2017股神经髂筋膜隐神经蒋嘉.ppt

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1、朝阳医院超声麻醉疼痛周髂筋膜、股神经和隐神经/收肌管阻滞朝阳医院麻醉科蒋嘉膝关节置换镇痛TerkawiAS,MavridisD,SesslerDI,etal.PainManagementModalitiesafterTotalKneeArthroplasty.ANetworkMeta-analysisof170RandomizedControlledTrials.Anesthesiology2017;126:923-37膝关节置换镇痛Primaryoutcomes:(1)acutepostoperativepain(duringrestandmo

2、vement)(2)postoperativeopioidconsumption(3)qualityofearlypostoperativerehabilitation(functionalassessments)Secondaryoutcomes:postoperativecomplications(e.g.,nausea,vomiting,falls),durationofhospitalization,bloodloss,procedurefailure,andpatientwithdrawalTerkawiAS,MavridisD,Ses

3、slerDI,etal.PainManagementModalitiesafterTotalKneeArthroplasty.ANetworkMeta-analysisof170RandomizedControlledTrials.Anesthesiology2017;126:923-37与PCA比较(A)Overallpainscoresinthefirst72hduringrest(B)overallpainscoresinthefirst72hduringmovement,(C)overallopioidconsumptioninthefi

4、rst72h(D)overallrangeonmotioninthefirst72h.TerkawiAS,MavridisD,SesslerDI,etal.PainManagementModalitiesafterTotalKneeArthroplasty.ANetworkMeta-analysisof170RandomizedControlledTrials.Anesthesiology2017;126:923-37RankingF/S(6)F/O(6)LP/S(3)FIC(3)PA(2)Rankingonhigh-qualitystu

5、diesF/SFICLPPAACBTerkawiAS,MavridisD,SesslerDI,etal.PainManagementModalitiesafterTotalKneeArthroplasty.ANetworkMeta-analysisof170RandomizedControlledTrials.Anesthesiology2017;126:923-37闭孔神经股神经股外侧皮神经隐神经髂筋膜阻滞•阻滞的是什么？髂筋膜外界：髂嵴内侧缘内界：小骨盆的界线向下一直延续到股骨小转子水平覆盖腰大肌和髂肌髂筋膜闭孔神经与髂肌和髂筋膜并没

6、有密切的联系闭孔神经髂筋膜阻滞的扩散范围（MRI）SwensonJD,DavisJJ,etal.Localanestheticinjectiondeeptothefasciailiacaattheleveloftheinguinalligament:thepatternofdistributionandeffectsontheobturatornerve.JournalofClinicalAnesthesia(2015)27,652–657腹股沟韧带水平骶骨水平冠状位腹股沟韧带水平髂筋膜阻滞超声引导髂筋膜阻滞的方法腹股沟韧带下法寻找缝匠肌和髂肌

7、药液扩散：缝匠肌和髂肌之间阻滞：股神经、股外侧皮神经？超声引导髂筋膜阻滞腹股沟韧带上法BullockWM,YalamuriSM,GregorySH,etal.Ultrasound-GuidedSuprainguinalFasciaIliacaTechniqueProvidesBenefitasanAnalgesicAdjunctforPatientsUndergoingTotalHipArthropla.JUltrasoundMed2017;36:433–438超声引导腹股沟韧带上髂筋膜阻滞寻找髂前上棘、髂肌、腹横肌药液扩散：腹横肌和髂肌

8、之间阻滞：股神经、股外侧皮神经、髂腹股沟神经BullockWM,YalamuriSM,GregorySH,etal.Ultrasoun