婦人科腹腔鏡下手術の術後鎮痛における体幹神経ブロックの有用性

抄録

Objective: Laparoscopic gynecological surgeries are widely used in the treatment of uterine and ovarian diseases and has advantages in terms of postoperative early recovery and cosmetic sequelae over open abdominal surgery. However, postoperative pain is significant. We evaluated the efficacy of ultrasound-guided truncal peripheral nerve block, including rectus sheath and transversus abdominis block.

Methods: Two hundred and ninety-six patients who underwent laparoscopic gynecological surgeries for uterine and ovarian diseases at our institution from January 2012 to August 2014 were identified from the medical records and evaluated in a retrospective manner. The patients in group A received rectus sheath and transversus abdominis block combined with general anesthesia and those in group B received general anesthesia alone. The factors measured after surgery included the postoperative demand for postoperative additional analgesia and antiemetics.

Results: Postoperative demand for analgesics during the postoperative 48 hours was significantly decreased in group A (group A versus B: 1 versus 3; p<0.001) and for antiemetics was also statistically decreased in group A (13.3% versus 24.8%; p=0.01). The second analysis of the demand for postoperative analgesics for each surgery type (laparoscopic hysterectomy, ovarian surgery, and myomectomy) was also significantly decreased in group A. However, the demand for antiemetics was only statistically lower for laparoscopic ovarian surgeries when analyzing by surgery type.

Conclusion: Truncal peripheral nerve block in laparoscopic gynecological surgery is effective in reducing postoperative analgesia demand and preventing nausea and vomiting than general anesthesia alone. However, changes in the demand for antiemetics depends on surgery type.