超声引导下臂丛神经阻滞知更.pptVIP

超声引导下臂丛神经阻滞技术 浙医二院麻醉科 周金锋 一、臂丛相关解剖基础 由第5-8颈神经前支和第1胸神经前 支大部分构成，经椎动脉后方、斜 角肌间隙向外侧穿出，组成三条干： ①C5、C6前支组成上干 ②C7前支单独成为中干 ③C8前支和T1前支大部分合成下干 在锁骨后第1肋骨中外缘分为前后两股 腋窝水平分成三束： ①上干和中干的前股合成外侧束-肌皮和正中神经 ②下干的前股成为内侧束-尺神经 ③三条干的后股组成后束-桡神经 一、臂丛相关解剖基础 一、臂丛相关解剖基础 一、臂丛相关解剖基础 二、超声下图像 C5 C6 C7 VA 二、超声下图像 C5 C6 C7 C8 VA 二、超声下图像 M A U R 三、实战攻略 临床关注点 起效时间 阻滞程度 药物剂量 成功率 操作难度 并发症 超声技术可以解决以上问题的关键——神经的定位及辨识度 设备因素 神经变异（50%） 操作技术 三、实战攻略——定位 三、实战攻略——定位 三、实战攻略——定位 三、实战攻略——定位 三、实战攻略 三、实战攻略 单点阻滞用于术后镇痛 An ultrasound (US)-guided block at the C7 root； Initial volume of ropivacaine 0.75% was 6 mL； Block success or failure determined a 1-mL decrease or increase for the subsequent patient； The minimum effective volume of local anesthetic in 50% and 95% of the patients was 2.9 mL (95% confidence interval, 2.4-3.5 mL) and 3.6 mL (95% confidence interval, 3.3-6.2 mL)； Minimum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmonary function.Reg Anesth Pain Med. 2010 Nov-Dec;35(6):529-34. 三、实战攻略 分干阻滞最低剂量 Successful surgical anesthesia for arthroscopic shoulder surgery can be achieved with 5 mL of 0.75% ropivacaine, or approximately 1.7 mL per each of the 3 trunks of the brachial plexus (superior, middle, and inferior). For the group as a whole, the median (range) sensory block onset time was 5 (5-20) minutes, the median (range) motor block for the biceps was 7.5 (5-15) minutes. The median (range) block duration was 9.9 (5-19) hours, and the mean (SD) block performance time was 8.0 ± 3.2 minutes. Mean duration of analgesia was 9.9 ± 3.7 hours. Duration of analgesia was not associated with volume of LA (r = 0.05, P = 0.83) The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5. 三、实战攻略 单点阻滞最低剂量研究 The proportion of patients with successful blockade increased sharply from approximately 57% at 6 ml to 100% by 7 ml, indicating that a small incre