臨床婦人科産科77巻1号

2023年01月発行

合併増大号　今月の臨床 最善で最新の産科麻酔診療をめざして

妊婦の疼痛緩和法

妊婦のペインクリニック

著者： 山口重樹¹ 山中恵里子¹ 木村嘉之¹

所属機関： ¹獨協医科大学医学部麻酔科学講座

ページ範囲：P.167 - P.175

文献概要

●妊婦が分娩に関連する痛み以外の痛みを自覚することは稀でなく，不適切な痛みの管理は妊娠継続に影響を及ぼす．

●妊婦が自覚する痛みの多くは，生活改善，理学療法，インターベンション治療などの非薬物療法によって管理されるべきで，管理可能でもある．

●妊婦の自覚する痛みの緩和のための薬物療法では，アセトアミノフェンを第一選択とする．

●アセトアミノフェン以外の薬の選択は，治療上の有益性が危険性を上回ると判断される場合に限定する．

参考文献

1）Kristiansson P, et al : Back pain during pregnancy : a prospective study. Spine（Phila Pa 1976） 21 : 702-709, 1996

2）Ritchie JR : Orthopedic considerations during pregnancy. Clin Obstet Gynecol 46 : 456-466, 2003

3）Kovacs FM, et al : Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy : a multicenter study conducted in the Spanish National Health Service. Spine（Phila Pa 1976） 37 : 1516-1533, 2012

4）To WW, et al : Persistence of back pain symptoms after pregnancy and bone mineral density changes as measured by quantitative ultrasound―a two year longitudinal follow up study. BMC Musculoskelet Disord 12 : 55, 2011

5）Marshall SA, et al : Relaxin deficiency results in increased expression of angiogenesis- and remodelling-related genes in the uterus of early pregnant mice but does not affect endometrial angiogenesis prior to implantation. Reprod Biol Endocrinol 14 : 11, 2016

6）Soh YM, et al : Relaxin regulates hyaluronan synthesis and aquaporins in the cervix of late pregnant mice. Endocrinology 153 : 6054-6064, 2012

7）Heenan AP, et al : Effects of human pregnancy on fluid regulation responses to short-term exercise. J Appl Physiol（1985） 95 : 2321-2327, 2003

8）Center for Disease Control and Prevention : Vital signs : overdoses of prescription opioid pain relievers and other drugs among women--United States, 1999-2010. MMWR Morb Mortal Wkly Rep 62 : 537-542, 2013

9）Rathmell JP, et al : Management of nonobstetric pain during pregnancy and lactation. Anesth Anal 85 : 1074-1087, 1997

10）Sabino J, et al : Pregnancy and low back pain. Curr Rev Musculoskelet Med 1 : 137-141, 2008

11）Borg-Stein J, et al : Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am 18 : 459-476, 2007

12）Lehrich J : Management of low back pain. Journal of Contemporary Neurology 1996 : 2-4, 1996

13）Pennick V, et al : Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev（8） : CD001139, 2013

14）Norén L, et al : Lumbar back and posterior pelvic pain during pregnancy : a 3-year follow-up. Eur Spine J 11 : 267-271, 2002

15）Choi HJ, et al : Prevalence and clinical features of arthralgia/arthritis in healthy pregnant women. Rheumatol Int 28 : 1111-1115, 2008

16）de Man YA, et al : Disease activity or remission of rheumatoid arthritis before, during and following pregnancy. Curr Opin Rheumatol 26 : 329-333, 2014

17）Shah S, et al : Pain management in pregnancy : multimodal approaches. Pain Res Treat 2015 : 987483, 2015

18）Albert H, et al : Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand 80 : 505-510, 2001

19）Padua L, et al : Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy. Clin Neurophysiol 112 : 1946-1951, 2001

20）Mabie WC : Peripheral neuropathies during pregnancy. Clin Obstet Gynecol 48 : 57-66, 2005

21）Peleg R, et al : Abdominal wall pain in pregnant women caused by thoracic lateral cutaneous nerve entrapment. Eur J Obstet Gynecol Reprod Biol 74 : 169-171, 1997

22）Sax TW, et al : Neuromuscular disorders in pregnancy. Muscle Nerve 34 : 559-571, 2006

23）木村嘉之，他 : 周産期の慢性疼痛薬物療法の注意点．分娩と麻，2022（in press）

24）Rebordosa C, et al : Acetaminophen use during pregnancy : effects on risk for congenital abnormalities. Am J Obstet Gynecol 198 : 178.e1-178.e7, 2008

25）Cooper M, et al : Antenatal acetaminophen use and attention-deficit/hyperactivity disorder : An interesting observed association but too early to infer causality. JAMA Pediatr 168 : 306-307, 2014

26）Hill DS, et al : Teratogenic effects of antiepileptic drugs. Expert Rev Neurother 10 : 943-959, 2010

27）Díaz RR, et al : Management of non-obstetric pain during pregnancy. Review article. Rev Colomb Anestesiol 40 : 213-223, 2012

錠　添付文書

29）Gentile S : Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf 13 : 207-225, 2014

30）Einarson A : Antidepressants and pregnancy : complexities of producing evidence-based information. CMAJ 182 : 1017-1018, 2010