Re:전침(electroacupuncture)으로 nerve block하는 방법. 어깨, 상지의 신경통이 있을때

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우선 중요한 것은 자침할 정확한 위치다. 

1. interscalene 부위의 brachial plexus

2. block을 원하는 신경의 dermatome

아래 논문은 리도카인으로 nerve block하는 방법과 부위다.

전침은 훨씬 부작용이 덜한대신, 정확한 신경을 자침하기가 쉽지 않다. 

전사각근과 중사각근 사이에 있는 brachial plexus의 다발을 보면 어느 trunk, 어느 division을 자침될 것인지 참 쉽지 않은 일이다.

Common Regional Nerve Blocks.pdf

1. interscalene

참고) The interscalene nerve block is typically used for shoulder, clavicle, or upper arm surgeries because it covers higher up on the shoulder. The disadvantage is that patients will experience phrenic nerve blockade resulting in diaphragmatic paralysis. 

- 환자에게서 실제로 경험한 일인데, interscalene부위 자침, dermatome 자침후 전침 block 시작 2-3분 후 호흡의 불편함 호소

- 심호흡하면서 부호흡근, 주호흡근의 muscle activation후 치료 진행.

2. supraclavicular

참고) The supraclavicular nerve block is ideal for procedures of the upper arm, from the mid‐humeral level down to the hand. The area covered is similar to the interscalene block, but does not cover the upper part of the shoulder as well. It has a rapid onset, with a dense and predictable level of pain control. There is a slightly higher risk of pneumothorax than the interscalene nerve block.

3. infraclavicular

참고) The infraclavicular nerve block is ideal for operations to the elbow and below. It has a lower risk of pneumothorax than the supraclavicular, although higher than the interscalene. This block has minimal risk of blocking the phrenic nerve.

4. Axillary

참고) The axillary block is the most distal block performed on the brachial plexus. Because of the distal location, the axillary block has minimal risk of respiratory compromise from either pneumothorax or phrenic nerve blockade. However, the axillary nerve block does not cover the lateral aspect of the forearm from the elbow to the thumb as well as the other blocks

5. Paravertebral

The paravertebral space is adjacent to the vertebral body. When a local anesthetic is injected into this space it blocks one or more nerve roots as they exit the spine. This leads to unilateral numbness of a specific area of the body. The most common indication is breast surgery, but it is used for chest and abdominal surgeries. The area that is blocked will depend on which level the local anesthetic is injected at. Potential complications include inadvertent vascular puncture, hypotension, hematoma, epidural spread or intrathecal spread, pleural puncture, and pneumothorax. Bilateral blocks may be performed.

6 Transversus Abdominis Plane

The Transversus Abdominis Plane (TAP) block is a technique where local anesthetic is injected into a potential space between the internal oblique and transversus abdominis muscles. This plane contains the nerves that provide sensation to the anterolateral abdominal wall, approximately T10‐L1, although in some patients the block will spread further up and/or down. The TAP Block is typically used for pain control after lower abdominal surgery including bowel, prostate, obstetric, and gynecological surgery. Potential complications include intraperitoneal injection, bowel hematoma, transient femoral nerve palsy, liver laceration and local anesthetic toxicity. Theoretically these risks have greatly decreased now that most TAP blocks are placed under ultrasound guidance. More research is needed to prove this.

If surgery enters the peritoneal cavity, the dull visceral pain from spasm and/or inflammation may still be present. The TAP block primarily covers the incisional pain. Depending on the type of local anesthetic used, a TAP Block typically lasts 12‐36 hours. The TAP block can produce relaxation of the abdominal wall muscles, which can result in a “flank bulge”, which may look like a hernia. This may be more pronounced in patients with low Body Mass Index (BMI). Any patient with significant abdominal distention following a TAP Block should be assessed for possible internal bleeding.

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nerve plexus를 정확하게 자침하기가 쉽지 않네요

[곰돌이풉]

좋은 자료 잘 보았습니다. 감사합니다. blind로 brachial plexus를 정확히 자침하기가 어려울텐데요. blind 말고 sono guide는 시도해보셨는지 궁금합니다.