躯干神经阻滞

胸壁手术镇痛方式的比较胸段硬膜外胸椎旁神经阻滞PECSBlockRiskpotential第一页，共54页。胸壁神经支配第二页，共54页。Intercostalnervesensorydistribution第三页，共54页。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)第四页，共54页。第五页，共54页。ThoracicParavertebralBlock第六页，共54页。ThoracicParavertebralBlock第七页，共54页。ThoracicParavertebralBlock第八页，共54页。Thoracicwallblock:

PECS1+PECS2+PECS3第九页，共54页。NeuralinnervationofanteriorchestwallandbreastSupraclavicularnerveC3-C4第十页，共54页。NeuralinnervationofanteriorchestwallandbreastLateralpectoralnerveC5-C7MedialpectoralnerveC8-T1第十一页，共54页。NeuralinnervationofanteriorchestwallandbreastLongthoracicnerveC5-C7第十二页，共54页。NeuralinnervationofanteriorchestwallandbreastThoracodorsalnerveC6-C8第十三页，共54页。NeuralinnervationofanteriorchestwallandbreastLateralintercostalcutaneoousnerveT2-T6AnteriorintercostalcutaneoousnerveT2-T6第十四页，共54页。Neuralinnervationofanteriorchestwallandbreast第十五页，共54页。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第十六页，共54页。Thoracicwallblock:

PECS1+PECS2+PECS3PECS1:interfascialplanebetweenpectoralismajorandminor

N.pectoralesmedialis+lateralis(M.pectoralismajor)

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113第十七页，共54页。GeorgThiemeVerlagPECS1第十八页，共54页。PECS1第十九页，共54页。PECS1:Injection第二十页，共54页。AstderA.thoracoacromialis第二十一页，共54页。Thoraxwallblock:

PECS1+PECS2+PECS3PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

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

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113第二十二页，共54页。GeorgThiemeVerlagM.serratusanterior第二十三页，共54页。N.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2000R.cutaneuslateralisR.cutaneusanteriorR.anteriorR.posterior第二十四页，共54页。GeorgThiemeVerlag第二十五页，共54页。PECS2第二十六页，共54页。PECS2:Zielregionmediallateral4.Rib5.Rib3.RippePleuraPleuraM.pectoralismajorM.pectoralisminorM.Serratusanterior第二十七页，共54页。PECS2

PECS2InjectionU第二十八页，共54页。PECS2:sensoryBlockade第二十九页，共54页。Thoracicwallblock:

PECS1+PECS2+PECS3PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

R.cutaneilateralisderR.anterioresderSpinalnervenT2-T6+N.thoracicuslongus(M.serratusanterior)

PECS3

LateralcutaneousbranchofthoracicintercostalneervenerveT2-T6+N.thoracodorsalis(M.latissimusdorsi)BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113第三十页，共54页。GeorgThiemeVerlag第三十一页，共54页。GeorgThiemeVerlag第三十二页，共54页。PECS3第三十三页，共54页。第三十四页，共54页。PECS3:sensoryBlockadeBlancoRetal,Anaesthesia2013,68,1107–1113第三十五页，共54页。第三十六页，共54页。第三十七页，共54页。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QudratusLumborumBlockadeandTAPRiskpotential第三十八页，共54页。QudratusLumborumBlock第三十九页，共54页。N.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2000R.cutaneuslateralisR.cutaneusanteriorQuadratuslumborumB.TABB.RectussheathB.第四十页，共54页。ClassicalTAPSubcostalTAP第四十一页，共54页。QuadratusLumborumBlock第四十二页，共54页。RectussheathBlock第四十三页，共54页。QudratusLumborumBlockadeBlancoR.RegAnaesthPainMed2007;32(Suppl1):130第四十四页，共54页。HebbardPD,JCanAnesth(2009)56:618–620M.erectorspinaeM.psoasM.QuadratuslumborumRectussheathB.TAPB.QuadratuslumborumB.第四十五页，共54页。Ultrasound-GuidedTransmuscularQuadratusLumborumBlockade第四十六页，共54页。QuadratuslumborumBlockadeTransmuscular

QuadratuslumborumBlockadeM.psoasM.QuadratuslumborumTransversusAbdominisplaneblockade第四十七页，共54页。第四十八页，共54页。ventralposterioranteriordorsalWirbelkörperM.psoasProcesstransversusM.erectorspineM.Quadratuslumborum第四十九页，共54页。TansversusAbdominsPlaneBlockade第五十页，