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周術期の主な鎮痛方法は,周術期抗血栓療法や手術の低侵襲化,オピオイドの副作用により硬膜外麻酔主体からオピオイド主体,そして区域麻酔を含んだ「多角的疼痛管理multimodal analgesia」へ変遷を遂げている。超音波ガイド下末梢神経ブロックでは,「より末梢(選択的)」または「コンパートメントブロック(またはinterfascial plane block)」がトレンドであり,日進月歩の飛躍を遂げている。
(超音波)解剖学,局所麻酔薬の特性,合併症についての知識が必要であるが,その知識をもとに術式,患者の状態も考慮して,適切な周術期鎮痛を提供できるようにすることが大切である。
The main approach to perioperative analgesia has shifted from epidural analgesia to opioid-based analgesia and then to ‘multimodal analgesia' including peripheral nerve blocks due to the use of perioperative antithrombotic therapy, minimally invasive surgery and side effects of opioids. The trend in ultrasound-guided peripheral nerve blocks is toward ‘more peripheral (selective)' or ‘compartmental blocks' (or interfascial plane blocks), which are making rapid progress. It is very important to provide appropriate perioperative analgesia based on a knowledge of anatomy, local anesthetic properties and complications, taking into account the surgical procedure and the condition of each patient. This review explains the concepts of recently developed nerve blocks, organizes the names, and accompanies them with new findings along with a basic explanation of each nerve block.
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