肋间神经阻滞麻醉下隆乳术

采用间神经阻滞麻醉行硅胶囊假体植入隆乳术，是我们自１９９３年４月以来所施行的新隆乳方法，这种方法具有操作简便，管理简单，手术中患者痛苦小等优点。文中报告了麻醉和手术方法及１５例３０侧乳房的手术结果，讨论了肋间神经阻滞麻醉下隆乳的优点，镇痛原理和麻醉操作注意事项。     

丙泊酚辅助局麻在隆乳术中的应用

随着人们生活水平的提高，审美意识的增强，越来越多的人加入整形美容手术的大军，而假体隆乳手术也越来越常见于门诊手术的开展。麻醉方式的选择对隆乳术至关重要。其原则为安全、无痛、操作简单、费用低廉。文献报道的麻醉方法很多，主要有局部浸润麻醉、硬膜外阻滞、肋间神经阻滞、全身麻醉。我院从2002年开始采用丙泊酚辅助局部浸润麻醉为287例小乳症患者行假体隆乳术，均取得了较好的麻醉效果。     

门诊隆乳术麻醉方法探讨

门诊隆乳术麻醉方法探讨张舵赵自然徐向民辛赤刘涛近年来，随着隆乳手术方法改进和技术的提高，手术时间明显缩短，受术者迫切要求在门诊完成手术，因此安全有效的麻醉方法成为关键。我科自１９９３年１月至今，在门诊完成以肋间神经阻滞麻醉为主的综合麻醉方法行隆乳术１...     

隆乳术麻醉效果观察

目的：探讨安全有效的隆乳术麻醉方式。方法：共处理83例患者，其中49例应用局部浸润麻醉＋肋间神经阻滞麻醉，34例应用局部浸润麻醉＋全身麻醉。手术分别采用腋下、乳晕下和乳腺下皱襞切口，假体放置于胸大肌下间隙。结果：两组患者均顺利完成隆乳术，但麻醉效果和全身反应各有不同。结论：笔者认为众多隆乳术麻醉方式中以局部浸润麻醉＋肋间神经阻滞麻醉和局部浸润麻醉＋全身麻醉效果为佳，但具体方式应因人而异，取长补短。     

低浓度浸润麻醉下隆乳术

低浓度浸润麻醉下隆乳术作者单位：３２５０００温州医学院附属第一医院整形科赵进军硅胶囊植入式隆乳术近年来越来越常见于门诊开展。此手术的关键之一就是麻醉方法的选择及其安全性。文献已有报道采用肋间神经阻滞麻醉和局部浸润麻醉［１，２］，但未见低浓度麻醉药胸大...     

隆乳术麻醉方法的比较

作者先后采用局部浸润、肋间神经阻滞、连续硬膜外阻滞、全身麻醉法行隆乳术１０３例，现将其麻醉效果进行分析比较。一、临床资料：本组共１０３例，其中局部浸润麻醉２０例，肋间神经阻滞３２例，连续硬膜外阻滞１６例，全身麻醉３５例（其中氯胺酮全麻１６例，异丙酚全...     

关于隆乳术麻醉方法有效性的思考

目的探讨隆乳术有效的麻醉方式.方法总结383例患者以各种麻醉方式隆乳的临床经验.分析隆乳术疼痛产生的机制和隆乳术的应用神经解剖.结果硬膜外麻醉和肋间神经阻滞技术不是胸大肌下间隙隆乳术理想的麻醉方式.局部肿胀麻醉只适用于乳房下间隙隆乳术和肌肉不发达的部分胸大肌下间隙隆乳术的患者.全身麻醉对任何术式均有效.结论隆乳术中应根据不同情况采用不同的麻醉方式.     

关于隆乳术麻醉方法有效性的思考

目的　探讨隆乳术有效的麻醉方式。方法　总结 3 83例患者以各种麻醉方式隆乳的临床经验。分析隆乳术疼痛产生的机制和隆乳术的应用神经解剖。结果　硬膜外麻醉和肋间神经阻滞技术不是胸大肌下间隙隆乳术理想的麻醉方式。局部肿胀麻醉只适用于乳房下间隙隆乳术和肌肉不发达的部分胸大肌下间隙隆乳术的患者。全身麻醉对任何术式均有效。结论　隆乳术中应根据不同情况采用不同的麻醉方式     

瑞芬太尼和咪唑安定联合TCI复合肋间神经阻滞在隆乳术中的应用

目的：探讨瑞芬太尼和咪唑安定联合TCI复合肋间神经阻滞用于隆乳手术的麻醉效果。方法：选择ASAⅠ～Ⅱ级拟行隆乳术的患者60例。在切皮前静脉输注咪唑安定0.05mg/kg,瑞芬太尼1μg/kg,术中同时开始泵入瑞芬太尼和咪唑安定。观察麻醉前、注射局麻药时、切皮前、手术30min、分离胸大肌后间隙时、停药时、停药后10min时的BIS值,MAP,HR,SpO2,ECG及镇静程度。所有患者行双侧胸3～5肋间神经阻滞。结果：与基础值相比,切皮前MAP降低（P〈0.05）,麻醉各时段HR的变化差异无统计学意义（P〉0.05）;麻醉中各时段BIS值均降低（P〈0.01）;切皮前,与基础值比较差异有显著意义（P〈0.01）;术中镇静、镇痛充分,镇静评分主要维持在3～5级。术中呼吸循环功能基本稳定。所有患者均对麻醉方法满意,并愿意在以后的类似手术中接受同样的麻醉方法。结论：瑞芬太尼和咪唑安定联合TCI复合肋间神经阻滞具有镇痛良好,胸大肌松弛,患者痛苦小,恢复快,并发症少,无精神创伤等优点,是隆乳手术安全有效的麻醉方法。     

静脉镇静镇痛复合肋间神经阻滞用于隆乳手术的临床观察

目的:观察静脉镇静镇痛复合肋间神经阻滞用于隆乳术的麻醉效果。方法:共60例行择期隆乳术的健康女性病人,随机采用负荷剂量后持续输注咪唑安定-芬太尼(M-F组,n=30)或咪唑安定-芬太尼-氯胺酮(M-F-K组,n=30)的方法,调整注速维持镇静深度在改良的OAA/S评分2～3分。所有病人行双侧T2～T7肋间神经阻滞。结果:两组病人术中呼吸循环功能稳定,镇静镇痛效果满意,以M-F-K组更为理想。两组病人均在停药后4～12min内清醒,时间无明显差别。术后24h随访所有病人均无术中记忆,对麻醉方法满意。结论:静脉镇静镇痛复合肋间阻滞具有镇痛良好,胸大肌松弛,病人痛苦小、恢复快、并发症少、无精神创伤等优点,是适合隆乳手术简单、安全有效的理想麻醉方法,以M-F-K镇静镇痛的效果更加理想。     

Management of pain after thoracotomy: experience of intercostal nerve block with alcohol during operation

Post-thoracotomy wound pain in 11 patients who underwent thoracic operation was controlled by intercostal nerve block with alcohol and thoracic epidural anesthesia. The intercostal nerve block was performed just before the closure of the thoracotomy wound. Epidural anesthesia was employed from the 1st to 5th post operative day. This method alleviated post-thoracotomy pain and obviated postoperative pulmonary complication in all patients in early post operative periods. In late post operative periods after discharge, intercostal nerve block could maintain excellent analgesia in 9 of 11 patients, only 2 patients required analgesic drugs or re-block of the intercostal nerve. Thus, intercostal nerve block with alcohol is an effective and simple option to control recalcitrant post-thoracotomy wound pain in thoracic surgery.     

