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8. 周围神经阻滞
8. 周围神经阻滞
Department of Anesthesiology
The First People's Hospital of Jingzhou
The First Affiliated Hospital of Yangtze University
BLOCK TECHNIQUES
Section Ⅰ
Fundamentals
What is the Peripheral Nerve Blocks ?
Patient cooperation and participation are key to the success and safety
of every regional anesthetic procedure;
patients who are unable to remain still for a procedure may be exposed
to increased risk.
Use of non-overdose
Aspiration before injection
Use of epinephrine(肾上腺素)-containing solutions for test doses
Use of small incremental volumes in establishing the block
Premedication: depressant or
Use of less dosage in elderly, poorly endurance of patients,in highly vascular
areas
Active correction of pathologic conditions such as sepsis, hypovolemia,
anemia, heart failure, hypercarbia, hypoxia, and acidosis
RISKS & CONTRAINDICATIONS
Treatment of toxicity
Stop injecting, at the first sign of toxicity
Get help
Give 100%oxygen and artificial ventilation, and consider hyperventilation in
presence of metabolic acidosis
Maintain airway (intubate if necessary)
Treat seizures (benzodiazepines, propofol, thiopental in small
doses),succinylcholine can be given to facilitate intubation
Support circulatory stability with volume replacement and vasopressors
If cardiac arrest with LA toxicity: prolonged CPR and treatment of arrhythmias
with standard protocols
Lipid emulsion: intralipid 20%, 1.5ml/kg
CHOICE OF LOCAL ANESTHETIC
Paresthesia Technique
The optimal transducer varies depending upon the depth of the target nerve and
approach angle of the needle relative to the transducer.
Section Ⅱ
UPPER EXTREMITY
PERIPHERAL NERVE BLOCKS
Brachial Plexus Anatomy
The brachial plexus is formed by the
union of the anterior primary divisions
of the fifth through the eighth cervical
nerves and the first thoracic nerves.
Contributions from C4 and T2 are
often minor or absent.
As the trunks pass over the lateral border of the first rib . and under
the clavicle, each trunk divides into anterior and posterior divisions.
Brachial Plexus Anatomy
The lateral cord gives off the lateral branch of the median nerve and terminates
as the musculocutaneous nerve;
the medial cord gives off the medial branch of the median nerve and terminates
as the ulnar nerve;
the posterior cord gives off the axillary nerve and terminates as the
radial nerve.
Local anesthetic may be deposited at any point along the brachial plexus,
depending on the desired block effects
Brachial Plexus Anatomy
median nerve
ulnar nerve
radial nerve
Interscalene Block
Interscalene Block
An interscalene brachial plexus block is
indicated for procedures involving the
shoulder and upper arm .
At this level, the major terminal nerves often are separated by fascia; therefore
multiple injections (10-mL each) may be required to reliably produce anesthesia
of the entire arm distal to the elbow.
Axillary Block