躯干神经阻滞

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Riskpotential胸壁神经支配IntercostalnervesensorydistributionNeuralinnervationofchestwall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)ThoracicParavertebralBlockThoracicParavertebralBlockThoracicParavertebralBlockThoracicwallblock:

PECS1+PECS2+PECS3NeuralinnervationofanteriorchestwallandbreastSupraclavicularnerveC3-C4NeuralinnervationofanteriorchestwallandbreastLateralpectoralnerveC5-C7MedialpectoralnerveC8-T1NeuralinnervationofanteriorchestwallandbreastLongthoracicnerveC5-C7NeuralinnervationofanteriorchestwallandbreastThoracodorsalnerveC6-C8NeuralinnervationofanteriorchestwallandbreastLateralintercostalcutaneoousnerveT2-T6AnteriorintercostalcutaneoousnerveT2-T6NeuralinnervationofanteriorchestwallandbreastThoracicwallblock:

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,Anaesthesia2013,68,1107–1113Thoracicwallblock:

PECS1+PECS2+PECS3PECS1:interfascialplanebetweenpectoralismajorandminor

N.pectoralesmedialis+lateralis(M.pectoralismajor)

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113GeorgThiemeVerlagPECS1.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,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113GeorgThiemeVerlagM.serratusanterior.N.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2000R.cutaneuslateralisR.cutaneusanteriorR.anteriorR.posterior.GeorgThiemeVerlag.PECS2.PECS2:Zielregionmediallateral4.Rib5.Rib3.RippePleuraPleuraM.pectoralismajorM.pectoralisminorM.Serratusanterior.PECS2

PECS2InjectionU.PECS2:sensoryBlockadeThoracicwallblock:

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,Anaesthesia2013,68,1107–1113GeorgThiemeVerlagGeorgThiemeVerlag.PECS3..PECS3:sensoryBlockadeBlancoRetal,Anaesthesia2013,68,1107–1113..腹壁手术术后镇痛方式的比较RiskpotentialQudratusLumborumBlock.N.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2000R.cutaneuslateralisR.cutaneusanteriorQuadratuslumborumB.TABB.RectussheathB.ClassicalTAPSubcostalTAP.QuadratusLumborumBlock.RectussheathBlock.QudratusLumborumBlockadeBlancoR.RegAnaesthPainMed2007;32(Suppl1):130.HebbardPD,JCanAnesth(2009)56:618–620M.erectorspinaeM.psoasM.QuadratuslumborumRectussheathB.TAPB.QuadratuslumborumB..Ultrasound-GuidedTransmuscularQuadratusLumborumBlockade.QuadratuslumborumBlockadeTransmuscular

QuadratuslumborumBlockadeM.psoasM.QuadratuslumborumTransversusAbdominisplaneblockade..ventralposterioranteriordorsalWirbelkörperM.psoasProcesstransversusM.erectorspineM.Quadratuslumborum.TansversusAbdominsPl