第10-2章 局部麻醉方法.pptVIP

第十章 局部麻醉方法Local anesthetic techniques泸州医学院附属医院麻醉科 欧册华 神经及神经丛阻滞Nerve Block 概述 outline 1、概念 concept 神经阻滞也称传导阻滞或传导麻醉，是将局麻药注射至神经干(丛)旁，暂时地阻滞神经的传导功能，达到手术无痛的方法。 Nerve block is a term that denotes the anesthesia or analgesia established when local anesthetic is injected in the vicinity of peripheral major nerve trunks or nerve plexus to prevent their conduction of electric impulses transiently and reversibly. 阻滞的程度不同，临床效果也不同，如果只有感觉神经受到阻滞，只能产生镇痛或无痛效果；如果感觉与运动神经都完全阻滞，则产生无痛和运动麻痹。 Sensory block to produce analgesia or painless. Sensory and motor block to produce analgesia and paralysis. 2、适应证 Indications 取决于手术范围、手术时间、病人的精神状态及合作程度，只要手术部位局限于某一或某些神经干(丛)所支配范围，并且阻滞时间能满足手术需要者均可。 The range of procedure, duration of operation, patient’s condition and cooperation, and operation site is supplied by one or several nerve trunks/plexus , and the duration of local anesthesia can meet the operation. 神经阻滞可单独应用，亦可与其他麻醉方法复合应用。 Nerve block can be applied alone or with other anesthesia. 3、禁忌证Contraindications 禁忌证：病人拒绝神经阻滯或麻醉影响手术操作，穿刺部位有感染、肿瘤、严重畸形以及对局麻药过敏者、凝血障碍等。 Bleeding diathesis, sepsis or tumor close to site of puncture, severe deformity, allergic reaction to local anesthetic, patient refusal , influence of operation or patient can’t cooperate. 4、注意事项 （1）神经阻滞多为盲探性操作，要求病人清醒合作能说出异感并能辨别异感放射的部位。 Most of nerve blocks are blind puncture, and require preservaion of consciousness and cooperation so that patients can tell paresthesia and the site of its radiations. （2）神经阻滞的成功有赖于穿刺入路的正确定位，所以必须熟悉解剖和定位的标志。 Successful nerve blocks rely on right approaches, so regional anatomy and landmarks must be mastered. （3）操作力求准确、轻巧，神经干旁常伴有血管，穿刺针经过的组织附近可能有体腔(如胸膜腔等)或脏器，误伤后可引起严重并发症或后遗症。 Exact and gentle operation(puncture) can avoid injury to the organs and tissues(eg. blood vessels, pleura, etc) close to the nerve，and then to avoid severe complicaions and sequelae. （4）某些神经阻滞有几种不同的入路和方法，一般宜采用简便、安全和易于成功的方法，但遇到病人穿刺点附近有感染、肿瘤或畸形时，则需变换入路。 Some nerve blocks have several approaches and methods, commonl