躯干神经阻滞ppt.ppt

躯干神经阻滞在胸腹手术中的应用肖颖胸壁手术镇痛方式的比较胸段硬膜外胸椎旁神经阻滞PECS BlockRiskpotential胸壁神经支配Intercostal nerve sensory distributionNeural innervation of chest wall硬膜外阻滞胸椎旁阻滞 前锯肌平面阻滞（肋间神经侧皮支）肋间神经阻滞 胸骨旁肋间神经阻滞(肋间神经前皮支)Thoracic Paravertebral BlockThoracic Paravertebral BlockThoracic Paravertebral BlockThoracic wall block:PECS 1+PECS 2+PECS 3Neural innervation of anterior chest wall and breastSupraclavicular nerveC3-C4Neural innervation of anterior chest wall and breastLateral pectoral nerveC5-C7Medial pectoral nerveC8-T1Neural innervation of anterior chest wall and breastLong thoracic nerveC5-C7Neural innervation of anterior chest wall and breastThoracodorsal nerveC6-C8Neural innervation of anterior chest wall and breastLateral intercostal cutaneoous nerveT2-T6Anterior intercostal cutaneoous nerveT2-T6Neural innervation of anterior chest wall and breastThoracic wall block:PECS 1+PECS 2+PECS 3Indication:postoperative Analgesia-PECS 1:Breast expander or subpectoral prostheses-PECS 2:+PECS 1:Tumor resection,Mastectomy+axillary lymph node clearance-PECS 3+PECS1:Mastectomy+axillary lymph node clearance+reconstructionBlanco R,Anaesthesia.2011 Sep;66(9):847-8Blanco R et al,Rev Esp Anestesiol Reanim.2012 Nov;59(9):470-5Blanco R et al,Anaesthesia 2013,68,11071113Thoracic wall block:PECS 1+PECS 2+PECS 3PECS 1:interfascial plane between pectoralis major and minor N.pectorales medialis+lateralis(M.pectoralis major)Blanco R,Anaesthesia.2011 Sep;66(9):847-8Blanco R et al,Rev Esp Anestesiol Reanim.2012 Nov;59(9):470-5Blanco R et al,Anaesthesia 2013,68,11071113Georg Thieme VerlagPECS 1PECS 1PECS 1:InjectionThorax wall block:PECS 1+PECS 2+PECS 3PECS 1 N.pectorales medialis+lateralis(M.pectoralis major)PECS 2 Lateral cutaneous branch of thoracic intercostal neerve nerve T2-T6+N.thoracicus longus(M.serratus anterior)Blanco R,Anaesthesia.2011 Sep;66(9):847-8Blanco R et al,Rev Esp Anestesiol Reanim.2012 Nov;59(9):470-5Blanco R et al,Anaesthesia 2013,68,11071113Georg Thieme VerlagM.serratus anteriorGeorg Thieme VerlagPECS 2PECS 2:Zielregionmediallateral4.Rib5.Rib3.RippePleuraPleuraM.pectoralis majorM.pectoralis minorM.Serratus anteriorPECS 2PECS 2InjectionUPECS 2:sensory BlockadeThoracic wall block:PECS 1+PECS 2+PECS 3PECS 1 N.pectorales medialis+lateralis(M.pectoralis major)PECS 2 R.cutanei lateralis der R.anteriores der Spinalnerven T2-T6+N.thoracicus longus(M.serratus anterior)PECS 3 Lateral cutaneous branch of thoracic intercostal neerve nerve T2-T6+N.thoracodorsalis(M.latissimus dorsi)Blanco R,Anaesthesia.2011 Sep;66(9):847-8Blanco R et al,Rev Esp Anestesiol Reanim.2012 Nov;59(9):470-5Blanco R et al,Anaesthesia 2013,68,11071113Georg Thieme VerlagGeorg Thieme VerlagPECS 3PECS 3:sensory BlockadeBlanco R et al,Anaesthesia 2013,68,11071113腹壁手术术后镇痛方式的比较胸段硬膜外胸椎旁神经阻滞Qudratus Lumborum Blockade and TAPRiskpotentialQudratus Lumborum BlockN.spinalisPutz/Pabst:Sobotta.Atlas der Anatomie des Menschen,21.Aufl.Urban&Fischer,2000R.cutaneus lateralis R.cutaneus anterior Quadratus lumborum B.TAB B.Rectus sheath B.Classical TAPSubcostal TAPQuadratus Lumborum BlockRectus sheath BlockQudratus Lumborum BlockadeBlanco R.Reg Anaesth Pain Med 2007;32(Suppl 1):130Hebbard PD,J Can Anesth(2009)56:618620M.erector spinaeM.psoasM.Quadratus lumborumRectus sheath B.TAP B.Quadratus lumborum B.Ultrasound-Guided Transmuscular Quadratus Lumborum BlockadeQuadratus lumborum Blockade Transmuscular Quadratus lumborum BlockadeM.psoasM.Quadratus lumborumTransversus Abdominis plane blockadeventralposterioranteriordorsalWirbelkrperM.psoasProcess transversusM.erector spineM.Quadratus lumborumTansversus Abdomins Plane BlockadeUltrasound-Guided Transversus Abdomins Plane BlockUltrasound-Guided Transversus Abdomins Plane BlockUltrasound-Guided Transversus Abdomins Plane Blockade