratus anterior

Question 19

objective for intercostal block

Answer 19

provide motor and sensory anesthesia of the trunk from the xiphoid to the pubis (single dermatome level)

Question 20

intercostal n. block indications

Answer 20

• acute & chronic pain syndromes of chest/upper abd
• rib fx
• herpes zoster (shingles)
• cholecystectomy
• chest tube insertion

Question 21

intercostal nerve block complications

Answer 21

PTX
LAST

Question 22

LA volume for intercostal n block

Answer 22

3-5 mL per dermatome level

Question 23

target of paravertebral block

Answer 23

spinal nerves exiting vertebral foramen

“unilateral epidural”

Question 24

paravertebral block indications

Answer 24

Segmental anesthesia or pain management of surgical procedures of the chest and abdomen when a neuraxial technique is contraindicated or refused

Question 25

complications of paravertebral block

Answer 25

* LAST * PTX * intrathoracic intrathecal injection * PDPH

Question 26

borders of paravertebral space

Answer 26

* anterior = parietal pleura * medial = vertebral body & intervertebral foramen * posterior border = transverse process & superior costotransverse ligament

Question 27

indications of erector spinae block

Answer 27

* Neuropathic pain * rib fractures * lumbar spine surgery * thoracic surgery * cardiac surgery * breast surgery * bariatric surgery * numerous abdominal procedures

Question 28

complications of erector spinae block

Answer 28

LAST PTX

Question 29

3 paired muscles of erector spinae

Answer 29

1. iliocostalis 2. longissismus 3. spinalis

Question 30

approx how many dermatome levels are covered by a thoracic ESP block

Answer 30

8-11 dermatome levels

Question 31

approx how many dermatome levels are covered by a lumbar ESP block

Answer 31

3-4 dermatome levels

Question 32

where does TAP block provide analgesia

Answer 32

abdominal wall (skin & muscle) and parietal peritonium

Question 33

where is LA injected in TAP block

Answer 33

between IO and TA muscles

Question 34

complications of TAP block

Answer 34

LAST peritoneal injury

Question 35

4 paired muscles of anterolateral abdominal wall

Answer 35

1. rectus abdominis 2. transverse abdominis 3. external oblique 4. internal oblique

Question 36

anatomic boundaries of inferior lumbar triangle

Answer 36

* Inferior border = Iliac crest * Posterior border = Latissimus dorsi * Anterior border = External oblique * Inside of the triangle (floor) = Internal oblique

Question 37

3 approaches to TAP block

Answer 37

1. subcostal 2. lateral 3. posterior

Question 38

where is LA injected for a rectus sheath block

Answer 38

fascial plane between rectus abdominis and posterior rectus sheath

Question 39

target of rectus sheath block

Answer 39

thoracolumbar nerves and the anterior cutaneous branches as they travel in the fascial plane between the rectus abdominis muscle and posterior rectus sheath.

Question 40

indications of rectus sheath block

Answer 40

procedures with midline abd incision

Question 41

complicaiton of rectus sheath block

Answer 41

LAST due to inadvertent vascular injection (inferior epigastric arteries travel within the rectus sheath).

Question 42

QL block low frequency transducer is used for

Answer 42

QL3

Question 43

complications of rectus sheath block

Answer 43

Inadvertent peritoneal puncture and visceral injury (kidney, liver, and spleen)

Question 44

which nerve block produces anesthesia by injecting LA into thoracolumbar fascia

Answer 44

QL1

Question 45

whats the difference in a PECS1 & PECS2 block

Answer 45

**PECS 1** * Injection site = Fascial plane between the pec major and pec minor **PECS 2** * Injection site = Fascial plane between the pec major and pec minor