躯干神经阻滞

1、躯干神经阻滞在胸腹手术中的应用肖颖胸壁手术镇痛方式的比较 胸段硬膜外 胸椎旁神经阻滞 PECS BlockRiskpotential胸壁神经支配Intercostal nerve sensory distributionNeural Neural innervationinnervation of chest wall of chest wall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)Thoracic Thoracic ParavertebralParavertebral Block BlockThoracic Thoracic

2、ParavertebralParavertebral Block BlockThoracic Thoracic ParavertebralParavertebral Block BlockThoracic wall block:PECS 1 + PECS 2 + PECS 3Neural Neural innervationinnervation of anterior chest of anterior chest wall and breastwall and breastSupraclavicularSupraclavicular nerve nerveC3-C4C3-C4Neural

3、Neural innervationinnervation of anterior chest of anterior chest wall and breastwall and breastLateral pectoral nerveLateral pectoral nerveC5-C7C5-C7Medial pectoral nerveMedial pectoral nerveC8-T1C8-T1Neural Neural innervationinnervation of anterior chest of anterior chest wall and breastwall and b

4、reastLong thoracic nerveLong thoracic nerveC5-C7C5-C7Neural Neural innervationinnervation of anterior chest of anterior chest wall and breastwall and breastThoracodorsalThoracodorsal nerve nerveC6-C8C6-C8Neural Neural innervationinnervation of anterior chest of anterior chest wall and breastwall and

5、 breastLateral Lateral intercostalintercostal cutaneoouscutaneoous nerve nerveT2-T6T2-T6Anterior Anterior intercostalintercostal cutaneoouscutaneoous nerve nerveT2-T6T2-T6Neural Neural innervationinnervation of anterior chest of anterior chest wall and breastwall and breastThoracic wall block:PECS 1

6、 + PECS 2 + PECS 3 Indication: postoperative Analgesia- PECS 1: Breast expander or subpectoral prostheses- PECS 2: + PECS 1: Tumor resection, Mastectomy + axillary lymph node clearance- PECS 3 + PECS1: Mastectomy + axillary lymph node clearance +reconstructionBlanco R, Anaesthesia. 2011 Sep;66(9):84

7、7-8Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5Blanco R et al, Anaesthesia 2013, 68, 11071113Thoracic wall block:PECS 1 + PECS 2 + PECS 3 PECS 1 : interfascial plane between pectoralis major PECS 1 : interfascial plane between pectoralis major and minorand minor N. pectorales medi

8、alis + lateralis (M. pectoralis major)Blanco R, Anaesthesia. 2011 Sep;66(9):847-8Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5Blanco R et al, Anaesthesia 2013, 68, 11071113Georg Thieme VerlagPECS 1PECS 1PECS 1PECS 1: InjectionAst der A. thoracoacromialisThorax wall block:PECS 1 + P

9、ECS 2 + PECS 3 PECS 1 PECS 1 N. pectorales medialis + lateralis (M. pectoralis major) PECS 2 PECS 2 L Lateral cutaneous branch of thoracic intercostal neerve nerve T2-T6 + N. thoracicus longus (M. serratus anterior)Blanco R, Anaesthesia. 2011 Sep;66(9):847-8Blanco R et al, Rev Esp Anestesiol Reanim.

10、 2012 Nov;59(9):470-5Blanco R et al, Anaesthesia 2013, 68, 11071113Georg Thieme VerlagM. serratus anteriorN. spinalisPutz/Pabst: Sobotta. Atlas der Anatomie des Menschen, 21. Aufl. Urban & Fischer, 2000R. cutaneus lateralis R. cutaneus anterior R. anteriorR. posteriorGeorg Thieme VerlagPECS 2PEC

11、S 2PECS 2: Zielregionmediallateral4. Rib5. Rib3. RippePleuraPleuraM. pectoralis majorM. pectoralis minorM. Serratus anteriorPECS 2PECS 2InjectionUPECS 2: sensory BlockadeThoracic wall block:PECS 1 + PECS 2 + PECS 3 PECS 1 PECS 1 N. pectorales medialis + lateralis (M. pectoralis major) PECS 2 PECS 2

12、R. cutanei lateralis der R. anteriores der Spinalnerven T2-T6 + N. thoracicus longus (M. serratus anterior) PECS 3PECS 3 L Lateral cutaneous branch of thoracic intercostal neerve nerve T2-T6 + N. thoracodorsalis (M. latissimus dorsi)Blanco R, Anaesthesia. 2011 Sep;66(9):847-8Blanco R et al, Rev Esp

13、Anestesiol Reanim. 2012 Nov;59(9):470-5Blanco R et al, Anaesthesia 2013, 68, 11071113Georg Thieme VerlagGeorg Thieme VerlagPECS 3PECS 3PECS 3: sensory BlockadeBlanco R et al, Anaesthesia 2013, 68, 11071113腹壁手术术后镇痛方式的比较 胸段硬膜外 胸椎旁神经阻滞 Qudratus Lumborum Blockade and TAPRiskpotentialQudratus Lumborum Bl

14、ockN. spinalisPutz/Pabst: Sobotta. Atlas der Anatomie des Menschen, 21. Aufl. Urban & Fischer, 2000R. cutaneus lateralis R. cutaneus anterior Quadratus lumborum B.TAB B.Rectus sheath B.Classical TAPSubcostal TAPQuadratus Lumborum BlockRectus sheath BlockQudratus Lumborum BlockadeBlanco R. Reg An

15、aesth Pain Med 2007;32(Suppl 1):130Hebbard PD, J Can Anesth (2009) 56:618620M. erector spinaeM. psoasM. Quadratus lumborumRectus sheath B.TAP B.Quadratus lumborum B.Ultrasound-Guided Transmuscular Quadratus Lumborum BlockadeQuadratus lumborum Blockade Transmuscular Quadratus lumborum BlockadeM. psoasM. Quadratus lumborumTransversus Abdominis plane blockadeventralposterioranteriordorsalWirbelkrperM. psoasP