骶丛坐骨神经阻滞PPT

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Quteal vessels
cutaneous nerve） • 阴部神经（Pudendal nerve） • 坐骨神经（Sciatic nerve）
GGPPS
坐骨神经(sciatic nerve) 是由L4、5，S1～3脊神经前支组成
坐骨神经
• 经坐骨结节和股骨大转子之间， 在臀大肌深面、股方肌浅面下行
• 沿大腿后坐骨神经上部的内侧有 股后皮神经和臀下动脉伴行
• 行至在腘窝横纹上方5～12cm ， 分为胫神经和腓总神经
胫神经（tibial nerve）
• 分为足底内侧神群
• 胫神经发出腓肠内侧皮神经， 在小腿下部与腓肠外侧皮神经 （发自腓总神经）吻合成腓肠 神经，经外踝后方弓形向前， 分布于足背和小趾外侧缘的皮 肤。
oiusck' in any pafienL To con£ m localization of the sacral plexus, an insulated needle attached to a nerve stimulates was advanced and, in each case, a sacral
plexus motor response was elicited (plantar flexion—12, dorsal flexi 1, ham— string muscle stimulation—3, gast-rocneinius muscle stimulation—1—not recorded) at a current between 0.2 and 0.5 mA. N o complications were observed. This report confimis the feasibility of using ultrasound to locate the sacral plexus using a parasacral apprnaclc
腓总神经（ common peroneal nerve）
• 自坐骨神经发出后沿股二头肌内 侧走向外下，绕腓骨颈外侧向前， 穿腓骨长肌分为腓浅和腓深神经
• 腓总神经的分布范围是小腿前、 外侧群肌和小腿外侧、足背和趾 背的皮肤
感觉支配
坐骨神经感觉和肌肉支配
1、骶旁神经丛阻滞
neuroaxial block
内侧条状带之外区域的小腿、足、踝、
• 膝关节以下部位除了小腿
跟腱不同类型手术提供麻醉和镇痛；
内侧条状带之外区域的手 • 联合应用（腰丛、髂腹下神经、股外
术麻醉和镇痛
侧皮神经、股神经、闭孔神经）：髋
• 联合腰丛阻滞可用于髋关
部、膝关节和大腿前后的手术
节和更近端下肢手术麻醉
Anatomy
骶从(sacral Plexus)是由L4-5，全部骶神） 经和尾神经前支组成 重要分支： • 臀上神经（Gluteal nerve superior • 臀下神经（Gluteal nerve inferior • 股后皮神经（Posterior femoral
Anna lJskova, Info
Jacques E. Chelly, M D , PhD, M B A
In this repor(, we describe the feasibility of l‹x:ating the sacral plexus nerve using a parasacral approach and an ultrasound-guided technique. The parasacral region using a curved probe (2—SMHz) was scanned in 17 patients iii search of the medial border of the ischial bone and the lateral border of the sacrtim, which represent the limit of the greater sciatic foremen. In addition, attempts were made to identify the pirikirrriis muscles and the gluteal arteries. Tue sacral plexus was identified at the level of tire sciatir fnramen as a round hyperechoic structure. The gluteal arteries were identified in 10 of 17 patients, but we faded to positively identify the pirif-oriiiis
(meals Craig 2IXJ8:108:1977-DU)
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foamen
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Table 1. &sRnt aixi Block Eka«stei&‹s
Pahezit
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Visualization of
臀上区短轴扫描
Lateral
Medial
臀中区短轴扫描
Lateral
Medial
臀中区长轴
Ultrasound Localization of the Sacral Plems Using a Parasacral Approach
Alon Y. Ben-Azi, M©
Rama Joshi, lvIO
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骶丛坐骨神经阻滞
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目录
01
适应证
02
解剖
03 阻滞四种方法
04
小结
骶丛神经阻滞适应证
坐骨神经阻滞适应证
• 臀部和坐骨神经支配区域 • 单独阻滞：膝关节以下部位除了小腿
的疼痛治疗