慢性呼吸不全患者の腹部大動脈瘤に対するステントグラフト内挿術において下肢末梢神経ブロックを用いた1症例

Endovascular Abdominal Aortic Aneurysm Repair Using a Lower-Extremity Peripheral Nerve Block in a Patient with Chronic Respiratory Failure

要旨

　腹部大動脈瘤に対するステントグラフト内挿術（endovascular aneurysm repair：EVAR）では，皮膚切開部の疼痛に加え，下肢血流遮断による虚血性疼痛への対応が求められる。慢性呼吸不全を有し，かつ抗血小板薬内服中であった症例に対し，鎮静と下肢末梢神経ブロックを併用した麻酔管理を行い，EVARを施行しえた。

　Performing an endovascular aneurysm repair（EVAR）for an abdominal aortic aneurysm requires the effective management of both pain from the surgical incision and ischemic pain resulting from the temporary occlusion of the lower-limb blood flow during the sheath’s insertion. We report the case details of a successful EVAR performed under a combination of sedation and peripheral nerve blocks of the lower extremities in a 72-year-old male patient with severe chronic respiratory failure due to a remote smoking history and who was also receiving antiplatelet therapy. This anesthetic strategy enabled us to avoid the risks that are associated with general and neuraxial anesthesia, and it may serve as a useful alternative in high-risk patients.