Latifzai Khushal, Sites Brian D, Koval Kenneth J
Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire03766, USA.
Bull NYU Hosp Jt Dis. 2008;66(4):306-16.
Anesthesia may be considered in terms of two categories: general and regional. The aim of general anesthesia is to induce analgesia, sedation, amnesia, suppression of autonomic reflexes, and relaxation of muscles. Regional anesthesia is more site-specific and is typically divided into three categories based on the location of injection: 1. a central neuraxial block is an injection of an anesthetic drug into the epidural or intrathecal space; 2. a peripheral nerve block is an injection near the nerve or plexus supplying the area under operation; and 3. a field block is an injection into the adjoining tissues with subsequent diffusion into the surgical area (in orthopaedics, it is typically employed for minor procedures of the hand or foot). Of these three categories of regional anesthesia (i.e., neuraxial, peripheral, and field blocks), this article focuses on the latter two. Although neuraxial blocks comprise an important part of regional anesthesia, they are typically performed by anesthesiologists in an operative setting for major procedures of the lower extremities. The intent of this article is to familiarize the orthopaedist with techniques that have implications for emergency rooms and other ambulatory settings in which regional techniques are sometimes favored over general alternatives because they entail less risk of systemic side effects and may involve more cost-effective use of resources.
全身麻醉和局部麻醉。全身麻醉的目的是诱导镇痛、镇静、失忆、抑制自主反射以及肌肉松弛。局部麻醉更具部位特异性，通常根据注射部位分为三类：1. 中枢神经轴阻滞是将麻醉药物注入硬膜外或鞘内间隙；2. 外周神经阻滞是在供应手术区域的神经或神经丛附近进行注射；3. 区域阻滞是向相邻组织注射，随后药物扩散至手术区域（在骨科中，它通常用于手部或足部的小手术）。在这三类局部麻醉（即神经轴阻滞、外周阻滞和区域阻滞）中，本文重点关注后两类。虽然神经轴阻滞是局部麻醉的重要组成部分，但它们通常由麻醉医生在手术室为下肢的大手术进行操作。本文旨在使骨科医生熟悉一些技术，这些技术适用于急诊室和其他门诊环境，在这些环境中，局部技术有时比全身麻醉更受青睐，因为它们的全身副作用风险较低，并且可能更有效地利用资源。
