Ohgoshi Yuichi, Ando Aki, Aikawa Katsuhiro, Kawagoe Izumi
Department of Anesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan.
Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan.
J Anesth. 2025 Jul 22. doi: 10.1007/s00540-025-03560-4.
We previously reported that administering local anesthetic into the space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess (SEDIC) at the 10th intercostal space via the re-modified thoracoabdominal nerves block through the perichondrial approach (RM-TAPA) effectively anesthetizes the lower abdomen (T9-T12). However, the analgesic area obtained by RM-TAPA was distinct from prior reports of M-TAPA, which achieved broader analgesic effects from T4 to L1. The aim of this study was to verify the range of analgesic effects when local anesthetics are administered into the SEDIC at the 9th intercostal space, which was estimated to be close to the needle tip of the M-TAPA, in ten healthy volunteers. Each volunteer received 20 mL of 0.2% ropivacaine into the SEDIC at the 9th intercostal space, and sensory blockade was assessed 1 h post-injection using a pinprick test. RM-TAPA performed at the 9th intercostal space provided adequate analgesia from T6 to T10. The analgesic effect on the lateral cutaneous branches was more pronounced on the right side than on the left. These findings imply that optimizing needle position and injection site in RM-TAPA, tailored to specific surgical needs, represents a refinement in perioperative pain management strategies.
我们之前报道过，通过改良的经软骨膜途径胸腹神经阻滞（RM-TAPA）在第10肋间间隙将局部麻醉药注入胸内筋膜、膈肌和肋膈隐窝之间的间隙（SEDIC），可有效麻醉下腹部（T9-T12）。然而，RM-TAPA获得的镇痛区域与之前报道的M-TAPA不同，M-TAPA可从T4至L1产生更广泛的镇痛效果。本研究的目的是在10名健康志愿者中验证在第9肋间间隙的SEDIC中注入局部麻醉药时的镇痛效果范围，该间隙估计接近M-TAPA的针尖位置。每位志愿者在第9肋间间隙的SEDIC中接受20 mL 0.2%的罗哌卡因，并在注射后1小时使用针刺试验评估感觉阻滞情况。在第9肋间间隙进行的RM-TAPA可提供从T6至T10的充分镇痛。对外侧皮支的镇痛效果在右侧比左侧更明显。这些发现表明，根据特定手术需求优化RM-TAPA中的针位置和注射部位，是围手术期疼痛管理策略的一项改进。
