Ultrasound-GuidedAnkleNerveBlock
经超声引导踝部神经阻滞
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作者?CatherineVandepitte,AnaM.Lopez,SamVanBoxstael,andHassaninJalil
本文是纽约区域麻醉学院的经典神经阻滞文章之一，鉴于自己的英文水平，设成中英文对照的模式，供各位老师参考。由于精力所限，没有认真校核，欢迎指出错误。
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FACTS事实
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Indications:Distalfootandtoesurgery
适应症：远端足和脚趾手术
Transducerposition:?abouttheankle;dependsonthenervetobeblocked
探头位置：踝部附近；取决于哪只神经被阻滞
Goal:localanestheticspreadsurroundingeachindividualnerve
目标：局部麻醉药扩散于每支神经
Localanesthetic:3–5mLpernerve
局部麻醉药：每支神经3-5ml
GENERALCONSIDERATIONS总则
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Usinganultrasound(US)-guidedtechniqueaffordsapractitionertheabilitytoreducethevolumeoflocalanestheticrequiredforankleblockade.Becausethenervesinvolvedarelocatedrelativelyclosetothesurface,anklenerveblocksareeasytoperform;however,knowledgeoftheanatomyoftheankleisessentialtoensuresuccess.
运用超声引导技术可以给操作者在在进行踝部阻滞时减少局部麻醉药的用量。因为涉及的神经位置相对于靠近皮肤表面，踝部神经容易实施；然而，踝部解剖学的知识对确保成功的阻滞非常关键。
ULTRASOUNDANATOMY
超声解剖
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Anklenerveblockinvolvesanesthetizingfiveseparatenerves:twodeepandthreesuperficialnerves.Thetwodeepnervesarethetibialnerveandthedeepperonealnerve,andthethreesuperficialnervesarethesuperficialperoneal,sural,andsaphenousnerves.Allnerves,exceptthesaphenous,areterminalbranchesofthesciaticnerve;thesaphenousnerveisasensorybranchofthefemoralnerve.
踝神经阻滞涉及麻醉五支神经：两深三浅。两支深部神经是胫神经和腓深神经，三支浅神经是腓浅神经，腓肠神经和隐神经。除了隐神经，其余的神经都是坐骨神经的末端分支；隐神经是股神经的感觉支。
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TibialNerve胫神经
Thetibialnerveisthelargestofthefivenervesattheanklelevelandprovidesinnervationtotheheelandsoleofthefoot.Withthelineartransducerplacedtransverselyat(orjustproximalto)thelevelofthemedialmalleolus,thenervecanbeseenimmediatelyposteriortotheposteriortibialartery(Figures1,2,and3).ColorDopplercanbeveryusefulinlocatingtheposteriortibialarterywhenitisnotreadilyapparent.Thenervetypicallyappearshyperechoicwithhoney