股神经髂筋膜隐神经蒋嘉.pptxVIP

会计学 1 股神经髂筋膜隐神经蒋嘉 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 第1页/共34页 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 withdrawal 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 第2页/共34页 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; 126:923-37 第3页/共34页 Ranking  F/S (6)  F/O(6)  LP/S (3) FIC (3)  PA (2) Ranking on high- quality studies F/S FIC LP PA ACB 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 第4页/共34页 闭孔神经 股神经 股外侧皮神经 隐神经 第5页/共34页 髂筋膜阻滞 •阻滞的是什么？ 第6页/共34页 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 第7页/共34页 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 第8页/共34页 髂筋膜阻滞的扩散范围（MRI） 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 腹股沟韧带水平 骶骨水平 冠状位 腹股沟韧带水平髂筋膜阻滞 第9页/共34页 超声引导髂筋膜阻滞的方法 腹股沟韧带下法