Regional Anesthesia for the Neuroaxis, Chest, Abdomen Regional/APS Rotations (Slides by Randall Malchow, MD) Regional Anesthesia for Chest and Abdomen Thoracic Epidurals Intercostals Paravertebral Block Ilioinguinal, Iliohypogastric Blocks TAP/Rectus Sheath Blocks Caudals Thoracic Dermatomes note C4-T2 interface Thoracic Spine Sharply angulated sp proc   Min flexion of spine (facets)   Thin ligamentum flavum   Thin epidural space 3-4 mm   (5-6 mm in lumbar) Interspace:   –  T4- Upper Rib Fxs –  T6- Thoracotomies –  T10- Laparotomies Midline Thoracic Epidural Spinous Process   at Trans Process of level below Angle 60-75 deg   cephalad Paramedian Approach   Esp impt at mid-thor region (Thoracotomy, MIDCABG)   Lg aperture   1 cm contralat to upper T6 sp proc   Touch side of sp proc, then adv needle perpendicular to lamina   Adv 15-30deg med; 45 deg cephalad TEA: for Cardiac Surgery Timing: Day Before vs   DOS Consider periop anticoag   (eg Valves) Preinduction placement/     Opioid: hydrophilic to Test Dose maximize other dermatomes   T3- Sternotomy   UE numbness common Arrow Flex-tip?   LE deficits concerning   Induction: Midaz 0.2mg/   Duration: 72hrs; remove p   CT’s out kg; Panc Limit advancement, 3cm   Secure catheters well   Half rate during CPB  USG Lumbar Epidural (parasag) Note 3 branches of Intercostal Nerves: -posterior -lateral -anterior Intercostal Nerve Block