2017超声引导下竖脊肌阻滞在临床应用-马丹旭

1、超声引导下竖脊肌平面阻滞 的临床应用,首都医科大学附属北京朝阳医院 麻醉科 马丹旭,2017-8-12,内容,一、筋膜和筋膜平面阻滞概况 二、竖脊肌平面阻滞在胸科手术的应用 三、竖脊肌平面阻滞在腹部手术的应用 四、竖脊肌平面阻滞在脊柱手术的应用,筋膜平面阻滞 Fascial plane blocks,PECS block Quadratus lumborum block Serratus plane block Transversus abdominis plane block,The erector spinae plane block: plane and simple. El-Boghd

2、adly K, Pawa A. Anaesthesia. 2017 Apr;72(4):434-438.,“诡异的筋膜”,麻醉,为筋膜平面阻滞提供空间,疼痛,人,体生物力学调控,胸腰筋膜,麻醉 腰方肌阻滞 竖脊肌平面阻滞 胸腰筋膜平面阻滞,疼痛 调节腰臀部和脊柱相关软组织张力 肌筋膜炎（急性腰肌扭伤） 神经病理性疼痛,超声引导下竖脊肌平面阻滞在胸科手术的 临床应用,超声引导下竖脊肌平面阻滞,Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in T

3、horacic Neuropathic Pain. Reg Anesth Pain Med. 2016,41(5):621-627.,T5横突竖脊肌平面阻滞范围,T5横突竖脊肌平面 阻滞范围,验证竖脊肌平面阻滞的有效性和安全性随机对照研究,持续竖脊肌平面阻滞,首次剂量 25ml 0.5%罗哌卡因；镇痛泵 8ml/h 0.2% 罗哌卡因，bolus 5ml ，锁定60min,超声引导下竖脊肌平面阻滞在腹部手术的 临床应用,双侧T7竖脊肌平面 阻滞用于腹壁疝手 术镇痛,双侧T7竖脊肌平面 阻滞用于减肥手术 镇痛,双侧T8持续竖脊肌 平面阻滞用于膀胱 前列腺切除术,术后第1天术后第2天术后第4天 每

4、侧首次剂量：3ml 2%利多卡因，10ml 0.25%布比卡因；置管，镇痛泵 6ml/h 0.1%布比卡因；手术结束前10ml 0.25%布比卡因,竖脊肌平面阻滞原理,Boezaart, A.P. Atlas of Peripheral Nerve blocks and Anatomy for Orthopaedic Anesthesia. 2008,Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic

5、Pain. Reg Anesth Pain Med. 2016,41(5):621- 627.,竖脊肌平面阻滞解剖示意图,Chin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases. Reg Anesth Pain Med. 2017,竖脊肌平面阻滞与后椎板阻滞,Pfeiffer G1, Oppitz N, Schne S, et al.Analgesia of the axi

6、lla using a paravertebral catheter in the lamina technique. Anaesthesist. 2006 Apr;55(4):423-7. Jttner T1, Werdehausen R, Hermanns H, et al. The paravertebral lamina technique: a new regional anesthesia approach for breast surgery. J Clin Anesth. 2011 Sep;23(6):443-50.,超声引导下竖脊肌平面阻滞在脊柱手术的 临床应用,Correspondence Clinical experiences of ultrasound- guided erector spinae plane block for thoracic vertebra surgery,Contents lists available at ScienceDirect,)ournal of Clinical Anesthesia,banzh tntrna,RhomBoid UI |QF FfHJSEl9,总结, 胸腰筋膜在麻醉/疼痛领域有广阔的研究空