Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
Anesth Analg. 2010 Mar 1;110(3):761-3. doi: 10.1213/ANE.0b013e3181c920b6. Epub 2009 Dec 15.
We describe the management of postoperative pain for a 10-year-old girl who underwent forequarter amputation for osteosarcoma of the left humerus. Because the brachial plexus itself was divided and resected during surgery, and the main body part innervated by the nerves from this plexus (the entire upper limb including the scapula and clavicle) was removed, providing analgesia via a brachial plexus block alone would probably not have provided adequate coverage. Because the tissue not resected with this surgery was innervated via the cervical and brachial plexuses and some upper thoracic nerve roots, we elected to combine a perioperative high continuous cervical paravertebral block at the C5 level with a continuous thoracic paravertebral block at the T2 level for postoperative analgesia. Our patient experienced excellent postoperative analgesia and required no narcotics during the immediate postoperative period.
我们介绍了一位 10 岁女孩的术后疼痛管理，她因左肱骨骨肉瘤接受了前肩部截肢手术。由于臂丛神经本身在手术中被分离和切除，而由该神经丛支配的主要身体部分（包括肩胛骨和锁骨的整个上肢）也被切除，因此单独进行臂丛神经阻滞可能无法提供充分的镇痛效果。由于与该手术一起未切除的组织通过颈丛和臂丛神经以及一些上胸神经根支配，我们选择在 C5 水平进行围手术期高持续颈椎旁阻滞，并在 T2 水平进行连续胸椎旁阻滞以提供术后镇痛。我们的患者术后镇痛效果极佳，在术后即刻期间无需使用麻醉性镇痛药。
