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The cervical plexus includes what nerves?
C1-C5
Which nerves control the phrenic nerve?
C3-C5
What nerves are part of the brachial plexus?
C5-C8, T1
Which brachial plexus block is indicated for shoulder surgery?
Interscalene
Which brachial plexus blocks are at risk for pneumothorax?
Supraclavicular
Infraclavicular
Which nerve causes extension at the elbow?
Radial

** Only one that causes extension
Which nerve/s causes flexion of the wrist?
Ulnar  and median
Which nerve......

supination of forearm
radial
pronation of forearm
median
opposition of the middle, forefinger and thumb and flexion of he lateral three fingers.
median
flexion and opposition of medial two fingers toward thumb.
ulnar
Extension of wrist and fingers
radial
Flexion at elbow
musculocutaneous
What landmarks are used for a cervical plexus block?
Draw a line between the mastoid process and the transverse process of C6.

What are indications for a cervical plexus block?
CEA, adjunct to interscalene for shoulder
What are 4 complications of cervical plexus block?
  • Block of phrenic nerve (hiccups)
  • Horners syndrome
  • Recurrent laryngeal nerve block (hoarseness)
  • accidental subarachnoid or epidural injection
What are the symptoms of horners syndrome?
  • ipsilateral ptosis
  • miosis
  • facial and arm flushing
  • anhydrosis
  • nasal congestion
With a cervical plexus block, you have to inject each level you want to block. How much LA should you inject per level?
4 ML

(3-5 ml)
What levels are blocked with a cervical plexus block?
C1-4
What is the most proximal brachial plexus block?

most distal?
proximal - Interscalene

distal - axillary
What nerve is frequently not blocked with an interscalene block?
Ulnar nerve
What are the landmarks for an interscalene block? Describe.
Sternocleidomastoid muscle is palpated, roll fingers off posteriorly, inject where C6 intersects.
How should the needle be facing for an interscalene block?
Almost perpendicular to the floor, caudad, posterior, medial
What do you need to avoid hitting with an interscalene block?
external jugular vein
What are complications associated with interscalene blocks? (3)
  • Unintentional epidural or spinal anesthesia
  • Puncture of the vertebral artery --> if injected LA --> seizures
  • Phrenic nerve block (unilateral)
What volume of LA should be injected for interscalene block?
20-40 ml
Advantages of supraclavicular block:
  • Most homogenous block
  • Quick onset
  • Arm can be in any position
Biggest risk with supraclavicular block:
pneumothorax
Contraindications to supraclavicular block:
  • severe respiratory disease
  • bilateral upper extremity block -- NEVER DO!¬† --> can get bilateral pneumothorax or phrenic nerve block!
Volume of LA for supraclavicular block:
40 ML
What landmarks are used to locate the injection site for the supraclavicular block?
Interscalene groove and midpoint of the clavicle (2 cm above)
Where do you inject for an infraclavicular block?
Samea s for supraclavicular, except 2 cm caudal from midpoint of clavicle.
Which nerve is blocked with an infraclavicular block that is not blocked with an axillary?
Musculocutaneous!
Which nerve is NOT in the axillary sheath of the brachial plexus?
musculocutaneous
What is the most popular technique for blocking the nerves of the arm?
axillary block
What surgical areas does the axillary block provide anesthesia?
forearm and wrist
What position must the arm be for an axillary block?
arm must be abducted
What landmarks are used for the axillary block?
coracobrachialis muscle, pectoralis major, brachial artery
What volume of anesthetic for axillary block?
40 ml
Describe needle insertion point for ulnar block at elbow?
Between medial condyle of humerus and olecranon process of the ulna.
What volume of LA is injected for ulnar block at elbow?
4 ml
What volume of anesthetic is injected for median and radial nerve blocks at the elbow?
4 ml
Where is the insertion point of the needle for the median nerve block?
* medial to the brachial artery
Where is the needle insertion point for a radial nerve block at the elbow?
In the groove betweent he brachioradialis muscle and biceps brachii muscle inertion.
Where do you inject LA for an ulnar nerve block at the wrist?
slightly adjacent to the ulnar artery
What is requried to block the dorsal branch of the ulnar nerve at the wrist?
A lidocaine wheal around the ulnar portion of the wrist.
How much LA is injected with an ulnar nerve block at the wrist?
3 ml
Where do you insert the needle for a median nerve block at the wrist? How much LA?
Between the long palmar muscle and the radial flexor muscle of the wrist.

3 ml
How do you do a radial nerve block at the wrist?

How much LA?
  • Wrist in neutral handshake position
  • Inject subcutaneous ring lof local anesthetic, beginning at the radial flexor muscle and extending to the dorsal surface of the ulnar styloid.
  • Injeect 5-7 ml (6 ml!)
Which two wrist blocks should NOT be done together? Why?
  • Do NOT perform a radial AND ulnar nerve block at the wrist.
  • They both require subcutaneous rings of LA --> could lead to compromsed circulation to the hand!
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