小児腹腔鏡下鼠径ヘルニア修復術において筋弛緩薬非使用の全身麻酔に併施する硬膜外麻酔と腹直筋鞘ブロックが手術視野に与える影響―後ろ向き研究―

Comparison of Surgical Visual Field of Epidural Anesthesia and Rectus Sheath Block in Pediatric Laparoscopic Percutaneous Extraperitoneal Closure Combined with General Anesthesia without Muscle Relaxants：A Retrospective Analysis

要旨

　小児の腹腔鏡下鼠径ヘルニア修復術において，筋弛緩薬を使用しない全身麻酔に併施する硬膜外麻酔（epidural anesthesia：EPI）および腹直筋鞘ブロック（rectus sheath block：RSB）が術中の視野に与える影響を後ろ向きに比較検討した。EPI群はRSB群より気腹中の視野スコアが有意に良好で，気腹時間が有意に短かった。

　Background：Brief laparoscopic procedures can be performed without muscle relaxation in some pediatric surgeries, but we have found no published studies comparing the effects of epidural anesthesia（EPI）and rectus sheath block（RSB）on the surgical visual field under these conditions.

　Methods：We retrospectively analyzed and compared the effects of EPI and RSB on the surgical visual field during pneumoperitoneum and the duration of pneumoperitoneum time in pediatric patients who underwent a laparoscopic percutaneous extraperitoneal closure（LPEC）under general anesthesia without the use of a muscle relaxant.

　Results：The EPI group（n＝15）had significantly better visual field scores during pneumoperitoneum compared to the RSB group（n＝15）, and the duration of pneumoperitoneum was significantly shorter in the EPI group.

　Conclusions：In cases of muscle relaxant-free general anesthesia for LPEC in children, the cases in which EPI was used had significantly better surgical visual fields and shorter pneumoperitoneum times compared to the cases in which RSB was used.