常见的躯干神经阻滞.ppt

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 Risk potential 胸壁神经支配 Intercostal nerve sensory distribution Neural innervation of chest wall 硬膜外阻滞 胸椎旁阻滞 前锯肌平面阻滞 （肋间神经侧皮支） 肋间神经阻滞 胸骨旁肋间神经阻滞 (肋间神经前皮支) Thoracic Paravertebral Block Thoracic Paravertebral Block Thoracic Paravertebral Block Thoracic wall block:PECS 1 + PECS 2 + PECS 3 Neural innervation of anterior chest wall and breast Supraclavicular nerve C3-C4 Neural innervation of anterior chest wall and breast Lateral pectoral nerve C5-C7 Medial pectoral nerve C8-T1 Neural innervation of anterior chest wall and breast Long thoracic nerve C5-C7 Neural innervation of anterior chest wall and breast Thoracodorsal nerve C6-C8 Neural innervation of anterior chest wall and breast Lateral intercostal cutaneoous nerve T2-T6 Anterior intercostal cutaneoous nerve T2-T6 Neural innervation of anterior chest wall and breast Thoracic wall block:PECS 1 + PECS 2 + PECS 3  Indication: 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 +reconstruction Blanco R, Anaesthesia. 2011 Sep;66(9):847-8 Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 1107–1113 Thoracic wall block:PECS 1 + PECS 2 + PECS 3 PECS 1 : interfascial plane between pectoralis major and minor N. pectorales medialis + lateralis (M. pectoralis major) Blanco R, Anaesthesia. 2011 Sep;66(9):847-8 Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 1107–1113 Georg Thieme Verlag PECS 1 PECS 1 PECS 1: Injection Ast der A. thoracoacromialis Thorax wall block:PECS 1 + PECS 2 + PECS 3 PECS 1 N. 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