大腿骨近位部骨折に対する超音波ガイド下大腿神経・大腿外側皮神経ブロックの有効性と問題点

Useufulness of Ultrasound-guided Femoral Nerve Block and Lateral Femoral Cutaneous Nerve Block for Patients with a Proximal Femoral Fracture

　大腿骨近位部骨折に対してHansson pin，SHS(sliding hip screw)を施行した11例に，超音波ガイド下大腿神経・大腿外側皮神経ブロックを施行し，3例では本ブロック単独での手術が可能であった．残りの8例では，追加の麻酔を要したため，本ブロック単独では手術を行うことは困難であると考えた．しかし，手術台への移動や，股関節屈曲，外転での鎮痛が得られたことを考えると，本ブロックが，側臥位をとる脊椎くも膜下麻酔に対する補助麻酔として有用になる可能性が示唆された．

　The purpose of this study was to assess the usefulness of ultrasound-guided femoral nerve block and lateral femoral cutaneous nerve block during surgery for patients with a proximal femoral fracture.

　We evaluated its usefulness in 11 patients who underwent Hansson pin or sliding hip screw surgery.　In three cases surgery was completed without any additional form of anesthesia, but in the other eight cases general anesthesia and administration of sedatives or analgesics was necessary.

　The results showed that femoral nerve block is not always sufficient to control pain during surgery to treat proximal hip fractures.　The results suggested that this block may be a useful adjunct to lumbar anesthesia, because it controlled pain during patient transfer to the operating table and positioning during hip flexion and abduction.