手術体位と呼吸器外科手術後の術側肩関節痛

術後肩関節痛を訴える症例について後方視的に検討した．対象は2017年1月1日より11月30日まで，側臥位で呼吸器手術を行った205例．未成年，再手術症例は除外した．年齢の中央値は71歳．男性136人，女性69人．60例を完全鏡視下，145例を小開胸で行った．肺葉切除以上が112例，以下が93例．完全鏡視下では患側上肢は挙上せず内転，小開胸では挙上外転した体位を取った．肩関節痛は39例で見られた．肩関節痛があった群はなかった群に比し，年齢，性別，手術時間，出血量で差がなかったが，完全鏡視下手術で有意に少なく，肺葉切除以上で有意に多かった．多変量解析では完全鏡視下手術のみが独立した因子であった．完...

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Published in日本呼吸器外科学会雑誌 Vol. 33; no. 2; pp. 102 - 106
Main Authors 矢田, 由美, 平井, 慶充, 西村, 好晴, 大橋, 拓矢, 川後, 光正, 房本, 安矢, 平井, 一成
Format Journal Article
LanguageJapanese
Published 特定非営利活動法人 日本呼吸器外科学会 15.03.2019
Subjects
完全鏡視下胸腔鏡手術
肩関節痛
術後疼痛
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ISSN0919-0945
1881-4158
DOI10.2995/jacsurg.33.102

