1、超声引导下竖脊肌平面阻滞超声引导下竖脊肌平面阻滞的临床应用的临床应用1XIQI内容一、筋膜和筋膜平面阻滞概况一、筋膜和筋膜平面阻滞概况二二、竖竖脊脊肌肌平平面面阻阻滞滞在在胸胸科科手手术术的的应应用用 三三、竖竖脊脊肌肌平平面面阻阻滞滞在在腹腹部部手手术术的的应应用用 四、竖脊肌平面阻滞在脊柱手术的应用四、竖脊肌平面阻滞在脊柱手术的应用2XIQI筋膜平面阻滞筋膜平面阻滞 Fascial plane blocksPECS blockQuadratus lumborum blockSerratus plane blockTransversus abdominis plane blockThe er
2、ector spinae plane block:plane and simple.El-Boghdadly K,Pawa A.Anaesthesia.2017 Apr;72(4):434-438.3XIQI“诡异的筋膜”麻醉麻醉为筋膜平面阻滞提供空间疼痛疼痛人体生物力学调控4XIQI胸腰筋膜麻醉麻醉 腰方肌阻滞 竖脊肌平面阻竖脊肌平面阻滞滞胸腰筋膜平面阻胸腰筋膜平面阻滞滞疼痛疼痛 调节腰臀部和脊柱相关软组织张力 肌筋膜炎(急性腰肌扭伤)神经病理性疼痛5XIQI超声引导下竖脊肌平面阻滞在超声引导下竖脊肌平面阻滞在胸科手术胸科手术的的临床应用临床应用6XIQI超声引导下竖脊肌平面阻滞Forero
3、 M,Adhikary SD,Lopez H,et al.The Erector Spinae Plane Block:A Novel Analgesic Technique in Thoracic Neuropathic Pain.Reg Anesth Pain Med.2016,41(5):621-627.7XIQIT5横突竖脊肌平面阻滞范围8XIQIT5横突竖脊肌平面 阻滞范围验证竖脊肌平面阻滞的有效性和安全性验证竖脊肌平面阻滞的有效性和安全性随机对照研随机对照研究究9XIQI持续竖脊肌平面阻滞首次剂量首次剂量 25ml 0.5%罗哌卡因;镇痛泵罗哌卡因;镇痛泵 8ml/h 0.2%罗哌
4、卡因,罗哌卡因,bolus 5ml,锁定,锁定60min10XIQI超声引导下竖脊肌平面阻滞在超声引导下竖脊肌平面阻滞在腹部手术腹部手术的的临床应用临床应用11XIQI双双侧侧T7竖竖脊脊肌肌平平面面 阻阻滞滞用用于于腹腹壁壁疝疝手手 术镇痛术镇痛双双侧侧T7竖竖脊脊肌肌平平面面 阻阻滞滞用用于于减减肥肥手手术术 镇痛镇痛双双侧侧T8持持续续竖竖脊脊肌肌 平平面面阻阻滞滞用用于于膀膀胱胱 前列腺切除术前列腺切除术12XIQI术后第1天术后第2天术后第4天每侧首次剂量:3ml 2%利多卡因,10ml 0.25%布比卡因;置管,镇痛泵 6ml/h 0.1%布比卡因;手术结束前10ml 0.25%布
5、比卡因13XIQI竖脊肌平面阻滞原理Boezaart,A.P.Atlas of Peripheral Nerve blocks and Anatomy for Orthopaedic Anesthesia.2008Forero M,Adhikary SD,Lopez H,et al.The Erector Spinae Plane Block:A Novel Analgesic Technique in Thoracic Neuropathic Pain.Reg Anesth Pain Med.2016,41(5):621-627.14XIQI竖脊肌平面阻滞解剖示意图Chin KJ,Malha
6、s L,Perlas A.The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery:A Report of 3 Cases.Reg Anesth Pain Med.201715XIQI竖脊肌平面阻滞与后椎板阻滞1.Pfeiffer G1,Oppitz N,Schne S,et al.Analgesia of the axilla using a paravertebral catheter in the lamina technique.Anaesthesist.2006
7、Apr;55(4):423-7.2.Jttner T1,Werdehausen R,Hermanns H,et al.The paravertebral lamina technique:a new regional anesthesia approach for breast surgery.J Clin Anesth.2011 Sep;23(6):443-50.16XIQI超声引导下竖脊肌平面阻滞在超声引导下竖脊肌平面阻滞在脊柱手术脊柱手术的的临床应用临床应用17XIQICorrespondenceClinical experiences of ultrasound-guided erec
8、tor spinae plane block for thoracic vertebra surgeryContents lists available at ScienceDirect)ournal of Clinical AnesthesiabanzhtntrnaRhomBoid UI|QF FfHJSEl918XIQI总结 胸腰筋膜在麻醉/疼痛领域有广阔的研究空间 竖脊肌平面阻滞优点优点:简便简便(横突/肌肉间隙图像容易识别)安全安全 (无气胸/硬膜外血肿/脊髓损伤的风险;受凝血功 能要求较小;单侧阻滞,对循环和呼吸功能影响小);有效有效(镇痛效果)19XIQIThank you!20XIQI