病毒式营销求职招聘QQ群 https://www.edunews.net.cn/2021/hlw_0329/27020.html?ivk_sa=1023197aUltrasound-GuidedLateralFemoralCutaneousNerveBlock
超声引导股外侧皮神经阻滞
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作者ThomasB.Clark,AnaM.Lopez,DaquanXu,andCatherineVandepitte
FACTS??事实
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??Indications:Postoperativeanalgesiaforhipsurgery,meralgiaparesthetica,andmusclebiopsyoftheproximallateralthigh
??适应症：髋部手术的术后镇痛，感觉异常性股痛，近端大腿外侧的活检。
Transducerposition:Transverse,inferiortotheanteriorsuperioriliacspine;thelateraledgeofthesartoriusmuscleshouldbevisualizedwithultrasound
??探头位置：横向，髂前上棘的下方，缝匠肌的外侧边缘在超声下应该被显影。
??Goal:LocalanestheticspreadaroundLFCNbetweenthetensorfasciaelataeandsartoriusmuscles
Localanesthetic:5mL(adults)
??目标：局部麻醉药应该在阔筋膜张肌与缝匠肌之间扩散。
??局部麻醉药：5ml(成人)
GENERALCONSIDERATIONS一般考虑
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???Thelateralfemoralcutaneousnerve(LFCN)dividesintoseveralbranchesinnervatingthelateralandanterioraspectsofthethigh.Ofnote,in45%ofpatients,innervationoftheLFCNextendseventotheanteriorthigh.Thevariableanatomyofthelateralfemoralcutaneousnervemakesitchallengingtoperformaneffectivelandmark-basedblock.USguidance,however,allowsformoreaccurateneedleinsertionintotheappropriatefascialplanethroughwhichtheLFCNpasses.
??股外侧皮神经分为几支支配大腿前外侧。值得注意的是，在45%的病人中，股外侧皮神经的支配取的区域甚至延展到大腿前面。股外侧皮神经的解剖学变异使之在通过体表标志来定位来进行有效的阻滞变得具有挑战性。然而超声引导可以使穿刺针更加精准的置入到有股外侧皮神经穿过的合适的筋膜平面。
ULTRASOUNDANATOMY超声解剖
??TheLFCNtypicallyisvisualizedbetweenthetensorfasciaelataemuscle(TFLM)andthesartorius?muscle(SaM),1–2cmmedialandinferiortotheanteriorsuperioriliacspine(ASIS)and0.5–1.0cmdeeptotheskinsurface(Figure1).Ultrasound(US)imagingoftheLFCNyieldsanovalhypoechoicsmallstructurewithahyperechoicrimthatcanbeeasilyseeninthehypoechoicbackground.TheLFCNcanbetracedproximally,asitrunsfromthelateraltothemedialedgeofthesuperficialfasciaoftheSaM.ThelateraledgeoftheSaMisausefullandmark,andassuch,itcanbereliedonthroughouttheprocedure.TheposteriorbranchoftheLFCNmaysometimesbeseenacrosstheanteriormarginoftheTFLM.
??股外侧皮神经通常在阔筋膜张肌与缝匠肌之间显现，髂前上棘内下方1-2cm，距皮肤表面0.5-1cm（图一）股外侧皮神经的超声影像表现为小的卵圆形的低回声结构，伴随高回声的外晕，容易在低回声的背景看到。股外侧皮神经可以通过向近端滑动，可以看到它由外侧向内侧走形于缝匠肌的浅筋膜。缝匠肌的外侧边缘是一个有用的标志，因此，可以在整个操作过程中依赖它。股外侧皮神经的后支有时可以在阔筋膜张肌的前缘被看到。
FIGURE1.Cross-sectionalanatomyofthelateralfemoralcutaneousnerve(LFCN).ShownaretheLFCN,sartoriusmuscle(SaM),andtensorfasciaelataemuscle(TFLM).(ReproducedwithpermissionfromHadzicA:?Hadzic’sPeripheralNerveBlocksandAnatomyforUltrasound-GuidedRegionalAnesthesia,2nded.NewYork:McGraw-Hill,.)
图一，股外侧皮神经的横截面解剖。显示了股外侧皮神经LFCN，缝匠肌SaM，阔筋膜张肌TFLM。
DISTRIBUTIONOFANESTHESIA?局麻药的分布
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??BlockoftheLFCNprovidesanesthesiaoranalgesiaintheanterolateralthigh.ThereisalargevariationintheareaofsensorycoverageamongindividualsbecauseofthehighlyvariablecourseoftheLFCNanditsbranches(Figure2).
??股外侧皮神经的阻滞可以提供大腿前外侧的麻醉与镇痛。由于股外侧皮神经及其分支的走形高度可变，从而导致使其覆盖的感觉区域在个体也有很大的不同。
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FIGURE2.Expecteddistributionoflateralfemorocutaneousnervesensoryblock.
图二，股外侧皮神经感觉阻滞的预期分布
??EQUIPMENT设备
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??Theequipmentre
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