一名患有术后腹直肌鞘血肿患者的连续腹直肌鞘阻滞：病例报告
Continuous rectus sheath block in a patient with a postoperative rectus sheath hematoma: a case report.
作者信息
Kumita Sho, Tachibana Shunsuke, Ichimiya Takahiro, Yamakage Michiaki
机构信息
Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 13, Chuo-Ku, Sapporo, Hokkaido, 090-8666, Japan.
Department of Anesthesia, Asahikawa City Hospital, 1-1-65 Kinseicho, Asahikawa, Hokkaido, 070-8610, Japan.
出版信息
JA Clin Rep. 2019 Mar 2;5(1):16. doi: 10.1186/s40981-019-0236-z.
BACKGROUND
Severe abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient's activities of daily living. A case of postoperative RSH for which a continuous rectus sheath block (RSB) was effective is reported.
CASE PRESENTATION
A 62-year-old woman who had no previous medical history underwent hysterectomy, total cystectomy, and ileal conduit surgery for bladder cancer under epidural and general anesthesia. She complained of severe abdominal pain 40 min after removal of the epidural catheter on postoperative day (POD) 4. Computed tomography showed an RSH on POD 12. For pain relief, an ultrasound-guided continuous RSB was performed on POD 17. After the block, the numerical rating scale (NRS) score during movement decreased immediately (from 10 to 2 or 3), and she had no further need for oral or intravenous analgesics. She was discharged from the hospital without any complications on POD 28.
CONCLUSIONS
Continuous RSB can be an effective technique for pain relief of postoperative RSH.
背景
腹直肌鞘血肿（RSH）引起的严重腹痛会降低患者的日常生活活动能力。本文报告了一例术后腹直肌鞘血肿，连续腹直肌鞘阻滞（RSB）对其有效。
病例介绍
一名62岁无既往病史的女性，在硬膜外麻醉和全身麻醉下接受了子宫切除术、全膀胱切除术及膀胱癌回肠代膀胱术。术后第4天拔除硬膜外导管40分钟后，她主诉严重腹痛。术后第12天计算机断层扫描显示存在腹直肌鞘血肿。为缓解疼痛，在术后第17天进行了超声引导下连续腹直肌鞘阻滞。阻滞术后，活动期间的数字评定量表（NRS）评分立即下降（从10降至2或3），且她不再需要口服或静脉注射镇痛药。她于术后第28天无任何并发症出院。
结论
连续腹直肌鞘阻滞可以是缓解术后腹直肌鞘血肿疼痛的有效技术。
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