研究者詳細 - 藤井　祐

論文 - 藤井　祐

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Clarification on chronic pain - a painfully persistent problem? A reply

Fujii T., Nishiwaki K.

ANAESTHESIA 75 巻 ( 3 ) 頁： 408 - 409 2020年3月

A single paravertebral injection via a needle vs. a catheter for the spreading to multiple intercostal levels: a randomized controlled trial

Fujii Tasuku, Shibata Yasuyuki, Ban Yasutaka, Shitaokoshi Akira, Takahashi Kunihiko, Matsui Shigeyuki, Nishiwaki Kimitoshi

JOURNAL OF ANESTHESIA 34 巻 ( 1 ) 頁： 72 - 78 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Anesthesia

Purpose: Thoracic paravertebral block (TPVB) provides a unilateral nerve block at multiple intercostal levels allowing injection of a local anesthetic into paravertebral space (PVS) via a needle or catheter. However, the most effective injection method remains unclear. This study compared the real-time spread of ropivacaine between two paravertebral injection methods using thoracoscopy. Methods: Thirty-four patients scheduled for thoracoscopic surgery were randomly allocated into the Needle or Catheter groups, and performed transverse in-plane ultrasound-guided TPVB. The Needle group received 20 ml of 0.5% ropivacaine via a needle placed into the lateral edge of PVS; the Catheter group received the same dose of ropivacaine via a catheter inserted 5 cm into PVS. The primary outcome was the spreading pattern of ropivacaine in each group. The secondary outcome was intraoperative vasopressor requirement after paravertebral injection. Results: In the Needle group, all cases showed ropivacaine spread to multiple intercostal levels, mainly across the ribs. Contrastingly, the Catheter group showed variable spreading patterns; multiple intercostal levels (n = 10) [across the ribs (n = 4), anterolateral aspect of the vertebral bodies (n = 6)] or unobservable spreading (no change; n = 7) (P = 0.007). Vasopressors were required in two and ten cases in the Needle and Catheter groups, respectively (P = 0.010). Conclusion: Paravertebral injection via a needle typically resulted in spreading to multiple intercostal levels, especially across the ribs on the peripheral side of injection site, whereas injection via a catheter resulted in variable spreading patterns. Therefore, injections via needles are more stable.

DOI： 10.1007/s00540-019-02713-6

Web of Science

Scopus

PubMed

Efficacy of pectoral nerve block type-2 (Pecs II block) versus serratus plane block for postoperative analgesia in breast cancer surgery: a retrospective study

Kubodera Kazumi, Fujii Tasuku, Akane Akiko, Aoki Wakana, Sekiguchi Akiko, Iwata Keiko, Ban Makiko, Ando Reiko, Nakamura Nozomi, Shibata Yasuyuki, Nishiwaki Kimitoshi

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 1 ) 頁： 93 - 99 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Thoracic wall nerve blocks reduce postoperative acute pain after breast cancer surgery (BCS); however, their short-term effects and the most effective technique remain unclear. To compare the effects of pectoral nerve block type-2 (Pecs II block) and serratus plane block for postoperative short-term analgesia, we retrospectively reviewed 43 BCS patients who underwent Pecs II block (n=22) or serratus plane block (n=21). The primary outcome was the proportion of patients with no complaints of pain 2 months post-BCS. The odds ratio (OR) was assessed, adjusting for axillary lymph node dissection. The secondary outcomes were pain severity 24 hours and 2 months post-operation using the numerical rating scale score, and morphine consumption within 24 hours. The proportion of patients without pain 2 months post-BCS was significantly less with Pecs II block than in patients with serratus plane block (55% vs. 19%, adjusted OR, 5.04; 95% confidence interval, 1.26-20.07; P=0.02); the median [interquartile range] score for pain 2 months post-operation was also significantly lower with Pecs II block (Pecs II block 0.5 [0-1] vs. serratus plane block 1 [1-2]); P=0.03). Regarding post-BCS acute analgesia, the median [interquartile range] postoperative 24-hour pain score was 2 [1-3] and 3 [1.5-3.5], and the median morphine consumption within 24 hours was 1.5 [0.75-5.5] and 3 [1.5-10] mg in Pecs II block and serratus plane block (P=0.47 and P=0.11), respectively. This study suggests that Pecs II block prevents short-term post-BCS pain better than serratus plane block. However, further studies are needed in order to support this finding.

