重症大動脈弁狭窄症を有する高齢者の人工骨頭置換術の周術期管理に対する低用量の脊髄くも膜下麻酔とPENGブロックの併用経験

Combination of Subarachnoid Block with a Low Dose of Bupivacaine and Peripheral Nerve Block for a Hip Hemiarthroplasty in a Patient with Severe Aortic Stenosis

要旨

　91歳の女性に左股関節の人工骨頭置換術を行った。心不全の既往があり，大動脈弁口面積が0.47cm²であった。麻酔管理は，0.5％等比重ブピバカイン5mgとフェンタニル15μgでの脊髄くも膜下麻酔でT12の麻酔域を得て，末梢神経ブロックを併用して行った。術中の循環動態は安定し良好な転帰を得た。

　We describe the case of a 91-year-old woman with severe aortic stenosis who underwent a left hip hemiarthroplasty. The preoperative ultrasound imaging revealed an aortic valve area at 0.46 cm², peak velocity at 4.76 m・sec^－1, and mean pressure gradient at 56 mmHg. The combination of a subarachnoid block and peripheral nerve block was thus performed for the hemiarthroplasty. The subarachnoid block was performed with bupivacaine（5 mg）and fentanyl（5 μg）, and analgesia below T12 was obtained. The peripheral nerve block with 20 ml of 0.375％ ropivacaine was as follows：a pericapsular nerve group（PENG）block（total of 14 ml）followed by a further 6 ml of a lateral femoral cutaneous nerve block. During the surgery, continuous and intermittent intravenous phenyrephrine was administered to maintain the patient’s hemodynamic state. The patient was discharged on the 10th postoperative day with no adverse events.