Therapeutic opioids activate endogenous pain modulating systems and produce analgesia

Endogenous opioids inhibit pain via descending modulatory systems

Opioids decrease the influx of calcium

Opioids inhibit GABA system leading to pain transmission

Opioids can produce analgesia following local administration

Augments conduction by decreasing large transient increase in permeability to sodium

LA interact directly with voltage gated sodium channels

LA decreases the propagation of action potentials

LA binds to sodium channels

LA are more active when applied externally to membrane

Unmyelinated fibers are resistant to LA compared with myelinated alpha fibers

Bupivacaine and ropivacaine are more selective for sensory fibers

Hydrogen ions potentiate use of dependent block

Spread of neuroaxial anesthesia is more in pregnancy

Local anesthetic binding proteins increase with infusions of LA

Works by inhibiting sodium permeability

Use is important for LA function

Potency of LA increase with increased molecular weight

Speed of onset slows with increase in LA lipid solubility and increased pKa

LA rate of onset is associated with increase in aqueous diffusion rate which declines with increased molecular weight

Phrenic nerve block is seen more with supraclavicular approach

Brachial plexus block has no effect on pulmonary function tests

Surgery in the sitting position increases the risk of brachial plexus block

Interscalene block can cause spinal cord injury

Total spinal anesthesia is a possible complications

Horner's syndrome is indicative of a successful interscalene gap block

Hoarseness is a known complication of interscalene gap block

Bronchodilation is a complication of posterior fossa of the neck approaches

Loss of hearing is a known complication of posterior fossa of the neck approaches

Transarterial approach may cause loss of pulse in axillary groove approaches

Derived from the dorsal rami of C5 - T1

Dorsal scapular nerve arises from the superior trunk

C5 and T1 rami are the targets in interscalene gap approaches

Blood supply is from subclavian and vertebral artery

Upper trunk is formed by C5 and C6

Is adequate for surgery of the upper limb distal to the shoulder

Proximal part of the medial side of the arm is adequately blocked

Lower volumes may be used in elderly population

Pneumothorax is a delayed complication

Does not cause phrenic nerve paralysis

Median nerve is the preaxial nerve of the hand

Radial nerve innervates the lumbricals of the hand

Lateral contribution to the median nerve is responsible for the intrinsic motors of the hand

Ulnar nerve has no branches in the arm until it leaves the cubital tunnel

The palsy of the posterior interosseous nerve causes a wrist drop

Ultrasound guidance totally eliminates pneumothorax

Local anesthetic deposition below 2nd segment of the axillary artery ensures good blockade

Approach blocks the cords of the brachial plexus

Ropivacaine causes greater motor block versus levobupivacaine

Median nerve involvement is the most common neurapraxia

Bupivacaine causes dose dependent prolongation of cardiac conduction

Most common arrhythmia seen with bupivacaine is ventricular tachycardia

Lidocaine causes more extrasystoles than ropivacaine

Ropivacaine produces less ventricular depression than bupivacaine

Side effects of bupivacaine is due to R(+) enantiomer

The saphenous nerve is purely sensory

The lateral femoral cutaneous nerve is purely sensory

The accessory obturator nerve is purely sensory

The sural nerve is purely sensory

The superfical peroneal nerve is purely sensory

LA should be seen spreading along the anterior rectus sheath

Indicated for surgical anesthesia

Should be done below the arcuate line

Local anesthetic spread extends to the transversus abdominis plane

Catheter placement are not a contraindication

Can spread to the epidural region

Injection can spread to the bilateral area

Spread is usually isolated at a single interspace

Anterior displacement of the pleura should not occur

Intertransverse process block does not cause a paravertebral block

The block is indicated for femoral shaft fractures

Higher incidence of LAST

The block is indicated for femoral neck fracturs

The block targets the lateral femoral cutaneous nerve

The block provides surgical anesthesia

The block is indicated for the procedure

The block avoids respiratory embarassment

Winging of the scapula is a possible complication

Higher chance of injuring the thyrocervical artery

Weakness in shoulder abduction is a possible complication

The block is indicated for the procedure

The block involves targeting 3 nerves

The first nerve along the needle path is a nerve that arises from the posterior cord

The subclavian artery is a useful landmark

The radial nerve is typically located in the 5 to 6 o'clock position relative to the subclavian artery

The Interpectoral Plane Block is indicated for this type of surgery

The Pecto-serratus Plane Block provides coverage of the lateral aspect of the surgery

The Transverse Thoracis Plane Block provides better coverage than the Pecto-intercostal Plane Block

LAST is a minimal complication as no vessel is located in the approach shown in the picture

The ICB nerve is easily blocked by the approach shown in the picture

The block is appropriate for the procedure

The block will provide surgical anesthesia for the procedure

Placement of a catheter will provide better analgesia for this patient

The nerve surrounded by LA at the right side of image innervates the dorsiflexors of the foot

0.75% Ropivacaine with epinephrine 1:200,000 is recommended