Anatomical bases for paravertebral an esthetic block: fluid communication between the thoracic and lumbar paravertebral regions
Anatomical bases for paravertebral an esthetic block: fluid communication between the thoracic and lumbar paravertebral regions
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DOI：
10.1007/bf01631341
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发表时间：
1999-12-01
影响因子：
1.4
通讯作者：
Carlsson, C
中科院分区：
文献类型：
--
作者：
Saito, T;Den, S;Carlsson, C
在椎旁区域注射局部麻醉剂在身体同侧产生镇痛区，即椎旁阻滞。关于这种阻滞的一个问题是局麻药是否从胸椎扩散到椎旁区域的腰椎水平。本研究的目的是了解麻醉液如何进入腰椎旁区域（如果有的话）。本研究使用了12具尸体。将15 ml深红色染料注射到第11胸椎节段的椎旁区域。为了检查染色剂的扩散，内脏被切除了。虽然深红色染料在壁层胸膜后面的胸内筋膜中扩散，但它也在筋膜中向下扩散，主要是沿着内脏神经。在隔膜的上表面，染料在筋膜中横向扩散，并通过内侧和外侧弓形韧带进入腹腔。在腹腔中，发现染料在腹横筋膜中广泛扩散，以至于累及肋下、髂腹下、髂腹股沟、生殖股、股外侧皮神经和股神经。我们得出结论，胸椎旁区域的染料可以通过内侧和外侧弓状韧带进入腹腔。本研究解释了胸椎和腰椎椎旁区域之间可能存在的液体连通，并证实了我们之前的临床观察结果。这一结果对椎旁麻醉的临床应用具有重要意义。
An injection of a local anesthetics in the paravertebral region produces an analgesic field on the same side of the body, a paravertebral block. One point in question about this block is whether the local anesthetic spreads from the thoracic to the lumbar level of the paravertebral region. The purpose of this study was to find how the anesthetic fluid traveled to the lumbar paravertebral region, if at all. Twelve cadavers were used in this study. 15 ml of crimson dye was injected into the paravertebral region at the 11th thoracic level. The viscerae were removed so that we could examine the dye spread. While the crimson dye spread in the endothoracic fascia posterior to the parietal pleura, it also spread downward in the fascia mostly along the splanchnic nerves. At the upper surface of the diaphragm the dye spread laterally in the fascia, and entered the abdominal cavity through the medial and lateral arcuate ligaments. In the abdominal cavity, the dye was found to have spread so widely in the transversalis fascia that the subcostal, iliohypogastric; ilioinguinal, genitofemoral, lateral femoral cutaneous and femoral nerves were involved. We concluded that the dye in the thoracic paravertebral region can enter the abdominal cavity through the medial and lateral arcuate ligaments. This study explained possible fluid communication between the thoracic and lumbar paravertebral regions and confirmed our former clinical observations. The result is important for the future clinical application of paravertebral-anesthesia.