胸椎旁阻滞的临床应用  

The application of thoracic paravertebral blockade

作　　者：张海燕[1] 李崎[1] 朱涛[1] 刘飞[1] 

机构地区：[1]四川大学华西医院麻醉科,成都610041

出　　处：《国际麻醉学与复苏杂志》2017年第12期1117-1122,1127,共7页International Journal of Anesthesiology and Resuscitation

摘　　要：背景胸椎旁阻滞（thoracicparavertebralblockade，TPVB）是一种将局部麻醉药注射到胸段椎间孔外口，阻滞行经在该区域内的脊神经根的一种区域神经阻滞技术。该技术可利用解剖定位或超声引导实施，可以为多种胸、腹部手术提供术后镇痛。一目的对该技术的解剖基础和临床应用进行文献综述。内容TPVB的局部麻醉药注射区域为胸椎旁间隙（thoracicparavertebralspace，TPvs），可用传统方法或超声引导定位。多种局部麻醉药，如布比卡因、利多卡因、罗哌卡因，均可用来实施TPVB，从而为接受单侧胸、腹部手术和患慢性疼痛综合征的患者减轻疼痛，也可用作乳腺手术的麻醉方式。趋向超声引导下的TPVB作为一种安全的多模式镇痛技术，其镇痛效果和硬膜外、椎管内麻醉相近，但其并发症更少。今后需要进一步的研究来扩大其应用范围，并预防其相关并发症。Background Thoracic paravertebral blockade （TPVB） is a regional nerve blocking technique by injecting local anesthetics into thoracic paravertebral space, adjacent to the intervertebral foramina, to block the roots of thoracic nerves. This technique can be performed under the guidance of anatomical markers or ultrasound, and has been widely applied in thoracic and abdominal surgeries for postoperative pain management. Objective To summarize anatomical basis and clinical application of TPVB. Content The injection sites of TPVB are located near thoracic paravertebral space （TPVS）, which can be identified with traditional and ultrasound-assisted methods. The local anesthetics including bupivacaine, lidocaine, and ropivaeaine, were administered with TPVB to relieve pain in one-sided thoracic and abdominal surgeries and chronic pain syndromes, and also to perform anesthesia in breast surgery. With satisfying analgesic and anesthetic effects, TPVB has less adverse effects than epidural and intravertebral anesthesia, and interpleural blockade. Trend TPVB under the guidance of ultrasound provides a safe drug injection technique for multimodal analgesia with similar efficacy to epidural and intravertebral injection, but less adverse effects. Further investigations are required to expand its application and to prevent related complications.

关 键 词：胸椎旁阻滞 临床应用 药代动力学 并发症 

分 类 号：R614[医药卫生—麻醉学]