産婦人科外来診療・小手術の局所浸潤麻酔・伝達麻酔

出版社： メジカルビュー社
著者：
発行日： 2022-08-01
分野： 臨床医学：外科  >  産婦人科学
ISBN： 9784758321280
電子書籍版： 2022-08-01 （第1版第1刷）
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産婦人科診療・小手術における痛みに対する麻酔処置（局所浸潤麻酔，伝達麻酔）について，麻酔の機序から手技の実際，さらにはこれらの麻酔を使用する産婦人科小手術の際の縫合法についても詳細に解説。
会陰縫合や不妊治療の採卵処置に対して“痛い”というイメージをもつ女性は少なくないが，簡便に広く情報を得ることができる現在においては，痛みを伴う治療への疑問や，より痛みの少ない治療への要望が高まっている。これまで重視されておらず，誰も教えてくれなかった局所浸潤麻酔や伝達麻酔を効果的に用いることで小手術の質を向上させ，痛みや負担を軽減できれば，患者満足度は向上し，ひいては施設の評判も高めることにもつながる。分娩恐怖症や流産・死産のグリーフケアなど，患者のメンタルヘルスケアについても記載。

目次

  • 第1章　“我慢”の産婦人科診療
    　1. 痛みを我慢させない診療とは？ Patient centered care
    　2. 婦人科の痛み
    　3. 産科領域の痛み
    　4. 出産恐怖症（tokophobia.） とは
    　5. 流産・死産のグリーフケア
    　6. 産婦人科と慢性疼痛
    　7. 内診のいらない分娩管理 超音波による児頭下降度の 評価と安全な器械分娩

    第2章　局所浸潤麻酔・伝達麻酔総論
    　1. 骨盤内血管・神経系解剖
    　2. 局所麻酔薬の種類と作用機序
    　3. 局所麻酔薬の副作用と対処法
    　4. 産婦人科における局所浸潤麻酔・伝達麻酔

    第3章　麻酔の実際
    　1. 局所浸潤麻酔の実際
    　　（1）産科
    　　　　　(1)会陰切開，会陰・陰唇・腟壁裂傷，会陰切開・裂傷の縫合法
    　　　　　(2)帝王切開術
    　　（2）婦人科外来
    　2. 伝達麻酔の実際
    　　（1）傍頸管麻酔（Paracervical block）
    　　　　　(1)総論
    　　　　　(2)流産手術
    　　　　　(3)採卵・ダグラス窩穿刺
    　　　　　(4)円錐切除術（LEEP・laser vaporization）
    　　（2.）陰部神経麻酔（Pudendal block）

    第4章　縫合部疼痛（異常瘢痕. を避ける縫合法
    　1. Patient centered suture
    　　求められる手術手技の改善
    　　Patient centered careを目指した縫合法
    　　頸管内出血が持続する場合
    　　早くからの出血傾向
    　　会陰裂傷の縫合
    　　深い軟産道裂傷
    　　陳旧性の直腸腟瘻や会陰直腸瘻
    　　止血・縫合困難な裂傷縫合
    　2. 異常瘢痕肉芽
    　　帝王切開瘢痕症候群の症例報告
    　　異常瘢痕肉芽の原因
    　　創傷治癒過程の発症原因
    　　痛み防止への配慮

この書籍の参考文献

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本参考文献は電子書籍掲載内容を元にしております。

第1章 "我慢" の産婦人科診療

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第2章 局所浸潤麻酔・伝達麻酔総論

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4) 医療上の必要性の高い未承認薬・適応外薬検討会議 公知申請への該当性に係る報告書 リドカイン塩酸塩 上肢手術における局所 (区域) 静脈内麻酔. https://www.pmda.go.jp/files/000206657.pdf
 
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3) Bonica JJ : Pudendal block and local anesthesia of the perineum. In Principles and Practice of Obstetric Analgesia & Anesthesia. p487-506, F. A. Davis Co, Philadelphia, 1967.
 

第3章 麻酔の実際

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P.121 掲載の参考文献
1) Bonica JJ : Paracervical and uterosacral block. In Principles and Practice of Obstetric Analgesia & Anesthesia. p507-19, F.A. Davis, Philadelphia, 1967.
 
2) Nichols M, Halvorson-Boyd G, RN, et al : Chapter 8. Pain management. In Management of unintended and abnormal pregnancy : Comprehensive abortion care. Paul M, Lichtenberg S, Borgatta L, et al (eds). p90-110, Wiley-Blackwell, Hoboken, 2009.
 
3) Neis F, Wallwiener D, Henes M, et al : Opinion paper : gynecological surgery in local anesthesia? Arch Gynecol Obstet 2022.https://link.springer.com/article/10.1007/s00404-022-06572-7
 
4) 竹田省 : 産科小手術に必要な外陰部・腟・子宮頸部周囲の解剖と局所麻酔. OGS NOW basic 5 産科手術を極める. 平松祐司 (編). p12-27, メジカルビュー社, 東京, 2021.
 
5) Levine EM, Fernandez CM : Paracervical Block for Intrauterine Device Placement Among Nulliparous Women : A Randomized Controlled Trial. Obstet Gynecol 2019 ; 133 (1) : 189.
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8) Asgari Z, Razavi M, Hosseini R, et al : Evaluation of Paracervical Block and IV Sedation for Pain Management during Hysteroscopic Polypectomy : A Randomized Clinical Trial. Pain Res Manag 2017 ; 2017 : 5309408.
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4) Duncan ID, McKinley CA, Pinion SB, et al : A double-blind, randomized, placebo-controlled trial of prilocaine and felypressin (Citanest and Octapressin) for the relief of pain associated with cervical biopsy and treatment with the Semm coagulator. J Low Genit Tract Dis 2005 ; 9 (3) : 171-5.
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P.141 掲載の参考文献
1) 関博之 : 鉗子分娩の特性・特徴. 竹田省, 関博之 (編). 児頭下降度の評価と鉗子遂娩術. p60-7, メジカルビュー社, 東京, 2015.
 
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4) Bonica JJ : Pudendal block and local anesthesia of the perineum. In Principles and Practice of Obstetric Analgesia & Anesthesia. FA David Company, Philadelphia, 1967, p487-506.
 

第4章 縫合部疼痛 ( 異常瘢痕 ) を避ける縫合法

P.152 掲載の参考文献
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4) Bonica JJ : Pudendal block and local anesthesia of the perineum. Principles and Practice of Obstetric Analgesia and Anesthesia. p487-506, F.A. Davis, Philadelphia, 1967.
 
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P.155 掲載の参考文献
1) 竹田省, 大久保貴司, 袖本武雄, ほか : 帝王切開子宮筋層創部の異常瘢痕肉芽と慢性炎症に対する診断と対策について. 産婦治療 1997 ; 74 : 93-100.
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2) 竹田省, 木下勝之, 馬場一憲 : 帝切創部の異常瘢痕肉芽及び癒着胎盤と子宮筋層内血流. 産婦の実際 1999 ; 48 : 37-44.
 
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8) 藤野一成, 竹田省 : 頸管狭窄・閉鎖 (円錐切除後, 頸管低形成). OGS NOW basic 6 不妊治療の外科的アプローチ 妊娠を目指して. 竹田省 (編). p161-7, メジカルビュー社, 東京, 2021.
 
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