Nerve-Block(神經(jīng)阻滯)-課件

NerveBlockNerveBlockSketchofthislessonGeneralintroductionLocalanesthetictoxicityCervicalplexusblockBrachialplexusblockSciaticblockDigitalblockSketchofthislessonGeneraliGeneralintroductionHistory

1880s,Cocainewasinjectedtoperipheralsiteforminorsurgeries.1885,Esmarchbandageusedtoarrestlocalcirculationtoprolongcoaine-inducedblock.1903,epinephrineas“chemicaltourniquet”emerged.1920,thefirstdefinitivetextbook,Regionalanesthesia:ItsTechnicandApplication,wasauthoredbyGastonLabatinU.S.A..Becameawell-acceptedcomponentofcomprehensiveanestheticcare,andexpandedfromoperatingsuitetopainmanagement.GeneralintroductionHistory188GeneralintroductionTechniqueofnerveblockistolocalizetheneuralstructures,usuallybyanatomyknowledgeandelicitedparesthesia.DevelopmentofnerveblockGeneralintroductionTechniqueGeneralintroductionIndication

Surgicalarea,consciousnessandcooperation,skilllevelofhandler.Contraindication

Infection,tumor,seriousmalformationonthepuncturesite;coagulationdisorder;allergytolocalanesthetics.GeneralintroductionIndicationLocalanestheticsLocalanestheticsLocalanesthetictoxicityLocalanesthetictoxicityYoushouldknowwhatcomplicationcouldbe

causedbyyourprocedurebeforeyoumastertheprocedure！未學(xué)打人，先學(xué)挨打！LocalanesthetictoxicityYoushouldknowwhatcomplicatLocalanesthetictoxicityConceptConcentrationoflocalanestheticinbloodfarexceedsthetolerancelimitationofhumanbodyandcauseadverseeffect.Centralnervoussystemandheartarevulnerable.Commoncause

Localanestheticoverdose;Accidentallyvesselinjection;Excessiveabsorbanceoflocalanesthetic;Systemicpathologyreducethetolerance.

LocalanesthetictoxicityConceLocalanesthetictoxicityCNStoxicity(Biphasiceffect)

CNSismoresusceptibletosystemicactionoflocalanestheticthancardiovascularsystemis.(Dose1:3)Earlysymptoms:dizziness,visualandauditorydisturbance,disorientation,excitatorysignincludingshivering,musculartwitching.Hypertension.

Ultimately,generalizedconvulsionwilloccur.Afterseizureactivityceases,respiratorydepressionevenarrestmayoccur.LocalanesthetictoxicityCNStLocalanesthetictoxicityCardiovasculartoxicity

Inhibitthemyocardialsodiumchannelandcausenegativeinotropicaction,reductionofCO,bradycardia,ventriculararrhythmiaevencardiacarrest.

LocalanesthetictoxicityCardiLocalanesthetictoxicityTreatmentoflocalanesthetictoxicity

1.Stopinjectionimmediately.2.Oxygensupplyandairwaymaintenance.3.Midazolam5mg/Propofol80-100mgiv.4.RespiratoryassistanceandsustainingtheHRandBloodpressure.5.Whencardiacarrestoccurs,CPRmustbeappliedpromptly.6.Bupivacaine-inducedcardiacarrest

ismoredifficulttoresuscitate.20%intralipidisconsiderabletobeapplied.LocalanesthetictoxicityTreatLocalanesthetictoxicityProphylaxisoflocalanesthetictoxicity

1.Notexceedthedosagelimitation,choosesuitabledoseaccordingtoevaluationofpatientsandtheblockagesite.2.Aspirationbeforeinjection.3.Useepinephrinetoreducetheabsorbance.4.Administrationofsmalldosebenzodiazepineorbarbital.5.Correctionofacidosis,hyperthermia,anemiaandhypovolemiapreoperatively.LocalanesthetictoxicityProphCervicalplexusblockIndication:SuperficialanddeepOperationsintheregionofneckandsupra-clavicularfossa.枕小神經(jīng)耳大神經(jīng)頸橫神經(jīng)鎖骨上神經(jīng)CervicalplexusblockIndicatioCervicalplexusblockTechniqueselectionSuperficialVsDeep?PharmacologicchoiceHighconcentrationVsLow?頸襻CervicalplexusblockTechniqueCervicalplexusblockComplications

1.Superficialblockrarelycauseanycomplication;2.Localanesthetictoxicity;3.Intrathecalinjection;4.Phrenicnerveblockage;5.Laryngealrecurrentnerveblockage;6.Honor’ssyndrome;7.HemorrageofvertebralarteryCervicalplexusblockComplicatCervicalplexusblockSuperficailcevicalplexusblockCervicalplexusblockSuperficaCervicalplexusblockDeepcervicalplexusblockCervicalplexusblockDeepcervBrachialplexusblockAnatomyofbrachialplexusBrachialplexusblockAnatomyoAxillaryblockIndicationForearm,handandwristsurgery.Position

Abductthearmatshoulder

PharmacologicchoiceHighvolumelowconcentration.0.25%Ropivacaine+0.5%Lidocaine30mlAnalgesialast4-6hrs

AxillaryblockIndicationAxillaryblockAdvantage:Mostsafeoneofall.Shortage:CrosssectionAxillaryblockAdvantage:CrossAxillaryblockAxillaryblockSupraclavicularblockIndicationInpatient,skillfulpractitionerPositionSupine,armaside,headturntooppositePharmacologicchoiceConsiderthelengthofblockageSupraclavicularblockIndicatioSupraclavicularblockAdvantage:Rapidonset;Wellmotorblockage;Easytoapproach.Shortage:Causepneumothorax;Phrenicnerveblockage.SupraclavicularblockAdvantageSupraclavicularblockSupraclavicularblockInterscaleneblockAnatomyIndicationPositionInterscaleneblockAnatomyInterscaleneblockPharmacologychoicesInterscaleneblockPharmacologyInterscaleneblockParesthesiaseekingmethodAdvantage:UpperarmandshoulderblockagewithlessLD;Safetyapproach.Shortage:Difficulttoblockulnarn.;vertebrala.injection;spinalorepiduralInjection;pneumothorax;phrenicn.block.InterscaleneblockParesthesiaInterscaleneblockSagittalplaneoptimizestheneedleangleInterscaleneblockSagittalplaSciaticblockSciaticblockDigitalblockDigitalblockCasediscussionFemale,54y,Diagnosis:humeralfracture.Surgery:Openreductionandinternalfixation.Anesthesia:Interscaleneblockwith2%lidocaine25mlwithepinephrine(1:200,000)Maneuver:“Immobileneedle”+carefulaspiration.After5min,p