Dwar Il-Lok tal-Anestesija Lokali

Anestesija lokali komuni tinkludi anestesija topika, anestesija ta 'infiltrazzjoni lokali, blokk reġjonali, u blokk tal-konduzzjoni tan-nervituri. L-aħħar jista 'jinqasam fi blokk trunk tan-nervituri, blokk epidurali u anestesija spinali. Anestesija lokali ġol-vini hija forma oħra ta 'anestesija lokali 1.

1. Anestesija topika

(1) Iddefinixxi l-istat bla tbatija prodott billi tikkuntattja l-anestetiku lokali b'effett osmotiku qawwi mal-mukuża lokali biex timblokka t-truf tan-nervituri superfiċjali permezz tal-mukuża, li tissejjaħ anestesija topika. Anestetiċi lokali użati fl-anestesija topika huma diffiċli biex jilħqu r-riċetturi ta 'l-uġigħ taħt l-epitelju, u jistgħu biss itaffu l-iskumdità kkawżata mill-mukuża. Jista 'jintuża għall-anestesija tal-wiċċ tal-kornea, kavità nażali, gerżuma, trakea u bronki.

(2) Precautions ① Before applying the cotton pad impregnated with local anesthetic on the mucosal surface, squeeze out the excess liquid medicine to prevent the toxic reaction from being absorbed too much. Padding should be performed under a headlamp or laryngoscope to facilitate proper placement 2. ②The rate of absorption of local anesthetics by the mucosa of different parts is different. Generally speaking, the application of high concentrations and large doses of local anesthetics on large mucosal areas is prone to toxic reactions, and severe cases can be fatal. The absorption rate of local anesthetics from the mucosa is equal to that of intravenous injection, especially in the tracheal and bronchial spray method. The local anesthetics are absorbed the fastest, so the dose should be strictly controlled. Resuscitation kits and medicines. ③ Before topical anesthesia, atropine must be injected to dry the mucous membranes and avoid saliva or secretions that hinder the contact between local anesthetics and mucous membranes. ④The local anesthetic ointment applied to the outer wall of the tracheal tube is preferably water-soluble. It should be noted that the onset time of anesthesia should be at least 1 minute. Therefore, it cannot be expected that the tracheal tube can be prevented from choking once it is inserted. Spray topical anesthesia of the mucous membranes of the pharynx, larynx and trachea.

2. Anestesija ta 'infiltrazzjoni lokali

(1) Iddefinixxi l-injezzjoni f'saffi ta 'anestetiku lokali tul il-linja ta' inċiżjoni kirurġika biex timblokka t-truf tan-nervituri fit-tessut, li tissejjaħ anestesija ta 'infiltrazzjoni lokali. Ħu labra tal-injezzjoni intradermali, iċ-ċanfrin tal-labra tkun qrib il-ġilda, u wara li tidħol fil-ġilda, injetta l-likwidu anestetiku lokali biex tifforma qoxra tal-larinġ bajda-bħal qoxra tal-ġilda, u mbagħad ittaqqab minn ġol-muntun tal-ġilda u injetta d-droga fi saffi. Il-labra tat-titqib għandha tiddaħħal mis-sit li jkun ġie infiltrat l-aħħar darba biex jitnaqqas l-uġigħ tat-titqib. L-injezzjoni ta 'likwidu anestetiku lokali għandha tkun taħt pressjoni biex tifforma infiltrazzjoni ta' tensjoni fit-tessut u tagħmel kuntatt estensiv mat-truf tan-nervituri biex ittejjeb l-effett anestetiku.

(2) Precautions ① The injection of local anesthetic should penetrate deep into the underlying tissue and infiltrate layer by layer. The nerve endings are most distributed in the membranous surface, subsarcolemma, and periosteum, and thick nerves often pass through. The amount of local anesthetic solution should be increased. The concentration can be increased if necessary. There are few nociceptive nerve endings in muscle fibers, and only a small amount of local anesthetic can produce a certain muscle relaxation effect. ② The puncture needle should be inserted slowly. When changing the direction of the puncture needle, the needle should be withdrawn to the subcutaneous surface first to avoid bending or breaking of the needle shaft. ③Aspirate before each injection to prevent the local anesthetic liquid from being injected into the blood vessel. After the injection of the local anesthetic liquid, it is necessary to wait for 4 to 5 minutes so that the effect of the local anesthetic is perfect. ④ Do not exceed the maximum amount of each injection to prevent local anesthetic toxicity. ⑤ It is not advisable to use local infiltration anesthesia for the site of infection and cancer.

3. Blokk reġjonali

Madwar iż-żona kirurġika, anestetiku lokali jiġi injettat madwar u fil-qiegħ biex jimblokka l-bagolli tan-nervituri u t-truf tan-nervituri li jidħlu fiż-żona kirurġika. Din tissejjaħ anestesija blokka reġjonali. L-injezzjoni surround tista 'titwettaq billi ddawwar it-tessut resected, jew madwar il-bażi tiegħu. Il-punti operattivi tal-blokk reġjonali huma l-istess bħal dawk tal-metodu ta 'infiltrazzjoni lokali. Il-vantaġġ ewlieni huwa li jevita t-titqib ta 'tessut patoloġiku, huwa adattat għal kirurġija minuri outpatient, u huwa adattat ukoll għal pazjenti fraġli jew anzjani b'kundizzjoni fiżika ħażina.

