人工股関節全置換術における簡便で効果的な周術期疼痛管理プロトコールの検討

Efficacy of Intrathecal Morphine and Nonsteroid Anti-Inflammatory Drugs for Perioperative Pain Management in Total Hip Arthroplasty

　初回人工関節置換術（THA）35例に0.1mgモルヒネを加えた脊椎麻酔で手術を施行し，12時間は除痛効果のあるこのくも膜下モルヒネと術翌日からCox-2阻害剤の定期的内服を組み合わせた疼痛管理プロトコールを用いて，術後の疼痛，早期歩行の達成を評価した．術当日はくも膜下モルヒネの効果で全例疼痛はなく，術翌日には71％の患者が歩行可能となった．その後も歩行に支障のない範囲の動作時痛で経過し，術後20日以内で88％の患者が杖歩行50m以上可能であった．このプロトコールはTHA後の除痛，早期リハビリテーションに有用であった．

　Intrathecal morphine provides excellent postoperative pain management. The objective of this study was to evaluate the efficacy of an pain management protocol that includes intrathecal morphine in terms of pain relief and the duration of rehabilitation after total hip arthroplasty. Spinal anesthesia with 100mg dose of a morphine was used to perform primary total hip arthroplasty in 35 patients, and they received a COX-2 inhibitor daily starting on postoperative day (POD) 1. This protocol provided effective pain relief in the first 12 hours after surgery. On postoperative day (POD) 1, 71％ of the patients were able to walk, and 88％ of the patients could walk more than 50m by POD 19. Thus, the pain management protocol that included intrathecal morphine provided efficacious analgesia and enabled more rapid rehabilitation of patients who underwent total hip arthroplasty.