Combined intercostal nerve block and epidural anesthesia in a patient with severe aortitis syndrome

A 74-year-old woman with aortitis syndrome was scheduled for mastectomy. Her left vertebral artery was totally occluded and left carotid arteries, left subclavia artery and bilateral common renal arteries were occluded. For anesthesia a catheter was inserted into the epidural space between T3 and T4. Lidocaine 80 mg (2%, 4 ml) was administered epidurally. Then intercostal nerve block was performed with bupivacaine 15 mg (0.5%, 3 ml) at T3 and T4 level. Local infiltration of lidocaine 50 mg (1%, 5 ml) was added. During the surgery, hemodynamics were stable and no neurological symptom was observed. Epidural anesthesia alone might be sufficient for anesthesia if higher concentration of local anesthetic was used. However, to avoid hemodynamic change, we used 1% lidocaine and added intercostal nerve block. We conclude that combined intercostal nerve block and epidural anesthesia was useful for a patient with severe aortitis syndrome in oder to monitor consciousness to detect cerebral ischemia and to avoid hemodynamic instability.     

肋间神经阻滞联合局麻微创经皮肾镜38例报告

目的探讨肋间神经阻滞联合局麻微创经皮肾镜碎石取石术（MPCNL）的可行性与安全性。 方法2018年10月至2019年11月,超声引导下于患侧第10、11、12肋骨下缘与脊柱交叉点处进行肋间神经阻滞,每个部位注射0.5%布比卡因5 ml（含1/1000肾上腺素）,然后在选定的穿刺通道上进行局部浸润麻醉（2%利多卡因10 ml+生理盐水15 ml混合液约10 ml）。采用超声引导下穿刺、一步扩张法MPCNL,分别在钬激光碎石开始10 min及术后2 h、6 h、24 h行视觉模拟评分（VAS）评估疼痛严重程度;术后2 h及术后第1天复查血常规评估术中出血量;术后4周复查腹部平片或超声评估结石清除率。 结果38例均顺利完成手术,无一例需改变麻醉方式,无严重并发症发生,无一例中转开放手术,术中及术后2 h、4 h、24 h的VAS均值分别为2.6、2.2、1.8和1.3分,术后4周结石总体清除率91.3%（21/23）。 结论选择合适的病例,肋间神经阻滞联合局麻MPCNL操作简便,手术安全,疗效满意,值得临床推广。     

超声引导下胸肋间筋膜阻滞的研究进展

肋间神经走行于肋间肌之间,在靠近胸骨的位置发出前皮支分布在皮肤表面,支配前胸壁区域的皮肤感觉。超声引导下胸肋间筋膜阻滞（PIFB）是近年来一种新兴的筋膜平面区域阻滞技术,通过将局麻药注射在胸大肌与肋间肌之间,在肋间神经移行途中将其阻断从而实现前胸壁区域的麻醉与镇痛。PIFB以其有效的镇痛效果、操作安全且易于学习的特点应用于乳腺、胸科、心脏等手术领域中,得到了患者和医师的广泛认可。本文通过对PIFB的解剖情况、操作技术、作用特点及临床应用方面进行论述,为PIFB的更多研究提供参考。     

59. Die Regionalanaesthesie in der Abdominal-Chirurgie

Summary Spinal and peridural anesthesia are most useful in lower abdominal operations. For upper laparotomies needing analgesia, good relaxation and quiet ventilation, intercostal block and peridural anesthesia with light general anesthesia are suitable techniques to avoid hypertension and metabolic responses (hyperglycemia, cortisol). During the postoperative period, regional blocks improve lung function and bowel motility, and afford early ambulation.     

The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostal blockade (T9 to T11) in healthy volunteers

