第十章---局部麻醉方法1.pptVIP

第十章第三节局部麻醉方法Local anesthetic techniques泸州医学院附属医院麻醉科 欧册华 神经及神经丛阻滞Nerve Block 病案讨论 Case discussion An 35-year-old man with a humeral fracture desires regional anesthesia for open reduction and internal fixation. An interscalene block with 25ml of 2%lidocaine with epinephrine (1:200,000)is administered using an “immobile needle” with full injection and careful aspiration. Immediately after injection, the patient becomes unconscious; and BP cannot be read ; ECG shows HR 45bpm; breath is very weak and slow. Questions 1.What are the most likely causes?? 2.What would be appropriate management? 概述 outline 1、概念 concept 神经阻滞也称传导阻滞或传导麻醉，是将局麻药注射至神经干(丛)旁，暂时地阻滞神经的传导功能，达到手术无痛的方法。 Nerve block is a term that denotes the anesthesia or analgesia established when local anesthetic is injected in the vicinity of peripheral major nerve trunks or nerve plexus to prevent their conduction of electric impulses transiently and reversibly. 阻滞的程度不同，临床效果也不同，如果只有感觉神经受到阻滞，只能产生镇痛或无痛效果；如果感觉与运动神经都完全阻滞，则产生无痛和运动麻痹。 Sensory block to produce analgesia or painless. Sensory and motor block to produce analgesia and paralysis. 2、适应证 Indications 取决于手术范围、手术时间、病人的精神状态及合作程度，只要手术部位局限于某一或某些神经干(丛)所支配范围，并且阻滞时间能满足手术需要者均可。 The range of procedure, duration of operation, patient’s condition and cooperation, and operation site is supplied by one or several nerve trunks/plexus , and the duration of local anesthesia can meet the operation. 神经阻滞可单独应用，亦可与其他麻醉方法复合应用。 Nerve block can be applied alone or with other anesthesia. 3、禁忌证Contraindications 禁忌证：病人拒绝神经阻滯或麻醉影响手术操作，穿刺部位有感染、肿瘤、严重畸形以及对局麻药过敏者、凝血障碍等。 Bleeding diathesis, sepsis or tumor close to site of puncture, severe deformity, allergic reaction to local anesthetic, patient refusal , influence of operation or patient can’t cooperate. 4、注意事项 （1）神经阻滞多为盲探性操作，要求病人清醒合作能说出异感并能辨别异感放射的部位。 Most of nerve blocks are blind puncture, and require preservaion of consciousness and cooperation so that patients can tell paresthesia and the site of its radiat