Matsui K, Yoshida M, Maemura Y, Ichihara Y, Yamagami M, Kikuchi H
Kouseikai Sagamidai Hospital, Zama.
Masui. 1994 Nov;43(11):1718-21.
The significance of phrenic nerve block was studied in the anesthetic management of laparoscopic cholecystectomy. Right phrenic nerve block with 1% mepivacaine 10 ml was performed after the patients were epidurally catheterized and anesthetized with isoflurane and nitrous oxide in oxygen. Intraoperative anesthetic requirement and postoperative shoulder pain incidence in patients with this block were compared with those in patients without block. Addition of the phrenic nerve block to general and epidural anesthesia did not reduce the intraoperative dosage of isoflurane, but it significantly prevented occurrence of postoperative right shoulder pain. It is known that phrenic nerve contains sensory element and that laparoscopic procedures of gall bladder elicit noxious stimuli which cannot be blocked by ordinary epidural anesthesia for abdominal surgery. Also, shoulder pain is said to be phrenic nerve-mediated referred pain. Our study suggests that blockade of these stimuli is effective in preventing postoperative event rather than intraoperative.
在腹腔镜胆囊切除术的麻醉管理中，研究了膈神经阻滞的意义。在患者进行硬膜外导管置入并用异氟烷和笑气-氧气混合气体麻醉后，用10毫升1%的甲哌卡因进行右侧膈神经阻滞。将接受这种阻滞的患者的术中麻醉需求和术后肩部疼痛发生率与未接受阻滞的患者进行比较。在全身麻醉和硬膜外麻醉中加入膈神经阻滞并没有减少异氟烷的术中用量，但它显著预防了术后右肩部疼痛的发生。已知膈神经含有感觉神经成分，并且胆囊的腹腔镜手术会引发有害刺激，而普通的腹部手术硬膜外麻醉无法阻断这些刺激。此外，据说肩部疼痛是由膈神经介导的牵涉痛。我们的研究表明，阻断这些刺激对预防术后事件有效，而非对术中事件有效。