DOI： 10.18999/nagjms.82.1.93

Web of Science

Scopus

PubMed

Comparison of Right Ventricular Function Between Patients With and Without Pulmonary Hypertension Owing to Left-Sided Heart Disease: Assessment Based on Right Ventricular Pressure-Volume Curves 国際誌

Kanemaru Eiki, Yoshitani Kenji, Kato Shinya, Fujii Tasuku, Tsukinaga Akito, Ohnishi Yoshihiko

JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 34 巻 ( 1 ) 頁： 143 - 150 2020年1月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiothoracic and Vascular Anesthesia

Objectives: Right ventricular (RV) failure with pulmonary hypertension (PH) is frequently encountered in patients with advanced left-sided heart disease (LHD). However, RV energetics in patients with postcapillary PH because of LHD has not been well studied. The authors investigated intraoperative RV energetics in patients with PH due to LHD based on pressure–volume curves with three-dimensional transesophageal echocardiography and pulmonary artery catheterization. Design: Exploratory study. Setting: National center. Participants: Thirty-three patients who underwent cardiac surgery for LHD were enrolled. Ten patients had PH (mean pulmonary artery pressure ≥ 25 mmHg). Interventions: None. Measurements and Main Results: RV stroke work index (RVSWI) was calculated by integrating the area bounded by the pressure–volume curve. RV minute work index (RVMWI) was calculated as RVSWI × heart rate. Right ventriculo-arterial coupling was estimated as stroke volume divided by end-systolic volume (SV/ESV). The authors compared RV energetics between patients with and without PH because of LHD. RVSWI and RVMWI were significantly higher in patients with PH (690.7 mmHg·mL/m2 [601.6-737.1] v 440.9 mmHg·mL/m2 [330.8-585.3], p = 0.015, and 60,068 mmHg·mL/m2/min [35,547-68,741] v 26,351 mmHg·mL/m2/min [17,316-32,517], p = 0.011, respectively), although cardiac index was nearly identical. SV/ESV was significantly lower in patients with PH (0.520 [0.305-0.810] v 0.820 (0.650-1.090), p = 0.007). Conclusions: Although cardiac index was similar, RVSWI and RVMWI were significantly higher and SV/ESV was significantly lower in patients with PH because of LHD, suggesting that patients with postcapillary PH have inefficient RV performance.

DOI： 10.1053/j.jvca.2019.05.025

Web of Science

Scopus

PubMed

A randomised controlled trial of pectoral nerve-2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

Fujii T., Shibata Y., Akane A., Aoki W., Sekiguchi A., Takahashi K., Matsui S., Nishiwaki K.

ANAESTHESIA 74 巻 ( 12 ) 頁： 1558 - 1562 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Anaesthesia

Thoracic interfascial plane blocks are effective for post-mastectomy acute analgesia. However, their effects on chronic pain are uncertain. We randomly allocated 80 women equally to pectoral nerve-2 (PECS 2) block or serratus plane block. The pectoral nerve-2 block reduced the rate of moderate or severe chronic pain from 13/40 (33%) with the serratus plane block to 4/40 (10%), p = 0.03, adjusted odds ratio (95%CI) 0.23 (0.07–0.80), p = 0.02. The rates of pain-free women at six postoperative months were indeterminate, 10/40 (25%) after serratus plane block vs. 19/40 (48%) after pectoral nerve-2 block, p = 0.06, adjusted odds ratio (95%CI) 2.9 (1.1–7.5), p = 0.03. Health-related quality of life at six postoperative months was similar after serratus plane and pectoral nerve-2 blocks, mean (SD) EQ-5D-3L scores 0.87 (0.15) vs. 0.91 (0.14), respectively, p = 0.21. The pectoral nerve-2 block reduced median (IQR [range]) morphine consumption in the first 24 postoperative hours from 6 (3–9 [1–25]) mg to 4 (2–7 [0–37]) mg, p = 0.04. However, acute pain scores after serratus plane and pectoral nerve-2 blocks were similar, median (IQR [range]) 23 (11–35 [0–70]) mm vs. 18 (11–27 [0–61]) mm, respectively, p = 0.44. Pectoral nerve-2 block reduced chronic pain 6 months after mastectomy compared with serratus plane block.

