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,Risk potential,胸壁神经支配,Intercostal nerve sensory distribution,Neural innervation 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 Paravertebral Block,Thoracic Paravertebral Block,Thoracic Paravertebral Block,Thoracic wall block:PECS 1 + P

2、ECS 2 + PECS 3,Neural innervation of anterior chest wall and breast,Supraclavicular nerve C3-C4,Neural innervation of anterior chest wall and breast,Lateral pectoral nerve C5-C7,Medial pectoral nerve C8-T1,Neural innervation of anterior chest wall and breast,Long thoracic nerve C5-C7,Neural innervat

3、ion of anterior chest wall and breast,Thoracodorsal nerve C6-C8,Neural innervation of anterior chest wall and breast,Lateral intercostal cutaneoous nerve T2-T6,Anterior intercostal cutaneoous nerve T2-T6,Neural innervation of anterior chest wall and breast,Thoracic wall block:PECS 1 + PECS 2 + PECS

4、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 +reconstruction,Blanco R, Anaesthesia. 2011 Sep;66(9):847-8 Blanco R et al,

5、 Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 11071113,Thoracic wall block:PECS 1 + 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):8

6、47-8 Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 11071113,Georg Thieme Verlag,PECS 1,PECS 1,PECS 1: Injection,Ast der A. thoracoacromialis,Thorax wall block:PECS 1 + PECS 2 + PECS 3,PECS 1 N. pectorales medialis + lateralis (M. pectoralis maj

7、or) PECS 2 Lateral cutaneous branch of thoracic intercostal neerve 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,Georg Thieme Verlag,

8、M. serratus anterior,N. spinalis,Putz/Pabst: 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,Georg Thieme Verlag,Georg Thieme Verlag,PECS 3,PECS 3: sensory Blockade,Bl

9、anco R et al, Anaesthesia 2013, 68, 11071113,腹壁手术术后镇痛方式的比较,Risk potential,Qudratus Lumborum Block,N. spinalis,Putz/Pabst: Sobotta. Atlas der Anatomie des Menschen, 21. Aufl. Urban 32(Suppl 1):130,Hebbard PD, J Can Anesth (2009) 56:618620,M. erector spinae,M. psoas,M. Quadratus lumborum,Rectus sheath

10、 B.,TAP B.,Quadratus lumborum B.,Ultrasound-Guided Transmuscular Quadratus Lumborum Blockade,Quadratus lumborum Blockade,Transmuscular Quadratus lumborum Blockade,M. psoas,M. Quadratus lumborum,Transversus Abdominis plane blockade,ventral,posterior,anterior,dorsal,Wirbelkrper,M. psoas,Process transversus,M. erector spine,M. Quadratus lumborum,Tansversus Abdomins Plane Blockade,Ultrasound-Guided Transversus A