PDF(Pubmed)
Abstract：
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
摘要：
区域麻醉是成功的骨科手术不可或缺的组成部分。神经轴麻醉通常用于手术麻醉，而周围神经阻滞通常用于术后镇痛。患者对区域麻醉的评估应包括神经系统，肺,心血管,和血液学评估。神经轴块包括脊柱，硬膜外,联合脊髓硬膜外。上肢外周神经阻滞包括肌间沟，锁骨上,锁骨下,和腋窝。下肢周围神经阻滞包括股神经阻滞，隐神经阻滞,坐骨神经阻滞,iPACK块,踝关节阻滞和腰丛阻滞。区域麻醉的选择是外科医生的一致决定，麻醉师,和病人的风险收益评估。区域区块的选择取决于患者的合作，病人姿势，手术结构，手术操作,止血带的使用和术后运动阻滞对物理治疗开始的影响。区域麻醉是安全的，但具有固有的失败风险和相对较低的并发症发生率，如局部麻醉全身毒性（LAST）。神经损伤,falls,血肿,感染和过敏反应。超声应用于区域麻醉程序，以提高疗效并最大程度地减少并发症。在区域麻醉管理期间，应随时提供LAST治疗指南和抢救药物（intralipal）。
