,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Nerve,Block,Nerve Block,Sketch of this lesson,General introduction,Local anesthetic toxicity,Cervical plexus block,Brachial plexus block,Sciatic block,Digital block,Sketch of this lessonGeneral i,General introduction,History,1880s,Cocaine was injected to peripheral site for minor surgeries.,1885,Esmarch bandage used to arrest local circulation to prolong coaine-induced block.,1903,epinephrine as“chemical tourniquet”emerged.,1920,the first definitive textbook,Regional anesthesia:Its Technic and Application,was authored by Gaston Labat in U.S.A.,Became a well-accepted component of comprehensive anesthetic care,and expanded from operating suite to pain management.,General introductionHistory188,General introduction,Technique of nerve block is to localize the neural structures,usually by anatomy knowledge and elicited paresthesia.,Development of nerve block,General introductionTechnique,General introduction,Indication,Surgical area,consciousness and cooperation,skill level of handler.,Contraindication,Infection,tumor,serious malformation on the puncture site;coagulation disorder;allergy to local anesthetics.,General introductionIndication,Local anesthetics,Local anesthetics,Local anesthetic toxicity,Local anesthetic toxicity,You should know what complication,could be,caused by your procedure,before you master the procedure,！,未学打人，先学挨打！,Local anesthetic toxicity,You should know what complicat,Local anesthetic toxicity,Concept,Concentration of local anesthetic in blood,far exceeds,the tolerance limitation of human body and cause adverse effect.,Central nervous system and heart are vulnerable.,Common cause,Local anesthetic over dose;,Accidentally vessel injection;,Excessive absorbance of local anesthetic;,Systemic pathology reduce the tolerance.,Local anesthetic toxicityConce,Local anesthetic toxicity,CNS toxicity(Biphasic effect),CNS is more susceptible to systemic action of local anesthetic than cardiovascular system is.(Dose 1:3),Early symptoms:dizziness,visual and auditory disturbance,disorientation,excitatory sign including shivering,muscular twitching.Hypertension.,Ultimately,generalized convulsion will occur.After seizure activity ceases,respiratory depression even arrest may occur.,Local anesthetic toxicityCNS t,Local anesthetic toxicity,Cardiovascular toxicity,Inhibit the myocardial sodium channel and cause negative inotropic action,reduction of CO,bradycardia,ventricular arrhythmia even cardiac arrest.,Local anesthetic toxicityCardi,Local anesthetic toxicity,Treatment of local anesthetic toxicity,1.Stop injection immediately.,2.Oxygen supply and airway maintenance.,3.Midazolam 5mg/Propofol 80-100mg iv.,4.Respiratory assistance and sustaining the HR and Blood pressure.,5.When cardiac arrest occurs,CPR must be applied promptly.,6.Bupivacaine-induced cardiac arrest,is more difficult to resuscitate.20%intralipid is considerable to be applied.,Local anesthetic toxicityTreat,Local anesthetic toxicity,Prophylaxis of local anesthetic toxicity,1.Not exceed the dosage limitation,choose suitable dose according to evaluation of patients and the blockage site.,2.Aspiration before injection.,3.Use epinephrine to reduce the absorbance.,4.Administration of small dose benzodiazepine or barbital.,5.Correction of acidosis,hyperthermia,anemia and hypovolemia preoperatively.,Local anesthetic toxicityProph,Cervical plexus block,Indication:,Superficial and deep Operations,in the region of neck and supra-,clavicular fossa.,枕小神经,耳大神经,颈横神经,锁骨上神经,Cervical plexus blockIndicatio,Cervical plexus block,Technique selection,Superficial Vs Deep?,Pharmacologic choice,High concentration Vs Low?,颈襻,Cervical plexus blockTechnique,Cervical plexus block,Complications,1.Superficial block rarely cause any complication;,2.Local anesthetic toxicity;,3.Intrathecal injection;,4.Phrenic nerve blockage;,5.Laryngeal recurrent nerve blockage;,6.Honors syndrome;,7.Hemorrage of vertebral artery,Cervical plexus blockComplicat,Cervical plexus block,Superficail cevical,plexus block,Cervical plexus blockSuperfica,Cervical plexus block,Deep cervical,plexus block,Cervical plexus blockDeep cerv,Brachial plexus block,Anatomy of brachial,plexus,Brachial plexus blockAnatomy o,Axillary block,Indication,Forearm,hand and wrist surgery.,Position,Abduct the arm at shoulder,Pharmacologic choice,High volume low concentration.,0.25%Ropivacaine+0.5%Lidocaine 30ml,Analgesia last 4-6 hrs,Axillary blockIndication,Axillary block,Advantage:,Most safe one of all.,Shortage:,Cross section,Axillary blockAdv