神经阻滞(英文).pptVIP

Nerve Blocks ;;;;Interscalene Block;Interscalene Block ;Key points;Needle is inserted perpendicular to the skin at a 45-degree caudad and slightly posterior angle . If a blunt needle bevel is used, a “click” may be detected as the needle passes through the prevertebral fascia. Inject 10 to 40 ml solution. Digital pressure above the injection site and downward massage along with a 45-degree head-up position may facilitate caudad spread and blockade of the lower trunk.;Side Effects and Complications ;Supraclavicular Block;;Key points;The needle is directed in a caudad, slightly medial, and posterior direction until a paresthesia or motor response is elicited or the first rib is encountered. If the first rib is encountered without elicitation of a paresthesia, the needle can be walked anteriorly and posteriorly along the rib until the plexus or the subclavian artery is located. Inject 20 to 30?mL of solution. ;Side Effects and Complications ;Axillary Block ;At this level, the musculocutaneous nerve(肌皮神经) has already left the sheath and lies in the substance of the coracobrachialis muscle(喙肱肌) The intercostobrachial nerve(肋间臂神经) is usually blocked by the skin wheal overlying the artery; adequate anesthesia for the tourniquet(止血带) can be ensured by extending the wheal 1 to 2?cm caudad and cephalad. ;;Key points;Identifying the axillary sheath ;Ultrasound guidance decreases block onset time and may reduce the number of needle redirections. After negative aspiration ,inject 40 to 50 milliliter solution. Another technique is Field block of the brachial plexus.you can inject 10 to 15?mL of solution on each side of the artery.;;Side Effects and Complications ;Lower Extremity Blocks ——prolonged postoperative analgesia ;;The technique must be combined with a sciatic block for anesthesia of the entire lower extremity. A psoas compartment block is often used to provide postoperative analgesia for patients undergoing major knee and hip surgery.;Lumbar Pl