軀干神經阻滯課件

1、,軀干神經阻滯在胸腹手術中的應用,肖穎,1,學習交流PPT,胸壁手術鎮(zhèn)痛方式的比較,Risk potential,2,學習交流PPT,胸壁神經支配,3,學習交流PPT,Intercostal nerve sensory distribution,4,學習交流PPT,Neural innervation of chest wall,硬膜外阻滯,胸椎旁阻滯,前鋸肌平面阻滯 （肋間神經側皮支）,肋間神經阻滯,胸骨旁肋間神經阻滯 (肋間神經前皮支),5,學習交流PPT,6,學習交流PPT,Thoracic Paravertebral Block,7,學習交流PPT,Thoracic Paraverte

2、bral Block,8,學習交流PPT,Thoracic Paravertebral Block,9,學習交流PPT,Thoracic wall block:PECS 1 + PECS 2 + PECS 3,10,學習交流PPT,Neural innervation of anterior chest wall and breast,Supraclavicular nerve C3-C4,11,學習交流PPT,Neural innervation of anterior chest wall and breast,Lateral pectoral nerve C5-C7,Medial pec

3、toral nerve C8-T1,12,學習交流PPT,Neural innervation of anterior chest wall and breast,Long thoracic nerve C5-C7,13,學習交流PPT,Neural innervation of anterior chest wall and breast,Thoracodorsal nerve C6-C8,14,學習交流PPT,Neural innervation of anterior chest wall and breast,Lateral intercostal cutaneoous nerve T

4、2-T6,Anterior intercostal cutaneoous nerve T2-T6,15,學習交流PPT,Neural innervation of anterior chest wall and breast,16,學習交流PPT,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

5、 + 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, 11071113,17,學習交流PPT,Thoracic wall block:PECS 1

6、 + 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, 11071113,18,學習交

7、流PPT,Georg Thieme Verlag,PECS 1,19,學習交流PPT,PECS 1,20,學習交流PPT,PECS 1: Injection,21,學習交流PPT,Ast der A. thoracoacromialis,22,學習交流PPT,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

8、nerve T2-T6 + N. thoracicus longus (M. serratus anterior),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, 11071113,23,學習交流PPT,Georg Thieme Verlag,M. serratus anterior,24,學習交流PPT,N. spinalis,Putz/Pabst:

9、Sobotta. Atlas der Anatomie des Menschen, 21. Aufl. Urban 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, 11071113,31,學習交流PPT,Georg Thieme Verlag,32,學習交流PPT,Georg Thieme Verlag,33,學習交流PPT,PECS 3,34,學習交流PPT,35,學習交流PPT,PECS 3: sensory B

10、lockade,Blanco R et al, Anaesthesia 2013, 68, 11071113,36,學習交流PPT,37,學習交流PPT,38,學習交流PPT,腹壁手術術后鎮(zhèn)痛方式的比較,Risk potential,39,學習交流PPT,Qudratus Lumborum Block,40,學習交流PPT,N. spinalis,Putz/Pabst: Sobotta. Atlas der Anatomie des Menschen, 21. Aufl. Urban 32(Suppl 1):130,45,學習交流PPT,Hebbard PD, J Can Anesth (20

11、09) 56:618620,M. erector spinae,M. psoas,M. Quadratus lumborum,Rectus sheath B.,TAP B.,Quadratus lumborum B.,46,學習交流PPT,Ultrasound-Guided Transmuscular Quadratus Lumborum Blockade,47,學習交流PPT,Quadratus lumborum Blockade,Transmuscular Quadratus lumborum Blockade,M. psoas,M. Quadratus lumborum,Transversus Abdominis plane blockade,48,學習交流PPT,49,學習交流PPT,ventral,posterior,anterior,dorsal,Wirbelkrper,M. psoas,Process transversus,M. erector spine,M. Quadratus lumborum,50,學習交流PPT,Tansversus Abdomins Plane Blockade,51,學習交流PPT,Ultrasound-Guided Transversus Abdomins Plane Block