腹腔鏡下胆囊摘出術後の鎮痛効果の後ろ向き比較検討：modified thoracoabdominal nerves block through perichondrial approach施行群と肋骨弓下腹横筋膜面ブロック併用右腹直筋鞘ブロック施行群

Evaluation of the Postoperative Analgesic Effects of Blocks for Laparoscopic Cholecystectomy：Modified Thoracoabdominal Nerves Block through Perichondrial Approach and the Combined Use of Right Rectus Sheath Block and Subcostal Transversus Abdominis Plane Block

要旨

　腹腔鏡下胆囊摘出術において，modified thoracoabdominal nerves block through perichondrial approach（M-TAPA）施行群と，肋骨弓下腹横筋膜面ブロック併用右腹直筋鞘ブロックの施行群とで術後鎮痛効果を後ろ向きに比較検討した。M-TAPA施行群で術後のnumerical rating scale（NRS）スコアが有意に低下した。

　Background：Various trunk blocks have been performed for postoperative pain after laparoscopic cholecystectomy（LC）, and their effects have been reported. We also reported that the combined use of bilateral rectus sheath block（RSB）and a subcostal transversus abdominis plane block（STAPB）had a better postoperative analgesic effect. In recent years, modified thoracoabdominal nerves block through perichondrial approach（M-TAPA）has been reported, and it has been reported that a wide range of long-term analgesic effects may be obtained. So, we retrospectively examined the effect of M-TAPA and STAP plus right RSB on pain management after LC.

　Methods：We administered anesthesia in two groups of patients：Group M-TAPA received ultrasound-guided M-TAPA（n＝42）and Group STAP received STAPB and right RSB（n＝47）. Patients used a numerical rating scale（NRS）to record postoperative pain levels. We compared the scores of the groups at 2, 6, 12, and 24 hours after returning to the ward.

　Results：NRS significantly decreased pain in Group M-TAPA compared with Group STAP after 6 and 12 hours.

　Conclusions：M-TAPA effectively controlled pain after LC and lowered NRS scores in this study.