17.8.28施克俭 胸壁神经阻滞

胸壁神经阻滞胸壁手术镇痛方式的比较胸段硬膜外胸椎旁神经阻滞胸壁外周神经阻滞胸壁神经支配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)ThoracicParavertebralBlockThoracicParavertebralBlockThoracicParavertebralBlockThoracicParavertebralBlock胸壁神经阻滞

NeuralinnervationofanteriorchestwallandbreastSupraclavicularnerveC3-C4NeuralinnervationofanteriorchestwallandbreastLateralpectoralnerveC5-C7MedialpectoralnerveC8-T1NeuralinnervationofanteriorchestwallandbreastLongthoracicnerveC5-C7NeuralinnervationofanteriorchestwallandbreastThoracodorsalnerveC6-C8NeuralinnervationofanteriorchestwallandbreastLateralintercostalcutaneoousnerveT2-T6AnteriorintercostalcutaneoousnerveT2-T6NeuralinnervationofanteriorchestwallandbreastThoracicwallblock:

PECS1:interfascialplanebetweenpectoralismajorandminor

N.pectoralesmedialis+lateralis(M.pectoralismajor)

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113GeorgThiemeVerlagPECS1PECS1PECS1:InjectionAstderA.thoracoacromialisThoraxwallblock:

PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

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

BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113GeorgThiemeVerlagM.serratusanteriorN.spinalisPutz/Pabst:Sobotta.AtlasderAnatomiedesMenschen,21.Aufl.Urban&Fischer,2000R.cutaneuslateralisR.cutaneusanteriorR.anteriorR.posteriorGeorgThiemeVerlagPECS2PECS2:Zielregionmediallateral4.Rib5.Rib3.RippePleuraPleuraM.pectoralismajorM.pectoralisminorM.SerratusanteriorPECS2

PECS2InjectionUPECS2:sensoryBlockadeThoracicwallblock:

PECS1

N.pectoralesmedialis+lateralis(M.pectoralismajor)

PECS2

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

Serratusplaneblock

LateralcutaneousbranchofthoracicintercostalneervenerveT2-T9+N.thoracodorsalis(M.latissimusdorsi)BlancoR,Anaesthesia.2011Sep;66(9):847-8BlancoRetal,RevEspAnestesiolReanim.2012Nov;59(9):470-5BlancoRetal,Anaesthesia2013,68,1107–1113GeorgT