臨床整形外科59巻1号

2024年01月発行

特集 はじめたい人と極めたい人のための　超音波ガイド下インターベンション

頚部の超音波ガイド下インターベンション

著者： 新堀博展¹

所属機関： ¹緩和会横浜クリニック

ページ範囲：P.53 - P.60

超音波ガイド下神経ブロックは優れた手技であり，臨床の場に急速に普及してきている．特に頚部は有用性が高い．神経根ブロックは椎体高位の同定と針先をどこに位置させるかがポイントである．従来のように透視下に放散痛を得る必要はない．椎間関節は関節面にプローブを合わせることで，高位の同定と穿刺が容易になる．また，星状神経節や上頚神経節を超音波で確認することで，従来のランドマーク法よりも，より目的に即した頚部交感神経ブロックが可能となる．

参考文献

1) Takeuchi M, Aoyama M, Wakao N, et al. Prevalence of C7 level anomalies at the C7 level:an important landmark for cervical nerve ultrasonography. Acta Radiol 2016;57(3):318-24.

2) Tudose RC, Rusu MC, Hostiuc S. The vertebral artery:a systematic review and a meta-analysis of the current literature. Diagnostics (Basel) 2023;13(12):2036. doi:10.3390/diagnostics13122036.

3) Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology 2004;100(6):1595-600.

4) Selander D, Dhunér KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anesthesia:an experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 1977;21(3):182-8.

5) Rice AS, McMahon SB. Peripheral nerve injury caused by injection needles used in regional anaesthesia:influence of bevel configuration, studied in a rat model. Br J Anaesth 1992;69(5):433-8.

6) Hadzic A, Dilberovic F, Shah S, et al. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med 2004;29(5):417-23.

7) Pal GP, Routal RV, Saggu SK. The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic region. J Anat 2001;198(Pt 4):431-41.

8) Lipov EG, Joshi JR, Sanders S, et al. Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer:a pilot study. Lancet Oncol 2008;9(6):523-32.

9) Treggiari MM, Romand JA, Martin JB, et al. Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. Stroke 2003;34(4):961-7.

10) Rae Olmsted KL, Bartoszek M, Mulvaney S, et al. Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms:a randomized clinical trial. JAMA Psychiatry 2020;77(2):130-8.

11) Hogan QH, Erickson SJ. MR imaging of the stellate ganglion:normal appearance. AJR Am J Roentgenol 1992;158(3):655-9.

12) Narouze S. Ultrasound-guided stellate ganglion block:safety and efficacy. Curr Pain Headache Rep 2014;18(6):424. doi:10.1007/s11916-014-0424-5.

13) Usui Y, Kobayashi T, Kakinuma H, et al. An anatomical basis for blocking of the deep cervical plexus and cervical sympathetic tract using an ultrasound-guided technique. Anesth Analg 2010;110(3):964-8.