抗凝固療法下の術後疼痛管理：下肢手術
下肢関節手術の主な目的は，疼痛緩和と運動機能回復や生活の質の向上である．しかし，手術自体が激しい術後痛を伴い，これが術後合併症や慢性痛を引き起こす可能性がある．したがって，手術の成果を向上させるためには，適切な術後鎮痛と早期からの理学療法の実施が重要となる．従来，術後鎮痛法として代表的であった硬膜外鎮痛法は，近年周術期の抗凝固療法の機会増加に伴い，制限されることが多くなった．代わって，末梢神経ブロックを中心とした多様式鎮痛法を用いた積極的な周術期疼痛管理が求められている．...
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| Published in | 日本臨床麻酔学会誌 Vol. 31; no. 5; pp. 841 - 845 |
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| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2011
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.31.841 |
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| Abstract | 下肢関節手術の主な目的は，疼痛緩和と運動機能回復や生活の質の向上である．しかし，手術自体が激しい術後痛を伴い，これが術後合併症や慢性痛を引き起こす可能性がある．したがって，手術の成果を向上させるためには，適切な術後鎮痛と早期からの理学療法の実施が重要となる．従来，術後鎮痛法として代表的であった硬膜外鎮痛法は，近年周術期の抗凝固療法の機会増加に伴い，制限されることが多くなった．代わって，末梢神経ブロックを中心とした多様式鎮痛法を用いた積極的な周術期疼痛管理が求められている． |
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| AbstractList | 下肢関節手術の主な目的は，疼痛緩和と運動機能回復や生活の質の向上である．しかし，手術自体が激しい術後痛を伴い，これが術後合併症や慢性痛を引き起こす可能性がある．したがって，手術の成果を向上させるためには，適切な術後鎮痛と早期からの理学療法の実施が重要となる．従来，術後鎮痛法として代表的であった硬膜外鎮痛法は，近年周術期の抗凝固療法の機会増加に伴い，制限されることが多くなった．代わって，末梢神経ブロックを中心とした多様式鎮痛法を用いた積極的な周術期疼痛管理が求められている． 「要旨」 下肢関節手術の主な目的は, 疼痛緩和と運動機能回復や生活の質の向上である. しかし, 手術自体が激しい術後痛を伴い, これが術後合併症や慢性痛を引き起こす可能性がある. したがって, 手術の成果を向上させるためには, 適切な術後鎮痛と早期からの理学療法の実施が重要となる. 従来, 術後鎮痛法として代表的であった硬膜外鎮痛法は, 近年周術期の抗凝固療法の機会増加に伴い, 制限されることが多くなった. 代わって, 末梢神経ブロックを中心とした多様式鎮痛法を用いた積極的な周術期疼痛管理が求められている. 「はじめに」 下肢関節手術の主目的は, 運動機能の回復と疼痛の緩和である. しかし, 骨折したり機能しにくくなった骨や関節をただ人工物で置き換えるだけでは, その機能を正常化させたり疼痛を除去することはできない1)～3). 手術結果の向上のためには, 術後早期離床と早期リハビリテーションによる関節運動の改善, さらには早期回復, 早期退院, 最終的には日常生活および社会生活への早期復帰が目標として定められるべきである4), 5). |
| Author | 佐倉, 伸一 |
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| References | 5) Shoji H, Solomonow M, Yoshino S, et al.: Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 13: 643-649, 1990 7) Perkins FM, Kehlet H: Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93: 1123-1133, 2000 14) Bickler P, Brandes J, Lee M, et al.: Bleeding complications from femoral and sciatic nerve catheters in patients receiving low molecular weight heparin. Anesth Analg 103: 1036-1037, 2006 9) Auroy Y, Narchi P, Messiah A, et al.: Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 87: 479-486, 1997 12) Pham Dang C, Gautheron E, Guilley J, et al.: The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med 30: 128-133, 2005 2) Walsh M, Woodhouse LJ, Thomas SG, et al.: Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther 78: 248-258, 1998 3) Murray DW, Frost SJ: Pain in the assessment of total knee replacement. J Bone Joint Surg Br 80: 426-431, 1998 1) March LM, Cross MJ, Lapsley H, et al.: Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Med J Aust 171: 235-238, 1999 6) Ilfeld BM, Meyer, RS, Le LT, et al.: Health-related quality of life after tricompartment knee arthroplasty with and without an extended-duration continuous femoral nerve block: a prospective, 1-year follow-up of a randomized, triple-masked, placebo-controlled study. Anesth Analg 108: 1320-1325, 2009 8) Hebl JR, Kopp SL, Ali MH, et al.: A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 