Iwata Masato, Kimoto Katsuhiro, Akasaki Yuka, Morioka Masayo, Nakayama Kana, Matsuzawa Nobuyoshi, Kuzumoto Naoya, Shimomura Toshiyuki
Masui. 2016 Sep;65(8):832-834.
We report a case in which unilateral thoracic para- vertebral block was used to effectively control pain in a 78-year-old male patient with Child's A liver cirrhosis and esophageal cancer. Epidural anesthesia was con- sidered risky in this case because of the low platelet count from cirrhosis. Therefore, we performed a unilat- eral thoracic paravertebral block and cannulation under general anesthesia. We administered 0.33% levobupi- vacaine 10 ml through the catheter for intraoperative analgesia. After the operation, we confirmed the place- ment of the catheter with a chest X-ray image : then, the patient was extubated and returned to the ward. Three hours after the operation, the patient com- plained of pain in his wound : hence, 0.33% levobupi- vacaine 5 ml was injected through the catheter, which effectively controlled pain for 10 hours. Further injec- tions were done 13 and 21 hours after the operation, and the catheter was removed 21 hours after the operation. While the catheter was in place, the patient scarcely complained of pain. The unilateral thoracic paravertebral block covered the wide range of wounds and provided good analgesia for the patient.
我们报告了一例使用单侧胸椎旁阻滞有效控制一名78岁患有Child A级肝硬化和食管癌男性患者疼痛的病例。由于肝硬化导致血小板计数低，该病例中硬膜外麻醉被认为具有风险。因此，我们在全身麻醉下进行了单侧胸椎旁阻滞和置管。我们通过导管注入0.33%左旋布比卡因10毫升用于术中镇痛。术后，我们通过胸部X光片确认了导管位置；然后，患者拔管并返回病房。术后三小时，患者主诉伤口疼痛；因此，通过导管注入0.33%左旋布比卡因5毫升，有效控制疼痛达10小时。术后13小时和21小时又进行了进一步注射，术后21小时拔除导管。在导管留置期间，患者几乎没有主诉疼痛。单侧胸椎旁阻滞覆盖了广泛的伤口范围，并为患者提供了良好的镇痛效果。
