EDAIC Regional Anesthesia and Pain Management 4

Question 1

What is the primary advantage of ropivacaine over bupivacaine for continuous peripheral nerve blocks?

Accepted Answer

Greater motor sparing at equivalent analgesic concentrations

Answer

Ropivacaine has less lipid solubility than bupivacaine, resulting in more differential sensory-motor block and a significantly lower risk of cardiotoxicity with accidental intravascular injection.

Question 2

In ultrasound-guided femoral nerve block, where is the nerve typically located relative to the femoral artery?

Accepted Answer

Lateral to the femoral artery, beneath the fascia iliaca

Answer

The femoral nerve lies lateral to the femoral artery and deep to the fascia iliaca (but outside the femoral sheath) at the inguinal level.

Question 3

Which opioid is most appropriate for a patient with severe renal impairment requiring analgesia?

Accepted Answer

Fentanyl

Answer

Fentanyl has no active renally-cleared metabolites, making it the preferred opioid in renal failure; morphine-6-glucuronide accumulates in renal failure and can cause profound sedation.

Question 4

The erector spinae plane (ESP) block deposits local anesthetic in which anatomical location?

Accepted Answer

Between the erector spinae muscle and the transverse process

Answer

The ESP block injects local anesthetic into the fascial plane between the erector spinae muscles (multifidus/longissimus) and the tip of the transverse process, where it can spread to block dorsal and ventral rami.

Question 5

A patient develops ringing in the ears, perioral numbness, and metallic taste during a scalp nerve block. What is the immediate management priority?

Accepted Answer

Stop injection, administer IV lipid emulsion if seizures develop

Answer

These are early CNS signs of local anesthetic systemic toxicity (LAST); injection should be stopped immediately and 20% lipid emulsion (1.5 mL/kg bolus) should be prepared for administration if cardiovascular or neurological deterioration occurs.

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC Regional Anesthesia and Pain Management 4