4. Anestesija lokali ġol-vini

(1) Iddefinixxi t-turniquet fuq it-tarf prossimali tar-riġlejn, u injetta anestesija lokali ġol-vina mit-tarf distali biex timblokka r-riġlejn taħt it-tourniquet. Il-metodu tal-anestesija jissejjaħ anestesija lokali ġol-vini. Huwa adattat għal kirurġija distali tar-riġlejn fejn tourniquet jista 'jitqiegħed b'mod sigur. Minħabba l-limitazzjoni tat-tourniquet, il-ħin tat-tħaddim huwa ġeneralment fi żmien 1 sa 2 sigħat. Dan il-metodu m'għandux jintuża jekk ikkombinat ma' mard vaskulari iskemiku sever tar-riġlejn. L-estremità t'isfel tintuża prinċipalment għall-kirurġija tas-sieq u l-għoġol. Jintuża tourniquet tal-għoġol, li għandu jitqiegħed taħt l-għonq tal-fibulari biex jiġi evitat li jiġi kompressat in-nerv peroneali superfiċjali.

(2) Precautions The main complication of intravenous local anesthesia is the toxic reaction caused by a large amount of local anesthetics entering the systemic circulation after loosening the tourniquet or air leakage. Therefore, attention should be paid to: ① Carefully check the tourniquet and inflatable device before operation, and calibrate the pressure gauge; ② When inflating, the pressure should reach at least 100mmHg of the systolic pressure on the side, and monitor the pressure gauge closely; ③ Do not relax within 20 minutes after injection Tourniquet, it is best to take intermittent deflation method when placing tourniquet, and observe the patient's state of mind.

5. Blokk tan-nervituri u tal-plexus

(1) Blokk tal-plexus ċervikali Blokk superfiċjali tal-plexus ċervikali jista 'jintuża għal kirurġija superfiċjali tal-għonq supraklavikulari, filwaqt li kirurġija tal-għonq fil-fond, bħal kirurġija tat-tirojde, endarterectomy tal-karotide, eċċ., Għadha teħtieġ blokka tal-plexus ċervikali fil-fond. Madankollu, minħabba li l-għonq għadu innervat mill-aħħar erba 'pari tan-nervituri kranjali, l-effett tal-blokk tal-plexus ċervikali waħdu mhuwiex perfett, u mediċini awżiljarji jistgħu jintużaw biex itaffu l-uġigħ.

(2) Blokk tal-plexus brachial jinkludi blokk tal-plexus brachial transcervical, blokk tal-kanal intermuskolari, blokk tal-plexus brachial supraklavikulari, blokk tal-plexus brachial subclavian, u blokk tal-plexus brachial axillary. metodu ta' approċċ. L-effett tal-blokk tal-ħames approċċi tal-plexus brachial ivarja minħabba l-anatomija ta 'kull parti, u l-innervazzjoni ta' kull parti tal-parti ta 'fuq hija wkoll differenti. Għalhekk, l-aktar approċċ ta 'imblokk xieraq għandu jintgħażel skond l-innervazzjoni tas-sit kirurġiku.

(3) Blokk tan-nervituri ta 'l-estremità ta' fuq Il-blokk tan-nervituri ta 'l-estremità ta' fuq huwa adattat prinċipalment għal kirurġija ta 'driegħ jew ta' l-idejn, u jista 'jintuża wkoll bħala rimedju għal blokk tal-plexus brachial mhux komplut. Prinċipalment jinkludu blokk tan-nervituri medjan, blokk tan-nervituri ulnari u blokk tan-nervituri radjali, li jistgħu jiġu mblukkati fil-minkeb jew il-polz. Jekk issir kirurġija tas-swaba ', il-blokk tan-nervituri interdiġitali huwa wkoll possibbli.

(4) Blokk tan-nervituri ta 'l-estremità t'isfel L-anestesija kollha ta' l-estremità t'isfel teħtieġ timblokka l-plexus lumbari u l-plexus sakrali fl-istess ħin. Minħabba l-ħtieġa għal injezzjonijiet multipli u tħaddim inkonvenjenti, mhuwiex użat ħafna fil-prattika klinika. Madankollu, blokk tal-plexus lumbosacral jista 'jintuża meta s-sit li jeħtieġ anestesija huwa limitat jew meta anestesija newraxjali hija kontra-indikata. Barra minn hekk, blokk tal-plexus lumbosacral jista 'jintuża wkoll bħala aġġunt għall-anestesija ġenerali għall-analġeżija ta' wara l-operazzjoni.

Although lumbar plexus block combined with intercostal nerve block can be used for lower abdominal surgery, it is rarely used clinically. Combined iliohypogastric nerve and ilioinguinal nerve block is a simple and practical method of anesthesia, which can be used for surgery in the area innervated by the iliohypogastric nerve and the ilioinguinal nerve. Hip surgery requires blocking of all lumbar nerves except the iliohypogastric and ilioinguinal nerves. The easiest way to do this is to block the lumbar plexus (lumbar plexus block in the psoas space). Thigh surgery requires anesthesia of the lateral femoral cutaneous nerve, femoral nerve, obturator nerve and sciatic nerve, and a lumbar plexus block in the psoas major space combined with sciatic nerve block can be performed. The lateral femoral cutaneous nerve and the femoral nerve can be combined or blocked separately for the anterior thigh surgery, and the "three-in-one" method can also be used. The lateral femoral cutaneous nerve block alone can be used for skin graft anesthesia, and the simple femoral nerve block is suitable for Postoperative pain relief for femoral shaft fractures, quadriceps plasty or ilium fracture repair. A combined lateral femoral cutaneous and femoral nerve block combined with a sciatic nerve block usually prevents tourniquet pain because the obturator nerve innervates very little skin. Open knee surgery requires block of the lateral femoral cutaneous nerve, femoral nerve, obturator nerve, and sciatic nerve. Combined femoral nerve and sciatic nerve block can also meet the surgical requirements. Distal knee surgery requires blocking of the saphenous nerve branches of the sciatic and femoral nerves, and ankle blocks can be used for foot surgery.

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