87A: 63-70, 2005 10) Swenson JD, Bay N, Loose E, et al.: Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients. Anesth Analg 103: 1436-1443, 2006 11) McNamee DA, Parks L, Milligan KR: Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand 46: 95-99, 2002 4) Ryu J, Saito S, Yamamoto K, et al.: Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 53: 35-40, 1993 13) Kandasami M, Kinninmonth AW, Sarungi M, et al.: Femoral nerve block for total knee replacement - a word of caution. Knee 16: 98-100, 2009 |
| References_xml | – reference: 1) March LM, Cross MJ, Lapsley H, et al.: Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Med J Aust 171: 235-238, 1999 – reference: 6) Ilfeld BM, Meyer, RS, Le LT, et al.: Health-related quality of life after tricompartment knee arthroplasty with and without an extended-duration continuous femoral nerve block: a prospective, 1-year follow-up of a randomized, triple-masked, placebo-controlled study. Anesth Analg 108: 1320-1325, 2009 – reference: 3) Murray DW, Frost SJ: Pain in the assessment of total knee replacement. J Bone Joint Surg Br 80: 426-431, 1998 – reference: 10) Swenson JD, Bay N, Loose E, et al.: Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients. Anesth Analg 103: 1436-1443, 2006 – reference: 8) Hebl JR, Kopp SL, Ali MH, et al.: A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 87A: 63-70, 2005 – reference: 5) Shoji H, Solomonow M, Yoshino S, et al.: Factors affecting postoperative flexion in total knee arthroplasty. Orthopedics 13: 643-649, 1990 – reference: 9) Auroy Y, Narchi P, Messiah A, et al.: Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 87: 479-486, 1997 – reference: 12) Pham Dang C, Gautheron E, Guilley J, et al.: The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med 30: 128-133, 2005 – reference: 13) Kandasami M, Kinninmonth AW, Sarungi M, et al.: Femoral nerve block for total knee replacement - a word of caution. Knee 16: 98-100, 2009 – reference: 4) Ryu J, Saito S, Yamamoto K, et al.: Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 53: 35-40, 1993 – reference: 2) Walsh M, Woodhouse LJ, Thomas SG, et al.: Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther 78: 248-258, 1998 – reference: 11) McNamee DA, Parks L, Milligan KR: Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block. Acta Anaesthesiol Scand 46: 95-99, 2002 – reference: 14) Bickler P, Brandes J, Lee M, et al.: Bleeding complications from femoral and sciatic nerve catheters in patients receiving low molecular weight heparin. Anesth Analg 103: 1036-1037, 2006 – reference: 7) Perkins FM, Kehlet H: Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93: 1123-1133, 2000 |
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| Snippet | ... 「要旨」 下肢関節手術の主な目的は, 疼痛緩和と運動機能回復や生活の質の向上である. しかし, 手術自体が激しい術後痛を伴い, これが術後合併症や慢性痛を引き起こす可能性がある. したがって, 手術の成果を向上させるためには, 適切な術後鎮痛と早期からの理学療法の実施が重要となる. 従来,... |
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| SubjectTerms | 下肢手術 人工膝関節置換術 多様式鎮痛法 大腿骨頭置換術 術後疼痛 |
| Title | 抗凝固療法下の術後疼痛管理：下肢手術 |
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