ミニ骨切除術を含む大伏在静脈の静脈内ラジオ波焼灼術中と術後の局所留置型麻酔法と脊髄麻酔法を比較

Comparing local tumescent anesthesia and spinal anesthesia methods during and after endovenous radiofrequency ablation of vena saphena magna that includes mini-phlebectomy operations.

• Macit Bitargil
• Helin El Kilic

抄録

背景:

大伏在静脈の高周波焼灼術（RFA）では、局所麻酔または脊髄麻酔の方法を使用することができる。前述の2つの方法の副作用を比較対照することに関しては、文献にギャップがある。本研究では、大伏在静脈の高周波焼灼術（ミニ静脈切除術も含む）の際の脊髄麻酔法と局所麻酔法をレトロスペクティブに比較することを目的としている。

BACKGROUND: Local or spinal anesthesia methods can be used during radiofrequency ablation (RFA) of the great saphenous vein. There is a gap in the literature regarding comparing and contrasting the side effects of the mentioned two methods. This study aims to retrospectively compare the spinal anesthesia method with the local tumescent anesthesia method during RFA of the great saphenous vein that also includes mini-phlebectomy.

方法:

RFAとミニ血栓摘出術を受けた患者を麻酔の適用方法により2つのグループに分けてレトロスペクティブに解析した。第1群は脊椎麻酔とトュメセント麻酔を併用してRFA手術を行った患者であり，第2群は局所トュメセント麻酔で同様の処置を行った患者であった．疼痛スコア、麻酔準備間隔の時間長と手術時間、頭痛、悪心嘔吐、尿閉などの麻酔関連副作用、QOLスコア、術後閉塞率、静脈炎、深部静脈血栓症（DVT）などの介入に関連した合併症をMann Whitney U、Wilcoxon、Chi-Square検定で分析し、比較した。

METHODS: We retrospectively analyzed patients who underwent RFA and mini-phlebectomy divided in two groups according to the anesthesia applied method. Group 1 contained patients who underwent the RFA operation under spinal anesthesia combined with tumescent anesthesia, and group 2 patients consisted of patients who underwent the same process under local tumescent anesthesia. Pain scores, the time length of preparation interval of anesthesia and the operation time, anesthesia-related side effects such as headache, nausea-vomiting, urinary retention, quality of life scores, postoperative occlusion rates, and complications related to the intervention such as phlebitis, deep vein thrombosis (DVT) were analyzed and compared via Mann Whitney U, Wilcoxon and Chi-Square tests.

結果:

2015年6月から2019年6月までに175例の患者に大伏在静脈RFAアブレーションを施行した。脊椎麻酔とツメセント麻酔を併用して103肢、局所ツメセント麻酔を併用して72肢を行った。ミニ血栓摘出術は全例に適用した。脊椎麻酔群の疼痛スコアは他の群に比べて低く、有意差があった。手術時間は両群とも有意差はなかったが、局所留置麻酔群の方が麻酔の準備段階が短く、有意差があった。頭痛、吐き気嘔吐、尿閉などの麻酔関連の副作用は両群間で有意差が認められ、局所留置麻酔群で低かった。術前のQOLスコアは両群とも術後に低下した。術後の閉塞率は1群96.1%、2群100%であったが、3ヶ月後には有意差は認められなかった。術後の静脈炎は1群3例、DVT2例、打撲2例、2群1例であったが、いずれの群においても術後の麻痺や麻痺は認められなかった。

RESULTS: Between June 2015 and June 2019 a great saphenous vein RFA ablation was performed in 175 patients. A total of 103 limbs were performed under spinal anesthesia combined with tumescent anesthesia and a total of 72 limbs were performed under local tumescent anesthesia. Mini phlebectomy was applied to all patients. Pain scores of the spinal anesthesia group were lower than the other group, and there was a significant difference. There was no significant difference between the operation lengths of both groups, but the preparation phase of anesthesia was shorter in local tumescent anesthesia patients, and the difference was significant. Anesthesia related side effects such as headache, nausea-vomiting, and urinary retention showed a significant difference between the two groups, and they were lower in the local tumescent anesthesia group. Preoperative quality of life scores of both groups decreased postoperatively. The postoperative occlusion rate of group 1 was 96.1%, and group 2 was 100 % at three months, but the difference was not significant. We encountered 3 cases of phlebitis, 2 cases of DVT and 2 cases of bruising in group 1, and 1 case of bruising in group 2. There was no postoperative paresis or paresthesia in either groups.

結論:

この単施設およびレトロスペクティブな報告では、175例のGSV RFAにおいて、局所ツメセント麻酔と脊椎麻酔を併用した場合と、局所ツメセント麻酔を併用した場合の両方の麻酔法が有効であることが示されている。疼痛スコアは脊椎麻酔の方が優れているが，局所麻酔法の方が効率が良く，時間も短く，頭痛，吐き気・嘔吐，尿閉や深部静脈血栓症などの合併症が少ないことが示された．

CONCLUSIONS: This monocenter and retrospective report of 175 GSV RFA using tumescent local anesthesia or spinal anesthesia combined with local tumescent anesthesia demonstrares that both methods of anesthesia are effective. Although the pain scores are better with spinal anesthesia, the local tumescent anesthesia method is more efficient, requiring a shorter time, and is associated with fewer complications such as headache, nausea-vomiting, or urinary retention and deep venous thrombosis.