不影響膈神經功能的肩部手術後止痛策略

良好的肩部手術後止痛，對於術後的恢復與復健影像甚鉅，傳統上重大肩部手術的麻醉與止痛是以肌間溝臂叢神經阻斷來進行，局部麻醉藥物的注射標的為頸5至頸7神經根周圍，這樣的阻斷方式無可避免地會造成膈神經的阻斷進而影響橫膈膜的功能，造成病患手術後的呼吸功能減損。隨著超音波導引區域麻醉的進步，近年以後各種更精緻更準確的神經阻斷區域麻醉，例如併用superior trunk及axillary nerve block等。在本演講中除相關文獻及最近各國相關臨床試驗結果的分享外，並將介紹於超音波影像上如何精確辨別phrenic nerve、superior trunk、axillary nerve，suprascapular nerve及cervical nerve roots及如何以超音波進行橫膈膜及呼吸功能之評估，做簡短介紹並作為後續的超音波工作坊的前置準備。

Phrenic Nerve Sparing Postoperative Analgesia for Major Shoulder Surgery

Effective postoperative analgesia after major shoulder surgery is paramount for patient comfort and facilitating rehabilitation program. Interscalene brachial plexus block has been adopted as standard of practice for major shoulder surgery for long time but inevitably will result in phrenic nerve blockade and diaphragm dysfunction after surgery that might further impair patient's recovery.
With the advancement of ultrasound guided regional anesthesia technique, new strategy for shoulder surgery analgesia has been developed, for example combined superior trunk and axillary nerve block may avoid unwanted phrenic nerve block. In this talk, we will summarize recent clinical trial result for these new analgesia strategy. We will also be demonstrating how to identify critical neural structures including phrenic nerve,superior trunk, axillary nerve,suprascapular nerve and cervical nerve roots. If time permitted, we will also be introducing how to perform ultrasound evaluation of diaphragm function as a preparation step for ultrasound workshop in the afternoon.