DOI： 10.1111/anae.14856

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/anae.14856

Measurement of the Aortic Annulus Area and Diameter by Three-Dimensional Transesophageal Echocardiography in Transcatheter Aortic Valve Replacement. 国際誌

Ebuchi K, Yoshitani K, Kanemaru E, Fujii T, Tsukinaga A, Shimahara Y, Ohnishi Y

Journal of cardiothoracic and vascular anesthesia 33 巻 ( 9 ) 頁： 2387 - 2393 2019年9月

Catheterization in an ultrasound-guided thoracic paravertebral block using thoracoscopy.

Fujii T, Shibata Y, Ban Y, Shitaokoshi A, Nishiwaki K

Asian journal of anesthesiology 55 巻 ( 1 ) 頁： 24 - 25 2017年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Journal of Anesthesiology

Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.

DOI： 10.1016/j.aja.2017.05.004

Scopus

PubMed

[Acute Subdural Hematoma due to the Breakage of an Epidural Catheter Left for a Long Time].

Fujii T, Suzuki K, Shibata Y, Nishiwaki K

Masui. The Japanese journal of anesthesiology 66 巻 ( 1 ) 頁： 65-69 2017年1月

僧帽弁形成術後の僧帽弁前尖収縮期前方運動に対してシベンゾリン静脈内投与が有効であった一例

藤井祐, 青山正, 石田祐基, 新屋苑恵, 貝沼関志, 西脇公俊

Cardiovascular Anesthesia 21 巻 ( 1 ) 頁： 69-74 2017年

記述言語：英語掲載種別：研究論文（学術雑誌）

僧帽弁形成術（MVP）後の僧帽弁前尖収縮期前方運動（SAM）に対してシベンゾリン静脈内投与が有効であった症例を報告する。　SAMは狭い左室流出路（LVOT）を通過する加速血流のVenturi効果により増幅弁前尖がLVOTに引き込まれて生じる。周術期管理は前負荷・後負荷の維持，心収縮力の抑制，心拍数の調節が重要である。SAMの発生機序から閉塞性肥大型心筋症の治療（β遮断薬，Ca2+拮抗薬，Na+チャネル遮断薬）も有効となる。β遮断薬が一般的に使用されているが，MVP後のLVOT狭窄は頻脈より心収縮力増強が主因とされているため，陰性変時作用より陰性変力作用が優位なNa+チャネル遮断薬のシベンゾリンも有用となりえる。

DOI： 10.11478/jscva.2016-3-022

Breakage and retention of thoracic paravertebral catheter: a case report.

Fujii T, Shibata Y, Nishiwaki K

JA clinical reports 3 巻 ( 1 ) 頁： 4 2017年

Observation of ultrasound-guided thoracic paravertebral block using thoracoscopy. 査読有り

Fujii T, Shibata Y, Nishiwaki K

Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists 54 巻 ( 3 ) 頁： 101-102 2016年9月

Radicular cyst in a deciduous tooth: a case report and literature review. 査読有り

Nagata T, Nomura J, Matsumura Y, Yanase S, Fujii T, Oka T, Uno S, Tagawa T

Journal of dentistry for children (Chicago, Ill.) 75 巻 ( 1 ) 頁： 80-84 2008年1月

Synergistic interaction of 5-aminolevulinic acid-based photodynamic therapy with simultaneous hyperthermia in an osteosarcoma tumor model. 査読有り

Yanase S, Nomura J, Matsumura Y, Nagata T, Fujii T, Tagawa T

International journal of oncology 29 巻 ( 2 ) 頁： 365-373 2006年8月

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