超声引导下臂丛神经阻滞知更

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1、超声引导下臂丛神经阻滞技术浙医二院麻醉科周金锋一、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：①C5、C6前支组成上干②C7前支单独成为中干③C8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：①上干和中干的前股合成外侧束-肌皮和正中神经②下干的前股成为内侧束-尺神经③三条干的后股组成后束-桡神经一、臂丛相关解剖基础一、臂丛相关解剖基础一、臂丛相关解剖基础神经分支主要运动功能正中神经屈指屈腕拇外展尺神经屈指屈腕拇内收肌皮神经屈肘桡神经伸指、伸腕、伸肘腋神经肩关节外展

2、一、臂丛相关解剖基础二、超声下图像C5C6C7VA二、超声下图像C5C6C7C8VA二、超声下图像MAUR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%）操作技术三、实战攻略——定位三、实战攻略——定位三、实战攻略——定位三、实战攻略——定位三、实战攻略三、实战攻略单点阻滞用于术后镇痛Anultrasound(US)-guidedblockattheC7root；Initialvolumeofropivacaine0.75%was6mL；Blocksuccessorfa

3、iluredetermineda1-mLdecreaseorincreaseforthesubsequentpatient；Theminimumeffectivevolumeoflocalanestheticin50%and95%ofthepatientswas2.9mL(95%confidenceinterval,2.4-3.5mL)and3.6mL(95%confidenceinterval,3.3-6.2mL)；Minimumeffectivevolumeoflocalanestheticforshoulderanalgesiabyultrasound-gu

4、idedblockatrootC7withassessmentofpulmonaryfunction.RegAnesthPainMed.2010Nov-Dec;35(6):529-34.三、实战攻略分干阻滞最低剂量Successfulsurgicalanesthesiaforarthroscopicshouldersurgerycanbeachievedwith5mLof0.75%ropivacaine,orapproximately1.7mLpereachofthe3trunksofthebrachialplexus(superior,middle,andinf

5、erior).Forthegroupasawhole,themedian(range)sensoryblockonsettimewas5(5-20)minutes,themedian(range)motorblockforthebicepswas7.5(5-15)minutes.Themedian(range)blockdurationwas9.9(5-19)hours,andthemean(SD)blockperformancetimewas8.0±3.2minutes.Meandurationofanalgesiawas9.9±3.7hours.Duratio

6、nofanalgesiawasnotassociatedwithvolumeofLA(r=0.05,P=0.83)Theminimumeffectiveanestheticvolumeof0.75%ropivacaineinultrasound-guidedinterscalenebrachialplexusblock.AnesthAnalg.2011Oct;113(4):951-5.三、实战攻略单点阻滞最低剂量研究Theproportionofpatientswithsuccessfulblockadeincreasedsharplyfromapproximat

7、ely57%at6mlto100%by7ml,indicatingthatasmallincreaseinvolumeofropivacaine0.75%markedlyaffectsthesuccessrate.Themedian(min-max)sensoryblockonsettimewas5(5-20)min,themedian(min-max)motorblocksforthebicepsandthedeltoidmuscleswere7.5(5-15)minand10(5-15)min,respectively.Themedian(min-max)bl

8、ockdu