超声引导下竖脊肌阻滞在临床应用.pptx

超声引导下竖脊肌平面阻滞的临床应用内容一、筋膜和筋膜平面阻滞概况二、竖脊肌平面阻滞在胸科手术的应用 三、竖脊肌平面阻滞在腹部手术的应用 四、竖脊肌平面阻滞在脊柱手术的应用筋膜平面阻滞 Fascial plane blocksPECS blockQuadratus lumborum blockSerratus plane blockTransversus abdominis plane blockThe erector spinae plane block: plane and simple. El-Boghdadly K, Pawa A. Anaesthesia. 2017 Apr;72(4):434-438.“诡异的筋膜”麻醉疼痛为筋膜平面阻滞提供空间体生物力学调控人胸腰筋膜疼痛 调节腰臀部和脊柱相关软组织张力 肌筋膜炎（急性腰肌扭伤） 神经病理性疼痛麻醉 腰方肌阻滞 竖脊肌平面阻滞胸腰筋膜平面阻滞超声引导下竖脊肌平面阻滞在胸科手术的临床应用超声引导下竖脊肌平面阻滞Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016,41(5):621-627.T5横突竖脊肌平面阻滞范围T5横突竖脊肌平面 阻滞范围验证竖脊肌平面阻滞的有效性和安全性——随机对照研究持续竖脊肌平面阻滞首次剂量 25ml 0.5%罗哌卡因；镇痛泵 8ml/h 0.2%罗哌卡因，bolus 5ml ，锁定60min超声引导下竖脊肌平面阻滞在腹部手术的临床应用双侧T7竖脊肌平面 阻滞用于减肥手术 镇痛双侧T7竖脊肌平面 阻滞用于腹壁疝手 术镇痛双侧T8持续竖脊肌 平面阻滞用于膀胱 前列腺切除术术后第1天 术后第2天 术后第4天每侧首次剂量：3ml 2%利多卡因，10ml 0.25%布比卡因；置管，镇痛泵 6ml/h 0.1%布比卡因；手术结束前10ml 0.25%布比卡因竖脊肌平面阻滞原理Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016,41(5):621- 627.Boezaart, A.P. Atlas of Peripheral Nerve blocks and Anatomy for Orthopaedic Anesthesia. 2008竖脊肌平面阻滞解剖示意图Chin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases. Reg Anesth Pain Med. 2017竖脊肌平面阻滞与后椎板阻滞/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uid/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uid/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uidi/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uid/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uid/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uidr/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uid/pubmed/?term=Pfeiffer%20G%5bAuthor%5damp;cauthor=trueamp;cauthor_uid=16404