躯干神经阻滞培训课件.ppt

胸壁手术镇痛方式的比较Riskpotential

胸壁神经支配

Intercostalnervesensorydistribution

Neuralinnervationofchestwall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)

ThoracicParavertebralBlock

ThoracicParavertebralBlock

ThoracicParavertebralBlock

Thoracicwallblock:

PECS1+PECS2+PECS3

NeuralinnervationofanteriorchestwallandbreastSupraclavicularnerveC3-C4

NeuralinnervationofanteriorchestwallandbreastLateralpectoralnerveC5-C7MedialpectoralnerveC8-T1

NeuralinnervationofanteriorchestwallandbreastLongthoracicnerveC5-C7

NeuralinnervationofanteriorchestwallandbreastThoracodorsalnerveC6-C8

NeuralinnervationofanteriorchestwallandbreastLateralintercostalcutaneoousnerveT2-T6AnteriorintercostalcutaneoousnerveT2-T6

Neuralinnervationofanteriorchestwallandbreast

Thoracicwallblock:

PECS1+PECS2+PECS3

Indication:postoperativeAnalgesia PECS1:Breastexpanderorsubpectoralprostheses PECS2:+PECS1:Tumorresection,Mastectomy+axillarylymphnodeclearance PECS3+PECS1:Mastectomy+axillarylymphnodeclearance+reconstructionBlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113

Thoracicwallblock:

PECS1+PECS2+PECS3PECS1:interfascialplanebetweenpectoralismajorandminorN.pectoralesmedialis+lateralis(M.pectoralismajor)

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113

GeorgThiemeVerlagPECS1

PECS1

PECS1:Injection

AstderA.thoracoacromialis

Thoraxwallblock:

PECS1+PECS2+PECS3PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

LateralcutaneousbranchofthoracicintercostalneervenerveT2-T6+N.thoracicuslongus(M.serratusanterior)

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolRe