躯干神经阻滞

躯干神经阻滞在胸腹手术中旳应用肖颖胸壁手术镇痛方式旳比较胸段硬膜外胸椎旁神经阻滞PECSBlockRiskpotential胸壁神经支配IntercostalnervesensorydistributionNeuralinnervationofchestwall硬膜外阻滞胸椎旁阻滞前锯肌平面阻滞（肋间神经侧皮支）肋间神经阻滞胸骨旁肋间神经阻滞(肋间神经前皮支)ThoracicParavertebralBlockThoracicParavertebralBlockThoracicParavertebralBlockThoracicwallblock:

PECS1+PECS2+PECS3NeuralinnervationofanteriorchestwallandbreastSupraclavicularnerveC3-C4NeuralinnervationofanteriorchestwallandbreastLateralpectoralnerveC5-C7MedialpectoralnerveC8-T1NeuralinnervationofanteriorchestwallandbreastLongthoracicnerveC5-C7NeuralinnervationofanteriorchestwallandbreastThoracodorsalnerveC6-C8NeuralinnervationofanteriorchestwallandbreastLateralintercostalcutaneoousnerveT2-T6AnteriorintercostalcutaneoousnerveT2-T6NeuralinnervationofanteriorchestwallandbreastThoracicwallblock:

PECS1+PECS2+PECS3

Indication:postoperativeAnalgesia PECS1:Breastexpanderorsubpectoralprostheses PECS2:+PECS1:Tumorresection,Mastectomy+axillarylymphnodeclearance PECS3+PECS1:Mastectomy+axillarylymphnodeclearance+reconstructionBlancoR,Anaesthesia.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113Thoracicwallblock:

PECS1+PECS2+PECS3PECS1:interfascialplanebetweenpectoralismajorandminor

N.pectoralesmedialis+lateralis(M.pectoralismajor)

BlancoR,Anaesthesia.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113GeorgThiemeVerlagPECS1PECS1PECS1:InjectionAstderA.thoracoacromialisThoraxwallblock:

PECS1+PECS2+PECS3PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

LateralcutaneousbranchofthoracicintercostalneervenerveT2-T6+N.thoracicuslongus(M.serratusanterior)

BlancoR,Anaesthesia.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113GeorgThiemeVerlagM.serratusanteriorN.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2023R.cutaneuslateralisR.cutaneusanteriorR.anteriorR.posteriorGeorgThiemeVerlagPECS2PECS2:Zielregionmediallateral4.Rib5.Rib3.RippePleuraPleuraM.pectoralismajorM.pectoralisminorM.SerratusanteriorPECS2

PECS2InjectionUPECS2:sensoryBlockadeThoracicwallblock:

PECS1+PECS2+PECS3PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

R.cutaneilateralisderR.anterioresderSpinalnervenT2-T6+N.thoracicuslongus(M.serratusanterior)

PECS3

LateralcutaneousbranchofthoracicintercostalneervenerveT2-T6+N.thoracodorsalis(M.latissimusdorsi)BlancoR,Anaesthesia.2023Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2023Nov;59(9):470-5BlancoRetal,Anaesthesia2023,68,1107–1113GeorgThiemeVerlagGeorgThiemeVerlagPECS3PECS3:sensoryBlockadeBlancoRetal,Anaesthesia2023,68,1107–1113腹壁手术术后镇痛方式旳比较胸段硬膜外胸椎旁神经阻滞QudratusLumborumBlockadeandTAPRiskpotentialQudratusLumborumBlockN.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2023R.cutaneuslateralisR.cutaneusanteriorQuadratuslumborumB.TABB.RectussheathB.ClassicalTAPSubcostalTAPQuadratusLumborumBlockRectussheathBlockQudratusLumborumBlockadeBlancoR.RegAnaesthPainMed2023;32(Suppl1):130HebbardPD,JCanAnesth(2023)56:618–620M.erectorspinaeM.psoasM.QuadratuslumborumRectussheathB.TAPB.QuadratuslumborumB.Ultrasound-GuidedTransmuscularQuadratusLumborumBlockadeQuadratuslumborumBlockadeTransmuscular

QuadratuslumborumBlockadeM.psoasM.QuadratuslumborumTransversusAbdominisplaneblockadeventralposterioranteriordorsalWirbelkörperM.psoasProcesstransversusM.erectorspineM.QuadratuslumborumTansversusAb