神经刺激器的应用课件.ppt

锁骨下阻滞 Indications: Elbow, forearm, hand surgery Landmarks: Medial clavicular head, coracoid process Nerve Stimulation: Hand twitch at 0.2-0.3 mA current Local anesthetic: 30-45 mL 锁骨下阻滞 1.5 mA. A local twitch of the pectoralis twitch of the brachial plexus 5 to 8 cm 锁骨下阻滞并发症 Hematoma Avoid multiple needle insertions through the pectoralis muscle - Apply firm pressure over the site of needle insertion after needle withdrawal - Carefully review indications for the single shot and avoid continuous infraclavicular block in patients with abnormal coagulation Systemic toxicity - Limit the volume/dose of long-acting local anesthetic - Carefully review risks and benefits of using long-acting local anesthetics for each and every patient/operation - Inject local anesthetic with frequent aspiration to rule out intravascular injection, carefully assessing the patient for signs of local anesthetic toxicity - Inject local anesthetic SLOWLY to avoid channeling of local anesthetic to smaller veins/lymphatic channels that may have been punctured during needle advancement 锁骨下阻滞并发症 Nerve Injury Use the nerve stimulator to confirm the needle position! This technique requires deep needle insertion and the use of paresthesia is not acceptable - Make sure that the nerve stimulator is fully functional and connected properly - Advance the needle slowly when the twitches of the pectoralis muscle cease Orient the bevel of the needle down to facilitate nerve stimulation and avoid contact of the plexus complements (and vascular walls) with the advancing tip of the needle - Do not inject against high pressures! In this scenario, withdraw the needle, check its patency by flushing it, and repeat the procedure - Stop injecting immediately when patients complain of pain on injection! Pneumothorax -This is an often feared but exceedingly rare complication罕见 The needle direction is actually away from the chest cavity (as opposed to interscalene or supraclavicular blocks) - Attention should be p