Nagata Jun, Watanabe Jun, Sawatsubashi Yusuke, Akiyama Masaki, Arase Koichi, Minagawa Noritaka, Torigoe Takayuki, Hamada Kotaro, Nakayama Yoshifumi, Hirata Keiji
Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Fukuoka 808-0024, Japan.
Department of Surgery, Yokosuka Kyosai Hospital, Kanagawa 238-0011, Japan.
World J Gastrointest Surg. 2017 Aug 27;9(8):182-185. doi: 10.4240/wjgs.v9.i8.182.
A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twenty-four hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.
本文介绍了一名62岁因巨大直肠癌导致急性直肠梗阻的男性患者。他接受了急诊腹腔镜结肠造口术。我们采用新型经腹膜途径，使用腹腔镜穿刺针注射镇痛剂。在此过程中，超声和腹腔镜图像辅助将镇痛剂准确注射到正确层次。腹腔镜可视化和超声成像相结合，确保镇痛剂渗透到正确层次，同时不会对肠道造成损伤。术后24小时，通过数字评分量表评估，患者咳嗽时疼痛强度为0至1，无需持续静脉镇痛。结肠梗阻时通常需要进行结肠造口术。有凝血功能障碍的患者不能使用硬膜外麻醉进行术后镇痛。我们报告了一种用于结肠造口术的新型腹腔镜腹直肌鞘阻滞方法。目前尚无关于经腹膜途径神经阻滞的文献报道。腹腔镜腹直肌鞘阻滞操作安全，对术后疼痛有足够的镇痛效果。该技术可被视为急性情况下的一种可选麻醉方案。
