軀干神經(jīng)阻滯

軀干神經(jīng)阻滯在胸腹手術(shù)中旳應(yīng)用肖穎胸壁手術(shù)鎮(zhèn)痛方式旳比較胸段硬膜外胸椎旁神經(jīng)阻滯PECSBlockRiskpotential胸壁神經(jīng)支配IntercostalnervesensorydistributionNeuralinnervationofchestwall硬膜外阻滯胸椎旁阻滯前鋸肌平面阻滯（肋間神經(jīng)側(cè)皮支）肋間神經(jīng)阻滯胸骨旁肋間神經(jīng)阻滯(肋間神經(jīng)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.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113Thoracicwallblock:

PECS1+PECS2+PECS3PECS1:interfascialplanebetweenpectoralismajorandminor

N.pectoralesmedialis+lateralis(M.pectoralismajor)

BlancoR,Anaesthesia.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113GeorgThiemeVerlagPECS1PECS1PECS1:InjectionAstderA.thoracoacromialisThoraxwallblock:

PECS1+PECS2+PECS3PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

LateralcutaneousbranchofthoracicintercostalneervenerveT2-T6+N.thoracicuslongus(M.serratusanterior)

BlancoR,Anaesthesia.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113GeorgThiemeVerlagM.serratusanteriorN.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2023R.cutaneuslateralisR.cutaneusanteriorR.anteriorR.posteriorGeorgThiemeVerlagPECS2PECS2:Zielregionmediallateral4.Rib5.Rib3.RippePleuraPleuraM.pectoralismajorM.pectoralisminorM.SerratusanteriorPECS2

PECS2InjectionUPECS2: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.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113GeorgThiemeVerlagGeorgThiemeVerlagPECS3PECS3:sensoryBlockadeBlancoRetal,Anaesthesia2023,68,1107–1113腹壁手術(shù)術(shù)后鎮(zhèn)痛方式旳比較胸段硬膜外胸椎旁神經(jīng)阻滯QudratusLumborumBlockadeandTAPRiskpotentialQudratusLumborumBlockN.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2023R.cutaneuslateralisR.cutaneusanteriorQuadratuslumborumB.TABB.RectussheathB.ClassicalTAPSubcostalTAPQuadratusLumborumBlockRectussheathBlockQudratusLumborumBlockadeBlancoR.RegAnaesthPainMed2023;32(Suppl1):130HebbardPD,JCanAnesth(2023)56:618–620M.erectorspinaeM.psoasM.QuadratuslumborumRectussheathB.TAPB.QuadratuslumborumB.Ultrasound-GuidedTransmuscularQuadratusLumborumBlockadeQuadratuslumborumBlockadeTransmuscular

QuadratuslumborumBlockadeM.psoasM.QuadratuslumborumTransversusAbdominisplaneblockadeventralposterioranteriordorsalWirbelk?rperM.psoasProcesstransversusM.erectorspineM.QuadratuslumborumTansversusAb