舌咽神经阻滞

一、适应证
顽固性神经痛。
恶性肿瘤转移性神经痛。
二、禁忌证
注射部位感染。
患者不能合作。
有严重出血倾向者。
三、解剖
舌咽神经、迷走神经和副神经一起出颈静脉孔,在茎突后方走行方向发生变化。
四、操作方法
患者取患侧向上侧卧,头前视位。或仰卧位头转向健侧。
体表定位:确定乳突前缘与外耳道下部之间为穿刺点。
常规消毒后,注射皮丘,用3.5cm长,7号短针垂直刺入皮肤,在深度约2~3cm,可触到茎突,然后将针尖沿乳突后缘刺入0.5~1cm,此时针尖的位置应在颈静脉孔的下面。回吸无血注射1%利多卡因3~5ml。

另一种入路可以选择乳突尖端与下颌角之间连线中点作为穿刺点,用3.5cm长,7号短针自穿刺点与皮肤呈直角穿刺,缓慢进针约2~2.5cm,触及茎突后沿茎突后缘进针0.5~1cm,回吸无血即可注药。
可用神经定位刺激器确定靶神经。

五、注意事项
1、可同时阻滞面神经出现霍纳氏综合征,无需特殊处理。
2、穿刺针尖位置较高时,可能同时阻滞副神经或迷走神经,致患者出现心动过速。
3、注射局麻药过量,可能同时阻滞舌下神经而出现一侧舌麻痹。
4、反复穿刺误伤颈内静脉发生血肿。

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