tailieunhanh - Ebook A practical approach to regional anesthesia (4/E): Part 2

Part 2 book “A practical approach to regional anesthesia” has contents: Sympathetic blockade, brachial plexus blocks, intravenous regional anesthesia, peripheral nerve blocks of the upper extremity, lumbar plexus blocks, postoperative pain management, ambulatory surgery, pediatric regional anesthesia, opthalmic anesthesia, and other contents. | 11 Sympathetic Blockade Christopher M. Bernards I. Introduction The sympathetic nervous system is a purely efferent system involved in a wide range of homeostatic functions including vasomotor tone, myocardial contractility, heart rate, bronchial tone, perspiration, gastrointestinal secretions, genitourinary function, pupil diameter, and so on. Sympathetic blocks can be used both diagnostically and therapeutically to block these functions (., perspiration in hyperhydrosis or vasomotor tone in vascular insufficiency). Also, there are pathological pain states involving the sympathetic nervous system (., sympathetically maintained pain) that can benefit from sympathetic block. In addition, there are afferent sensory nerves, particularly from the viscera, that travel with the efferent sympathetic fibers. Blockade of these sensory afferents can relieve pain either as an adjunct to surgical anesthesia or to treat both malignant and nonmalignant chronic pain. Sympathetic blockade can be performed based solely on the anatomic landmarks described in the subsequent text and this degree of accuracy is generally sufficient when using these blocks as an adjunct to surgical anesthesia (., celiac plexus block as part of a general anesthetic for cholecystectomy). However, when used for diagnostic or neurolytic block use of radiographic (., computed tomography [CT], fluoroscopy) or ultrasound guidance is recommended because of the greater accuracy these techniques provide. 156 II. Anatomy A. The cell bodies of sympathetic preganglionic neurons arise in the intermediolateral gray matter of spinal segments from T1 to L2. These cell bodies receive input from both local spinal interneurons as part of sympathetic reflex arcs and descending control from brainstem centers (Figure ). B. Sympathetic preganglionic neurons from each spinal cord segment course within the corresponding spinal nerve as it traverses the intrathecal and epidural spaces. After exiting the spinal

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• A practical approach
• Regional anesthesia
• Sympathetic blockade
• Brachial plexus blocks
• Intravenous regional anesthesia
• Postoperative pain management
• Ambulatory surgery
• Pediatric regional anesthesia
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