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Volume 74, Issue 2 （February 2025）

麻酔 74巻2号（2025年2月発行）

Japanese English

症例集積研究

周術期管理チームの介入による低侵襲呼吸器外科手術での硬膜外鎮痛の要否の検討 An Evaluation of the Necessity of Epidural Analgesia during Minimally Invasive Respiratory Surgery through Intervention by the Perioperative Pain Management Team 乕田凪穂 ¹ , 山本俊介 ¹ , 林純子 ² , 久利通興 ¹ , 井口和江 ² , 藤野裕士 ¹ Nagiho TORADA ¹ , Shunsuke YAMAMOTO ¹ , Junko HAYASHI ² , Michioki KURI ¹ , Kazue IGUCHI ² , Yuji FUJINO ¹ ¹大阪大学大学院医学系研究科生体統御医学講座麻酔集中治療医学教室 ²大阪大学医学部附属病院看護部 ¹Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine ²Nursing Division of Osaka University Hospital キーワード：低侵襲呼吸器外科手術 , 術後疼痛 , 硬膜外鎮痛 , 神経ブロック Keyword: minimally invasive respiratory surgery , postoperative pain , epidural analgesia , nerve block pp.74-79

発行日 2025年2月10日 Published Date 2025/2/10

DOI https://doi.org/10.18916/masui.2025020005

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要旨

　2023年度より低侵襲呼吸器外科手術で周術期管理チームが術後疼痛管理に介入し，硬膜外鎮痛ではなく経静脈的自己調節鎮痛法（intravenous patient-controlled analgesia：IV-PCA）・神経ブロックの併用で管理が行われるようになった。硬膜外鎮痛の有無による疼痛の差を，106症例を対象に術後（postoperative day：POD）3日間の安静/運動時痛を疼痛スケール（numerical rating scale：NRS）で評価した。安静時POD0NRS（P＝0.00172），運動時POD1NRS（P＝0.025）で有意差を認めたのみで同等の鎮痛管理が可能であった。

　Background：Our hospital’s perioperative management team has become actively involved in postoperative pain management for patients who have undergone respiratory surgery. We investigated whether there was a difference in postoperative pain between the use and nonuse of epidural analgesia in minimally invasive respiratory surgery.

　Methods：We compared pain at rest and pain during movement up to the 3rd postoperative day（POD）among patients in whom epidural analgesia was used/not used during minimally invasive respiratory surgery for lung cancer and thymoma.

　Results：Each group was comprised of 106 adult patients. There were 52 males and 54 females in the epidural group and 60 males and 46 females in the non-epidural group. The average of age was 66, in whichever case. Operative duration was 169 minutes in the epidural group and 156 minutes in the non-epidural group. No significant differences was observed at these sections. The self-reported numerical rating scale（NRS）pain values at rest from the non-epidural patients on POD0 were significantly higher than the epidural group’s values, with median（25th-75th percentiles）：NRS 3（2-6） vs. NRS 3 points（1-5）, respectively；p＝0.00172. In contrast, the NRS pain values during movement on POD1 were significantly higher in the non-epidural group compared to the epidural group：NRS 5（3-7） vs. NRS 4 points（3-6, respectively；p＝0.025. However, at other evaluation timepoints there were no significant between-group differences in rest pain, pain during movement.

　Conclusions：In minimally invasive respiratory surgery, good postoperative analgesia can be achieved without the use of epidural analgesia.