1.体位及超声探头摆放
- 患者取俯卧/侧卧位，患者若无侧卧位禁忌，嘱患者稍低头弯腰抱膝，使背部充分暴露的同时，超声探头更易紧贴皮肤。
- 选择低频凸阵探头，尽可能在一个扫查平面内获取更多的脊柱节段的图像，用于观察后期局麻药扩散。
- 探头置于患者脊柱长轴旁矢状位，marker点在尾端。
2.超声扫查手法及经典超声图像
辨别腰椎横突是我们能成功完成ESPB的关键。将探头置于腋后线，平行于脊柱中线向内扫查，首次出现的高亮影即为腰椎横突。
3.穿刺路径及用药
找到横突后，固定探头，采用平面内进针法，头端向尾端进行穿刺，当针尖到达横突后回退，注射2-3ml的生理盐水，确定针尖在竖脊肌和腰椎横突之间后，每侧给予0.4%罗哌卡因20ml。
02、ESPB的争议
ESPB阻滞目标是脊神经的后支，但临床上更希望向腹侧扩散阻滞脊神经的前支甚至交感神经干，达到胸腹壁的皮区阻滞和交感神经抑制的效果，达到减轻体壁疼痛和内脏痛的目的，并为此不断探索ESPB最佳的阻滞入路[4]。
A点：横突外侧表面，B点：横突韧带深面
A和B是比较的注射位点
03、总结
- ESPB前标准的患者体位、脊柱旁正中矢状面的超声图像显示、局麻药在竖脊肌与横突之间可见性扩散，是临床效果优良且可重复的必要条件。
- 胸段ESPB的目标神经更多的是脊神经前支，在横突外侧越过横突间韧带进行局麻药注射，可达到更好的腹侧区域扩散、前支阻滞的效果，还能避免椎旁阻滞损伤胸膜的风险。
- 腰段ESPB的目标神经是脊神经后支的内侧支和外侧支，根据腰段脊神经后支走形可知，腰段ESPB在横突尖端给药，阻滞效果及扩散更好，扩散至硬膜外的风险更小。
作者简介
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作者: 马三太 时间: 2024-5-8 21:10
图文并茂，简明扼要。
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