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Abstract 術後肩関節痛を訴える症例について後方視的に検討した．対象は2017年1月1日より11月30日まで，側臥位で呼吸器手術を行った205例．未成年，再手術症例は除外した．年齢の中央値は71歳．男性136人，女性69人．60例を完全鏡視下，145例を小開胸で行った．肺葉切除以上が112例，以下が93例．完全鏡視下では患側上肢は挙上せず内転，小開胸では挙上外転した体位を取った．肩関節痛は39例で見られた．肩関節痛があった群はなかった群に比し，年齢，性別，手術時間，出血量で差がなかったが，完全鏡視下手術で有意に少なく，肺葉切除以上で有意に多かった．多変量解析では完全鏡視下手術のみが独立した因子であった．完全鏡視下手術では患側上肢は健側に沿わせ内転内旋させる．完全鏡視下手術例では60例中1例のみ軽い肩関節痛を訴えたのみであった．患側上肢を内転内旋する体位が術後肩関節痛の予防に有用であると考えられた．
AbstractList 術後肩関節痛を訴える症例について後方視的に検討した．対象は2017年1月1日より11月30日まで，側臥位で呼吸器手術を行った205例．未成年，再手術症例は除外した．年齢の中央値は71歳．男性136人，女性69人．60例を完全鏡視下，145例を小開胸で行った．肺葉切除以上が112例，以下が93例．完全鏡視下では患側上肢は挙上せず内転，小開胸では挙上外転した体位を取った．肩関節痛は39例で見られた．肩関節痛があった群はなかった群に比し，年齢，性別，手術時間，出血量で差がなかったが，完全鏡視下手術で有意に少なく，肺葉切除以上で有意に多かった．多変量解析では完全鏡視下手術のみが独立した因子であった．完全鏡視下手術では患側上肢は健側に沿わせ内転内旋させる．完全鏡視下手術例では60例中1例のみ軽い肩関節痛を訴えたのみであった．患側上肢を内転内旋する体位が術後肩関節痛の予防に有用であると考えられた．
Author 平井, 慶充
川後, 光正
矢田, 由美
西村, 好晴
平井, 一成
房本, 安矢
大橋, 拓矢
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References 1. Barak M, Ziser A, Katz Y. Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain. J Cardiothorac Vasc Anesth 2004; 18: 458-60.
2. Mac TB, Girard F, Chouinard P, Boudreault D, Lafontaine ER, Ruel M, et al. Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: A double-blind placebo-controlled study. J Cardiothorac Vasc Anesth 2005; 19: 475-8.
11. Misiołek H, Karpe J, Copik M, Marcinkowski A, Jastrzę-bska A, Szelka A, et al. Ipsilateral shoulder pain after thoracic surgery procedures under general and regional anesthesia - a retrospective observational study. Kardiochir Torakochirurgia Pol 2014; 11: 44-7.
5. Burgess FW, Anderson DM, Colonna D, Sborov M J, Cavanaugh DG. Ipsilateral shoulder pain following thoracic surgery. Anesthesiology 1993; 78: 365-8.
7. Danelli G, Berti M, Casati A, Bobbio A, Ghisi D, Mele R, et al. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine. Eur J Anaesthesiol 2007; 24: 596-601.
8. Mark JB, Brodsky JB. Ipsilateral shoulder pain following thoracic operations. Anesthesiology 1993; 79: 192-3.
9. Scawn ND, Pennefather SH, Soorae A, Wang JY, Russell GN. Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg 2001; 93: 260-4.
3. Pennefather SH, Akrofi ME, Kendall JB, Russell GN, Scawn ND. Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia. Br J Anaesth 2005; 94: 234-8.
4. Bunchungmongkol N, Pipanmekaporn T, Paiboonworachat S, Saeteng S, Tantraworasin A. Incidence and risk factors associated with ipsilateral shoulder pain after thoracic surgery. J Cardiothorac Vasc Anesth 2014; 28: 979-82.
6. Bamgbade OA, Dorje P, Adhikary GS. The dual etiology of ipsilateral shoulder pain after thoracic surgery. J Clin Anesth 2007; 19: 296-8.
10. Ohmori A, Iranami H, Fujii K, Yamazaki A, Doko Y. Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery. J Cardiothorac Vasc Anesth 2013; 27: 1310-4.
References_xml – reference: 9. Scawn ND, Pennefather SH, Soorae A, Wang JY, Russell GN. Ipsilateral shoulder pain after thoracotomy with epidural analgesia: the influence of phrenic nerve infiltration with lidocaine. Anesth Analg 2001; 93: 260-4.
– reference: 2. Mac TB, Girard F, Chouinard P, Boudreault D, Lafontaine ER, Ruel M, et al. Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia: A double-blind placebo-controlled study. J Cardiothorac Vasc Anesth 2005; 19: 475-8.
– reference: 7. Danelli G, Berti M, Casati A, Bobbio A, Ghisi D, Mele R, et al. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine. Eur J Anaesthesiol 2007; 24: 596-601.
– reference: 1. Barak M, Ziser A, Katz Y. Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain. J Cardiothorac Vasc Anesth 2004; 18: 458-60.
– reference: 3. Pennefather SH, Akrofi ME, Kendall JB, Russell GN, Scawn ND. Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia. Br J Anaesth 2005; 94: 234-8.
– reference: 5. Burgess FW, Anderson DM, Colonna D, Sborov M J, Cavanaugh DG. Ipsilateral shoulder pain following thoracic surgery. Anesthesiology 1993; 78: 365-8.
– reference: 6. Bamgbade OA, Dorje P, Adhikary GS. The dual etiology of ipsilateral shoulder pain after thoracic surgery. J Clin Anesth 2007; 19: 296-8.
– reference: 10. Ohmori A, Iranami H, Fujii K, Yamazaki A, Doko Y. Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery. J Cardiothorac Vasc Anesth 2013; 27: 1310-4.
– reference: 4. Bunchungmongkol N, Pipanmekaporn T, Paiboonworachat S, Saeteng S, Tantraworasin A. Incidence and risk factors associated with ipsilateral shoulder pain after thoracic surgery. J Cardiothorac Vasc Anesth 2014; 28: 979-82.
– reference: 8. Mark JB, Brodsky JB. Ipsilateral shoulder pain following thoracic operations. Anesthesiology 1993; 79: 192-3.
– reference: 11. Misiołek H, Karpe J, Copik M, Marcinkowski A, Jastrzę-bska A, Szelka A, et al. Ipsilateral shoulder pain after thoracic surgery procedures under general and regional anesthesia - a retrospective observational study. Kardiochir Torakochirurgia Pol 2014; 11: 44-7.
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Snippet 術後肩関節痛を訴える症例について後方視的に検討した．対象は2017年1月1日より11月30日まで，側臥位で呼吸器手術を行った205例．未成年，再手術症例は除外した．年齢の中...
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SubjectTerms 完全鏡視下胸腔鏡手術
肩関節痛
術後疼痛
Title 手術体位と呼吸器外科手術後の術側肩関節痛
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