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帝王切開術における硬膜外開始量の違いが術後鎮痛に及ぼす影響
Effects of different epidural initiation volumes on postoperative analgesia in cesarean section.
PMID: 32682357 DOI: 10.3906/sag-1905-44.
抄録
BBBackgrounds.本研究の目的は、帝王切開後の術後疼痛に対して硬膜外鎮痛薬（PCEA）を投与された妊婦において、硬膜外開始量の違いが術後疼痛スコア、鎮痛要求量、副作用に及ぼす影響を比較することであった。
BBackgrounds: The aim of this study was to compare the effects of different epidural initiation volumes on the postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections.
材料と方法:
この無作為化二重盲検試験には、18～45歳の妊婦81名が参加した。帝王切開の際には硬膜外麻酔を併用した。患者を3群に分け、硬膜外カテーテルを介した脊髄ブロックの90分後に試験薬（0.0625％ブピバカイン＋フェンタニル2 ?g/ml）を異なる量（20ml、10ml、5ml）で投与した。安静時および運動時の視覚アナログスケール（VAS）スコア、初回PCEA投与時間、1時間あたりに必要なPCEA投与回数、総鎮痛薬消費量および副作用を術後に記録した。
MATERIALS AND METHODS: Eighty-one pregnant women, aged 18-45 years old, were included in this randomized, double-blinded study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into three groups and different volumes (20 ml, 10 ml, and 5 ml) of study drug (0.0625% bupivacaine plus 2 ?g/ml of fentanyl) were administered ninety minutes after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed and side effects were recorded postoperatively.
結果:
VAS安静時スコアとVAS運動スコアには統計的に有意な差はなかった。最初の鎮痛剤の必要量までの時間は、10群と20群で5群に比べて長く、最初の2時間の鎮痛剤の必要量は20群で他の群に比べて少なかった。
RESULTS: There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 hours was lower in Group 20 than in the other groups.
結論:
異なる量のPCEAを開始しても、同様の疼痛スコアが得られた。しかし、20mlの容量では、術後初期の鎮痛剤の必要量が少なくなり、鎮痛の必要性を遅らせることができた。
CONCLUSIONS: The PCEA initiations with different volumes provided similar pain scores. However, the 20 ml volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.