颈肩部手术神经阻滞.pptxVIP

颈肩部神经阻滞;;;Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery Anatomical, Physiologic, and Clinical Considerations Anesthesiology, 2017, 127(1):173;;肩部神经支配;肩部神经支配;;;;;;解剖学基础;;;;超声引导下颈浅丛阻滞;;超声引导下肌间沟神经阻滞;;A 1 mL test dose of local anesthetic was given to exclude intraneural injection and to assess the spread of the injection around the structure. 15 mL of local anesthetic was injected in incremental doses adjacent to the nerve structure, and, when necessary, minor adjustments were made to ensure spread of local anesthetic around the structure.;Cadaver dissection after new technique performed under ultrasound guidance in Fig. 2 with .2 cc methylene blue injected at C5 nerve root; remainder of brachial plexus in view. Arrow shows methylene blue at C5 nerve root. Forceps shown at distal brachial plexus in relation to injection at C5.;;;;;膈神经麻痹;膈神经麻痹;副膈神经 大多发自第5、或第5、6、第4颈神经。多为单侧。副膈神经与臂丛的关系要比与颈丛的关系更为密切。 副膈神经与膈神经迟早必将合并为一。根据膈神经与副膈神经的支数多少,可归纳成五个类型: 第一型一支,即膈神经本身。 第二型二支,即膈神经与副膈神经各一支。 第三型三支,即膈神经一支,副膈神经二支。 五型中以第一型(占43.1%)与第二型(占43.3%)最多,均可列为国人之标准型;肥胖患者;;膈神经麻痹;膈神经麻痹;药物的体积影响;局部麻醉剂浓度;注射距离;Sonogram at C7 vertebral level. * indicates root C7; ASM： anterior scalene muscle; Black arrows：needle; CA, carotid artery; MSM： middle scalene muscle; VA： vertebral artery; X：后结节. The anterior tubercle is absent.;Extrafascial injection for interscalene brachial plexus block reduces respiratory complications compared with a conventional intrafascial injection;;Extrafascial injection for interscalene brachial plexus block reduces respiratory complications compared with a conventional intrafascial injection;肩胛上神经和腋神经阻滞;Suprascapular and Interscalene Nerve Block for Shoulder Surgery A Systematic Review and Meta-analysis;A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery An Equivalence Study;;;;;;Dexmedetomidine as a Perineural Local Anaesthetic Adjunct to Prolong Peripheral Nerve Block Dur