颈项疼痛之源详解.ppt

神经解剖——臂丛 颈椎间盘突出引起的神经压迫 Mediators of inflammation and pain 带状疱疹的病理生理 其他 颈项部痛的其他病因 肿瘤 椎体转移性肿瘤 肿瘤治疗——放疗引起的神经痛 外伤引起的脊髓损伤 * Elevated blood sugars Rash Itching Weight gain Extra energy Soreness at the site of injection Bleeding Death (in rare cases * Sympathetic innervation to the face and upper extremity passes through the stellate ganglion. It is this anatomic feature which allows us to block the sympathetic nervous system to these regions for such conditions as reflex sympathetic dystrophy or post-herpetic neuralgia. The fibers originate off the T1 to T8 spinal cord segments, and ascend to synapse in the inferior (stellate), middle, or superior cervical ganglia. Again, however, the majority of the fibers pass through the stellate ganglion. The ganglion lies anterior to the C7 transverse process, but because of its close proximity to the lung at this level, the block is performed at the C6 level (Chassaignacs tubercle). Due to the close proximity of major vascular structures, the risk of intravascular injection poses a significant consideration. Intravascular injection of even a small amount of local anesthetic could potentially result in seizure activity. Therefore, intravenous access should be established prior to performing the block. The patient is placed in the supine position, the neck prepped with betadine, and a 25 gauge needle is placed down onto the tranverse process of C6. This is usually at a fairly shallow depth. A local anesthetic solution is then injected after negative aspiration for heme is performed. The patient is observed for a Horners syndrome, and the skin temperature of the upper extremities monitored for the expected increase. Complications include intravascular injection, hoarseness, difficulty swallowing, weakness of the upper extremity, and intrathecal injection. Clearly, this block should only be performed in an area with full resuscitative equipment, and by personnel adept at handling these complications. * Sympathetic innervation