肩腱板手術における頚部持続硬膜外カテーテルの至適高位の検討

抄録

The purpose of this study was to evaluate the optimal location of the continuous epidural catheters (CEC) for rotator cuff surgery. Forty shoulders of 39 patients, whose average age was 67 years old underwent rotator cuff repair, were inserted a radiopaque cervical CEC(17G, Hakko, Nagano, Japan) preoperatively and identified their location by X-rays. The regimen of the postoperative pain control was unified,2ml/hour of 1%mepivacaine was administrated into the epidural space and additional analgesic agents were adequately prescribed according to the patients' request. The patients grouped into two, one that the tip of the catheter was located above C4(“Cranial Group”, n=26) and below C4/5(“Caudal Group”, n=14). The patient's backgrounds of the two groups were not uneven. The cranial group was significantly better (p<0.01) on the visual/verbal analog pain scale at the time of return to the ward, of applying an abduction brace, of starting physiotherapy, and few requested additional analgesic agents, whereas no differences in the duration of bracing, incidence of CRPS/RSD, postoperative contracture, active elevation angle at discharge, and the Japan Orthopaedic Association(JOA) shoulder score 1-year after surgery. There were no complications related to epidural catheters. We recommend that the tip of the epidural catheter for rotator cuff surgery should locate cranial to C4, but care must be taken with regards to the complications related to the deep detention of the catheter.