Term
What term describes spinal and epidural blocks? |
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Definition
Central Neuraxial Blockade |
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Term
Vertebrae:
Total:
# Cervical:
# Thoracic:
# Lumbar:
# Sacral
# Coccyx: |
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Definition
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Term
What are vertebral bodies separated by? |
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Definition
Fibrocartilaginous intervertebral disks |
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Term
What part of the vertebrae is easily palpated? |
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Definition
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Term
What 3 things can happen if a spinal nerve is pinched or "squished'? |
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Definition
Pain
Sensory Loss
Muscle Spasm |
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Term
Distinguish between the angle of the spinous process in the lumbar region versus the thoracic region.
Why is this knowledge important to us? |
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Definition
Lumbar: horizontal spinal process
Thoracic: more vertical and even overlap
Helps to determine angle of needle insertion in regionals |
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Term
Compare and contrast lumbar and thoracic vertebrae |
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Definition
Lumbar: larger with shorter and more horizontal spinous process, larger gaps btwn
Thoracic: smaller with longer and more vertical spinous processes, tighter gaps btwn |
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Term
Name the 3 spinal ligaments |
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Definition
Supraspinous ligament
Interspinous ligament
Ligamentum flavum |
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Term
| Supraspinous Ligament: describe and give location |
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Definition
strong, fibrous cord joining tips of spinous process together that becomes more thick/wide in lumbar area
the major ligament in cervical and upper thoracic regions
C-7 to sacrum |
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Term
What connects the spinous processes of individual vertebrae from tip to root? |
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Definition
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Term
Describe the ligamentum flava |
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Definition
| Yellow, elastic fiber running in short segments btwn vertical arches - strongest of the ligaments - "muscle sparer" |
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Term
You are performing a regional technique and are absolutely certain you are in the correct location. Why do you have blood return during aspiration? |
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Definition
Small vessels penetrate the ligamentum flavum and can be a source of blood return on aspiration. |
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Term
In an adult at L2-3, what is the thickness of the ligamentum flava? |
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Definition
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Term
| The spinal cord extends from what to what in adults and children? |
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Definition
Medulla oblongata to L1 in adult and L3 in children |
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Term
| Where is the cauda equina located? |
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Definition
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Term
| The spinal cord terminates at the _________ and is held in place by the ___________ |
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Definition
conus medullaris
filum terminale |
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Term
At the cervical level, the nerves arise from what point in proximity to their respective vertebrae? At what spinal level does this change? |
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Definition
Cervical - nerves arise ABOVE respective vertebrae
T-1 |
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Term
| The spinal cord enlarges in the cervical region and becomes what? What level does this enlargement occur at? |
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Definition
The ventral nerve roots form the brachial plexus that innervates the upper extremities.
C4-T1 |
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Term
The 3 layers of meninges are: |
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Definition
dura mater
arachnoid mater
pia mater |
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Term
The risk of delivering a subarachnoid injection following a caudal block is higher in adults or children? |
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Definition
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Term
T/F
You will be able to distinguish between the ligamentum flava and the dura mater when passing a needle through the layers. |
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Definition
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Term
The CSF is located where?
What is the function of the CSF? |
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Definition
Subarachnoid space
protects cord and brain from shock and is the medium for interaction with local anesthetics and opioids during regional anesthesia |
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Term
| Should the pia mater ever be punctured during good regional technique? |
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Definition
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Term
T/F
The epidural is an actual space |
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Definition
False - it is a potential space |
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Term
What does the epidural space contain?
What is unique about the fat found here? |
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Definition
fat tissue, connective tissue, nerve roots, segmental arteries, lymphatics, epidural venous plexus
The fat is liquid like and will allow a catheter to be placed as well as accept fluid(drugs) |
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Term
This meninge is continous with the central canals of the ventricles and cord. |
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Definition
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Term
| Where is the epidural space located? |
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Definition
Base of cranium to the sacrococcygeal membrane |
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Term
| The epidural space is best approached from this position ___________ because if approached otherwise, this space will ____________ |
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Definition
midline
narrows if approached laterally |
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Term
Give the measurements of the epidural space in the following regions:
midlumbar
thoracic
cervical |
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Definition
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Term
List the 9 layers for SAB - in order from most exterior to interior |
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Definition
Skin
SQ
Supraspinous ligament
Intraspinous ligament
Ligamentum flava
epidural space
dura mater
arachnoid mater
SAS |
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Term
Why does an epidural require a greater amount of volume of drug to get an adequate spread? |
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Definition
| Because the dura mater covers the nerve root/rootlets for a distance and this slows diffusion towards the spinal cord and increases the lateral distance to exposed ("bare") nerve roots |
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Term
How many spinal nerve roots extend from the spinal cord? |
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Definition
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