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超声引导下前锯肌平面阻滞的叙述性综述

A narrative review of ultrasound-guided serratus anterior plane block.

作者信息

Xie Cuiyu, Ran Guo, Chen Daoqi, Lu Yao

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.

Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, China.

出版信息

Ann Palliat Med. 2021 Jan;10(1):700-706. doi: 10.21037/apm-20-1542. Epub 2020 Dec 31.

Abstract

Ultrasound-guided serratus anterior plane block (SAPB) is located using ultrasound at the level of the midaxillary line and the fifth rib, and a certain amount of local anesthetics is injected either superficially or deeply into the serratus anterior muscle, blocking the third to sixth intercostal nerves, the long thoracic and thoracodorsal nerves. It is mainly used in breast surgeries, rib fractures and thoracotomy to manage the pain of the anterolateral chest wall. The surgery of anterolateral chest wall is often accompanied by severe postoperative pain, leading to postoperative infection, atelectasis and other complications, and prolonged hospitalization. However, effective pain management can reduce the occurrence of postoperative pulmonary complications, promote patients to get out of bed as soon as possible, and accelerate the recovery of patients. Recently, with the development of ultrasonic technology and equipment, SAPB has entered the era of visualization, further improving the safety and success rate of operations. SAPB, as a new technology of regional block, has a higher positioning accuracy, a higher success rate, lesser complications, and simpler and more effective postoperative analgesia effect. Compared with thoracic epidural analgesia and thoracic paravertebral block, SAPB has a good ultrasonic anatomical basis; thus, has a broad application prospect in clinics. In this paper, the SAPB in clinical application was reviewed.

摘要

超声引导下前锯肌平面阻滞(SAPB)是在腋中线与第五肋水平使用超声定位,将一定量局部麻醉药浅部或深部注射到前锯肌内,阻滞第三至第六肋间神经、胸长神经和胸背神经。它主要用于乳腺手术、肋骨骨折和开胸手术以处理前胸壁疼痛。前胸壁手术常伴有严重的术后疼痛,导致术后感染、肺不张等并发症以及住院时间延长。然而,有效的疼痛管理可减少术后肺部并发症的发生,促进患者尽早下床,并加速患者康复。近年来,随着超声技术和设备的发展,SAPB进入了可视化时代,进一步提高了手术的安全性和成功率。SAPB作为一种区域阻滞新技术,具有更高的定位准确性、更高的成功率、更少的并发症以及更简单有效的术后镇痛效果。与胸段硬膜外镇痛和胸段椎旁阻滞相比,SAPB具有良好的超声解剖学基础;因此,在临床上具有广阔的应用前景。本文对SAPB在临床中的应用进行了综述。

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