神经阻滞(英文)概要1.ppt

Nerve Blocks 王戡 Anatomy Side effect and complication Sedation Upper Extremity Blocks Lower Extremity Blocks Upper Extremity Blocks Interscalene Block The principal indication for an interscalene block is surgery on the shoulder. Blockade of the inferior trunk is often incomplete and requires supplementation at the ulnar nerve. Interscalene Block Key points Supine position ; head turned away and briefly lift ; Posterior border of the sternocleidomastoid muscle (胸锁乳突肌); over the belly of the anterior scalene muscle Ricoid cartilage and intersecting the interscalene groove Needle is inserted perpendicular to the skin at a 45-degree caudad and slightly posterior angle . If a blunt needle bevel is used, a “click” may be detected as the needle passes through the prevertebral fascia. Inject 10 to 40 ml solution. Digital pressure above the injection site and downward massage along with a 45-degree head-up position may facilitate caudad spread and blockade of the lower trunk. Side Effects and Complications Diaphragmatic paresis膈肌麻痹 (100%) 25% reduction in pulmonary function Severe hypotension and bradycardia. Nerve damage or neuritis. Supraclavicular Block Indications for a supraclavicular block are operations on the elbow, forearm, and hand. Brachial plexus is compact and a small volume of solution produces rapid onset of reliable blockade of the branchial plexus Key points supine position ; head turned away ; hand extended along the side; raises the head slightly interscalene groove ; midpoint of the clavicle ; subclavian artery posterolateral direction of the subclavian artery The needle is directed in a caudad, slightly medial, and posterior direction until a paresthesia or motor response is elicited or the first rib is encountered. If the first rib is encountered without elicitation of a paresthesia, the