超声引导下臂丛神经阻滞知更课件.ppt
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1、超声引导下臂丛神经阻滞知更,1,超声引导下臂丛神经阻滞技术,浙医二院麻醉科 周金锋,超声引导下臂丛神经阻滞知更,2,超声引导下臂丛神经阻滞知更,3,一、臂丛相关解剖基础,由第5-8颈神经前支和第1胸神经前支大部分构成,经椎动脉后方、斜角肌间隙向外侧穿出,组成三条干:C5、C6前支组成上干C7前支单独成为中干C8前支和T1前支大部分合成下干在锁骨后第1肋骨中外缘分为前后两股腋窝水平分成三束:上干和中干的前股合成外侧束-肌皮和正中神经下干的前股成为内侧束-尺神经三条干的后股组成后束-桡神经,超声引导下臂丛神经阻滞知更,4,一、臂丛相关解剖基础,超声引导下臂丛神经阻滞知更,5,一、臂丛相关解剖基础,
2、超声引导下臂丛神经阻滞知更,6,一、臂丛相关解剖基础,超声引导下臂丛神经阻滞知更,7,一、臂丛相关解剖基础,超声引导下臂丛神经阻滞知更,8,二、超声下图像,C5C6C7VA,超声引导下臂丛神经阻滞知更,9,二、超声下图像,C5C6C7C8VA,超声引导下臂丛神经阻滞知更,10,二、超声下图像,MAUR,超声引导下臂丛神经阻滞知更,11,三、实战攻略,临床关注点起效时间阻滞程度药物剂量成功率操作难度并发症,超声技术可以解决以上问题的关键神经的定位及辨识度设备因素神经变异(50%)操作技术,超声引导下臂丛神经阻滞知更,12,三、实战攻略定位,超声引导下臂丛神经阻滞知更,13,三、实战攻略定位,超声
3、引导下臂丛神经阻滞知更,14,三、实战攻略定位,超声引导下臂丛神经阻滞知更,15,三、实战攻略定位,超声引导下臂丛神经阻滞知更,16,三、实战攻略,超声引导下臂丛神经阻滞知更,17,三、实战攻略,单点阻滞用于术后镇痛An ultrasound (US)-guided block at the C7 root;Initial volume of ropivacaine 0.75% was 6 mL;Block success or failure determined a 1-mL decrease or increase for the subsequent patient;The minim
4、um effective volume of local anesthetic in 50% and 95% of the patients was 2.9 mL (95% confidence interval, 2.4-3.5 mL) and 3.6 mL (95% confidence interval, 3.3-6.2 mL);Minimum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmon
5、ary function.Reg Anesth Pain Med. 2010 Nov-Dec;35(6):529-34.,超声引导下臂丛神经阻滞知更,18,三、实战攻略,分干阻滞最低剂量Successful surgical anesthesia for arthroscopic shoulder surgery can be achieved with 5 mL of 0.75% ropivacaine, or approximately 1.7 mL per each of the 3 trunks of the brachial plexus (superior, middle, and
6、 inferior). For the group as a whole, the median (range) sensory block onset time was 5 (5-20) minutes, the median (range) motor block for the biceps was 7.5 (5-15) minutes.The median (range) block duration was 9.9 (5-19) hours, and the mean (SD) block performance time was 8.0 3.2 minutes. Mean dura
7、tion of analgesia was 9.9 3.7 hours. Duration of analgesia was not associated with volume of LA (r = 0.05, P = 0.83)The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5.,超声引导下臂丛神经阻滞知更,19,三、实战攻略,单点阻滞最
8、低剂量研究The proportion of patients with successful blockade increased sharply from approximately 57% at 6 ml to 100% by 7 ml, indicating that a small increase in volume of ropivacaine 0.75% markedly affects the success rate.The median (min-max) sensory block onset time was 5 (5-20) min, the median (min
9、-max) motor blocks for the biceps and the deltoid muscles were 7.5 (5-15) min and 10 (5-15) min, respectively. The median (min-max) block duration was 8.9 (3-15) h.Effective volume of ropivacaine 0.75% through a catheter required for interscalene brachial plexus blockade.Anesthesiology. 2013 Apr; 11
10、8 (4):863-7.,超声引导下臂丛神经阻滞知更,20,三、实战攻略,最低剂量及作用时间研究Lidocaine 1.5% with epinephrine 1:200 000The mean (95% CI) volume to surround each nerve was: radial 3.42 (2.84-3.99) ml, median 2.75 (2.31-3.19) ml, ulnar 2.58 (2.14-3.03) ml, and musculocutaneous 2.30 (1.96-2.64) ml. The mean (95% CI) onset time for
11、complete sensory block was: radial 22.5 (13.5-31.5) min, median 26.8 (18.5-35.0) min, ulnar 26.6 (17.8-35.4) min, and musculocutaneous 15.8 (7.45-24.2) min. The mean (95% CI) last recorded time with complete block was: radial 137.1 (105.6-168.7) min, median 144.7 (123.4-166.0) min, ulnar 183.2 (158.
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