腰椎椎間板ヘルニアに対する持続硬膜外ブロックの経験

Continuous Epidural Block for Lumber Disc Herniation

　入院のうえ保存的加療を行った腰椎椎間板ヘルニア患者44例を，選択的神経根ブロック施行後に腰部持続硬膜外ブロックを行った21例（Epi群）と，選択的神経根ブロック後に理学療法を行った23例（非Epi群）に分け，腰部持続硬膜外ブロックの有用性を比較検討した．入院後4カ月でEpi群は81％，非Epi群は60％が手術を回避できた．特に非Epi群では1カ月以内の手術例が多く，急性期疼痛管理が重要と考えられた．持続硬膜外ブロックは，疼痛管理にすぐれ，急性期疼痛に対して有効な治療法の1つと考えられた．

　We analyzed the effect of a continuous epidural block in 21 patients with lumbar disc herniation who had undergone a selective nerve root block (Epi group) and compared the results with those of 23 patients who underwent rehabilitation after undergoing a selective nerve root block (non-Epi group). Seventeen (81％) of the patients in the Epi group and 14 (60％) of the patients in the non-Epi group did not have to undergo surgery within a 4-month post-admission period. Since most of the patients in the non-Epi group who underwent surgery did so one month after admission, the control of acute pain appears to be important. Thus, the application of a continuous epidural block appears to be useful for pain control because of lumbar disc hernation.