MAC Regional Anesthesia & Pain Management 2 — Questions and Answers
Question 1: Which analgesic approach best exemplifies multimodal analgesia?
- High-dose opioids alone
- Combining NSAIDs, acetaminophen, regional block, and low-dose opioids (Correct answer)
- Epidural opioids only
- Ketamine infusion alone
Correct answer: Combining NSAIDs, acetaminophen, regional block, and low-dose opioids
Multimodal analgesia combines medications with different mechanisms to achieve superior analgesia while minimizing opioid-related side effects.
Question 2: What complication is specifically associated with intrathecal morphine administration?
- Dense motor block
- Delayed respiratory depression up to 24 hours (Correct answer)
- Hyperthermia
- Seizures
Correct answer: Delayed respiratory depression up to 24 hours
Intrathecal morphine can cause delayed respiratory depression up to 24 hours after administration due to its hydrophilic nature and rostral spread in CSF.
Question 3: Which dermatome level must be achieved for a cesarean section under spinal anesthesia?
- T10
- T8
- T4 (Correct answer)
- T6
Correct answer: T4
A sensory block to T4 (nipple line) is required for cesarean section to prevent pain from peritoneal manipulation.
Question 4: What is the most common complication of epidural analgesia?
- Epidural hematoma
- Hypotension (Correct answer)
- Permanent neurologic injury
- Total spinal
Correct answer: Hypotension
Hypotension is the most common complication of epidural analgesia, resulting from sympathetic blockade causing vasodilation and decreased preload.
Question 5: Which coagulation parameter is most important before performing neuraxial anesthesia in a patient on anticoagulants?
- Bleeding time
- INR and platelet count (Correct answer)
- Fibrinogen level
- Factor VIII activity
Correct answer: INR and platelet count
INR and platelet count must be within acceptable ranges before neuraxial procedures to minimize epidural hematoma risk per ASRA guidelines.
Question 6: What is the mechanism of action of local anesthetics?
- Calcium channel blockade
- Voltage-gated sodium channel blockade (Correct answer)
- Potassium channel activation
- GABA receptor agonism
Correct answer: Voltage-gated sodium channel blockade
Local anesthetics block voltage-gated sodium channels, preventing action potential propagation along nerve fibers.
MAC Regional Anesthesia & Pain Management 2
Which analgesic approach best exemplifies multimodal analgesia?