躯干神经阻滞__培训课件.pptxVIP

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Riskpotential胸壁神经支配Intercostal nerve sensory distributionNeural innervation of chest wall硬膜外阻滞胸椎旁阻滞肋间神经阻滞 前锯肌平面阻滞（肋间神经侧皮支） 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, 1107–1113Thoracic 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, 1107–1113PECS 1Georg Thieme VerlagPECS 1PECS 1: InjectionAst der A. thoracoacromialisThorax wall block:PECS 1 + PECS 2 + PECS 3PECS 1N. 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 e