Biodegradable microcapsules containing bupivacaine/dexamethasone produce an anesthetic duration of 7-11 days in animal models. In this investigation, we explored the effect of increasing doses (Part 1) and the effect of including dexamethasone (Part 2) on the onset, density, and duration of analgesia and anesthesia produced by bupivacaine microcapsules. Concentrations ranging from 0.3125% to 5.0% in microcapsules were compared with 0.25% aqueous bupivacaine (bilateral injection, three intercostal nerves, 2 mL per nerve) (Part 1). Part 2 compared 2.5% microcapsules with or without the inclusion of dexamethasone by unilateral blockade. Sensory block was assessed by pinprick, temperature sensation, and subjective numbness (0, not numb; 10, totally numb). Pharmacodynamic assessments and plasma drug concentrations of bupivacaine and dexamethasone were measured for 96 h. The onset time was reduced and the duration of analgesia increased over the 0.3125%-5.0% dose range (P < 0.02). Onset with 2.5% microcapsules approximated that of 0.25% aqueous bupivacaine. Microcapsule block duration increased to at least 96 h and was significantly longer than aqueous bupivacaine (P < 0.001). Inclusion of dexamethasone increased the duration of pinprick anesthesia in 2.5% microcapsules (P = 0.03). We conclude that bupivacaine/dexamethasone microcapsules are well tolerated and demonstrate a dose-related effect in onset and duration of intercostal blockade. Inclusion of dexamethasone increases intercostal block anesthesia.     

Ultrasound-guided umbilical nerve block in children: a brief description of a new approach

BACKGROUND: The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and paraumbilical block. However, multiple anatomic variations have been described and some complications may occur. Ultrasonographic guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. This case series describes a new ultrasound-guided puncture technique of the 10th intercostal nerve in pediatric umbilical surgery. METHODS: Ten children (age range: 2-5 years) scheduled for umbilical hernia repair were included. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 10-MHz linear probe. An ultrasound-guided peripheral block of the 10th intercostal nerve in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 20 punctures). Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. RESULTS: Umbilical anatomy was clearly identified by ultrasound in all cases. The epigastric vessels were identified--above the umbilicus--within the depth of the muscular mass of the RM. The spread of local anesthetic was ultrasound-controlled in all cases. However, the intercostal nerve could not be visualized. All blocks were effective during the surgery. Postoperative analgesia was only required in two children in the second postoperative hour. There were no complications. CONCLUSIONS: Ultrasound guidance enables performance of an effective umbilical block in the lateral edge of RM. Further studies should be carried on to visualize the intercostal nerve and to compare this technique with the classical ones.     

Anesthetic management with remifentanil during thoracic surgery in a pediatric patient--case report of a patient with congenital cyst adenoid malformation

We gave general anesthesia for the lower right lobe resection in an infant with congenital cystic adenomatoid malformation (CCAM). Anesthesia was performed with sevoflurane inhalation, intravenous infusion of remifentanil and intermittent injection of fentanyl. Intraoperative anesthetic course was uneventful except for failure of one lung ventilation. After all surgical procedures, intercostal nerve block under direct vision by surgeon and intravenous infusion of fentanyl were performed for postoperative analgesia. Emergence from anesthesia was prompt, and the tracheal tube could be removed without any troubles. Remifentanil is an effective and safe opioid to use for thoracic surgery even in infants.     

Anatomy of the intercostal nerve: Its importance during thoracic surgery

Complications from attempts to block the intercostal nerves intraneurally before closure of a thoracotomy have resulted in hypotension with or without spinal block. Placement of a chest tube has resulted in transection of the intercostal nerve. The first of these complications can be avoided by not attempting intraneural block of the nerves intrathoracically. Avoidance of the latter requires careful dissection of the intercostal spaces and identification of the intercostal nerve, as opposed to stab insertion of a chest tube.     

Cryoanalgesia for post-thoracotomy pain relief

A randomized study comparing the postoperative requirements of narcotics of three groups of patients (Group I: no analgesia; Group II: internal intercostal nerve block; Group III: cryoanalgesia) was conducted. This study was performed in order to assess the efficiency of cryoanalgesia versus internal intercostal nerve block to obtain pain relief after thoracotomy. Regarding post-operative narcotic requirements (Piritramide-Dipidolor), there was no significant difference between Group I and Group II patients, but patients from Group III required a significantly lower amount of narcotics during the first 36 postoperative hours (p less than 0.01). We conclude that, although cryoanalgesia does not provide complete post-thoracotomy pain relief, it is however an easy and safe method and is more efficient than internal intercostal nerve block for pain relief after thoracotomy.