2017股神经、髂筋膜、隐神经-蒋嘉.pptxVIP

朝阳医院超声麻醉疼痛周髂筋膜、股神经和隐神经/收肌管阻滞朝阳医院麻醉科 蒋嘉膝关节置换镇痛Terkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty. A Network Meta- analysis of 170 Randomized Controlled Trials. Anesthesiology 2017; 126:923-37膝关节置换镇痛Primary outcomes:(1) acute postoperative pain (during rest and movement)(2) postoperative opioid consumption(3) quality of early postoperative rehabilitation (functional assessments)Secondary outcomes:postoperative complications (e.g., nausea, vomiting, falls), duration of hospitalization, blood loss, procedure failure, and patient withdrawalTerkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty. A Network Meta- analysis of 170 Randomized Controlled Trials. Anesthesiology 2017; 126:923-37与PCA比较(A) Overall pain scores in the first 72 h duringrest(B) overall pain scores in the first 72 h during movement,(C) overall opioid consumption in the first 72 h(D) overall range on motion in the first 72 h.Terkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty. A Network Meta-analysis of 170 Randomized Controlled Trials.Anesthesiology 2017; 126:923-37Ranking? F/S (6)? F/O(6)? LP/S (3)FIC (3)? PA (2)Ranking on high-quality studiesF/SFICLPPAACBTerkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty. A Network Meta-analysis of 170 Randomized Controlled Trials. Anesthesiology 2017; 126:923-37股外侧皮神经闭孔神经股神经隐神经髂筋膜阻滞?阻滞的是什么？髂筋膜? 外界：髂嵴内侧缘? 内界：小骨盆的界线? 向下一直延续 到股骨小转子 水平? 覆盖腰大肌和 髂肌髂筋膜闭孔神经与髂肌和髂筋膜并没有密切的联系闭 孔 神 经髂筋膜阻滞的扩散范围（MRI）腹股沟韧带水平腹股沟韧带水平髂筋膜阻滞冠状位骶骨水平Swenson JD, Davis JJ, et al. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve. Journal of Clinical Anesthesia (2015) 27, 652–657超声引导髂筋膜阻滞的方法腹股沟韧带下法? 寻找缝匠肌和髂肌? 药液扩散：缝匠肌和髂肌之间? 阻滞：股神经、股外侧皮神经？超声引导髂筋膜阻滞腹股沟韧带上法Bullock WM, Yalamuri SM, Gregory SH, et al. Ultrasound-