Nerve Block（神经阻滞）幻灯片.pptVIP

Axillary block Supraclavicular block Indication Inpatient, skillful practitioner Position Supine, arm aside, head turn to opposite Pharmacologic choice Consider the length of blockage Supraclavicular block Advantage: Rapid onset; Well motor blockage; Easy to approach. Shortage: Cause pneumothorax; Phrenic nerve blockage. Supraclavicular block Interscalene block Anatomy Indication Position Interscalene block Pharmacology choices Interscalene block Paresthesia seeking method Advantage:Upper arm and shoulder blockage with less LD;Safety approach. Shortage:Difficult to block ulnar n.; vertebral a. injection; spinal or epidural Injection; pneumothorax; phrenic n. block. Interscalene block Sagittal plane optimizes the needle angle Sciatic block Digital block Case discussion Female, 54y, Diagnosis: humeral fracture. Surgery: Open reduction and internal fixation. Anesthesia: Interscalene block with 2% lidocaine 25ml with epinephrine (1:200,000) Maneuver: “Immobile needle”+careful aspiration. After 5 min, patient notes numbness of the operative arm but starts to complain of increasing dyspnea. Case discussion What could be appropriate management? What are the most likely causes? What could be appropriate management? Apply full monitoring: EKG, NIBP, SPO2, Supplemental oxygen. Preparation of general anesthesia induction: tracheal intubation, controlled ventilation. Vasopressors and atropine. Mental status and ventilatory exchange . What are the most likely causes? Spinal injection Cervical epidural injection Phrenic n. block Pneumothorax Anxiety Nerve Block Sketch of this lesson General introduction Local anesthetic toxicity Cervical plexus block Brachial plexus block Sciatic block Digital block General introduction History 1880s, Cocaine was injected to peripheral site for minor surgeries. 1885, Esmarch bandage used to arrest local circulation to prolong coaine-induced block. 1903, epinephrine as “chemical tourniquet” emerged. 1920, t