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首页> 外文期刊>Current opinion in anaesthesiology >Functional anatomy of the nerve and optimal placement of the needle for successful (and) safe nerve blocks
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Functional anatomy of the nerve and optimal placement of the needle for successful (and) safe nerve blocks

机译：针对成功（和）安全神经块针的神经和最佳放置的功能解剖

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Purpose of review Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. Recent findings The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks. In this kind of blocks, the target for injection is the plane itself and not a nerve in particular. transversus abdominis plane, pectoralis muscles, erector spinae plane blocks are some examples of fascial blocks. Because injecting into a fascial plane is not controversial, these blocks are not included in our discussion of optimal placement of the needle. To determine optimal needle placement, it is important to have a clear definition of what constitutes intraneural. Although, there is almost universal agreement that the violation of the epineurium defines the intraneural concept, the literature include several studies where this assessment is erroneous. Although intentional intraneural injection is still considered objectionable, some literature suggests that injecting intraneurally, especially if extrafascicular, may be benign. This evidence is limited and anecdotal. It is necessary to have a better understanding of what intraneural injection is when dealing with any type of nerve blocks, be that single nerve, plexuses, or the sciatic nerve. Perineural injections provide successful anesthesia without putting the nerve integrity at risk. That practice is supported by years of experience and common sense. Currently, there is no evidence to support any kind of intraneural injections, intrafascicular or extrafascicular.
机译：审查目的总结了目前关于神经阻滞和最佳注射部位的临床相关方面的目前思考。最近发现，超声波在区域麻醉中的广泛使用改变了区域麻醉的实践，并产生了新的可能性。其中是能够识别迷恋的飞机，这已成为一组新的块，漂亮平面块的基础。在这种块中，注射的目标是平面本身而不是特定神经。横向腹部肌肉腹部肌肉，肌脊柱型平面块是一些筋膜块的例子。因为注射到阳台不是争议的，所以这些块不包括在我们对针的最佳放置中的讨论中。为了确定最佳针头放置，重要的是要明确定义内部构成的内容。虽然，几乎存在普遍的协议，即违反EPIneurium定义了内部概念，文献包括几项研究，这种评估是错误的。虽然故意肾内注射仍被认为是令人反感的，但一些文献表明，intarnulally，特别是如果胃肠，可能是良性的。此证据有限，轶事。有必要更好地理解肾内注射在处理任何类型的神经块时，是单身神经，丛或坐骨神经。麻纹注射提供成功的麻醉，而不会使神经完整有风险。多年的经验和常识支持这种做法。目前，没有证据支持任何类型的内腔注射，肠内注射，胸腔内或外肠。

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