日本臨床麻酔学会 vol.37
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1 621 日本臨床麻酔学会第 36 回大会教育講演日臨麻会誌 Vol.37 No.5, , 2017 超音波ガイド下神経ブロックの効率的習得法 * 村田寛明 [ 要旨 ] 教科書からは超音波ガイド下神経ブロック (USGNB) の手技, 適応および関連する超音波解剖学の知識が得られる.NYSORA などのウェブサイトや YouTube で共有される教育的動画は実践的な知識の習得に役立つ.Facebook には USGNB について双方向性に情報交換できる非公開グループが存在する. ハンズオンセミナーでは描出の実践的な技術を, 超音波検査トレーニング用ファントムでは描出に必要な超音波プローブ操作と穿刺の技術を, そして食用肉などを用いた手作りファントムでは薬液の注入技術を習得できる. これらの知識と技術を身につけた上で施設の状況に応じて臨床経験を積む. 所属施設では実施していない新たな手技を導入する際には, 他施設の見学も有用である. キーワード : 超音波ガイド下神経ブロック, 超音波解剖学, ハンズオンワークショップ, ファントム はじめに ultrasound-guided nerve block USGNB USGNB USGNB USGNB USGNB USGNB on-the-job training USGNB off-the-job training USGNB 図 1 USGNB USGNB sonoanatomy
2 622 Vol.37 No.5/Sep 図 1 超音波ガイド下神経ブロックを学ぶ上で習得するべき項目 USGNB Ⅰ 教科書 USGNB USGNB USGNB 2019 Japanese Regional Anesthesia Certificate Examination J- RACE USGNB 2005 The European Society of Regional Anaesthesia and Pain Therapy ESRA The European Diploma in Regional Anaesthesia & Acute Pain Management EDRA EDRA USGNB 表 1 USGNB 2012 Hadzic s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia 2 Hadzic s Textbook of Regional Anesthesia and Acute Pain Management USGNB USGNB 1 4 USGNB Ⅱ インターネット USGNB The New York School of Regional Anesthesia NYSORA NYSORA
3 623 表 1 The European Diploma in Regional Anaesthesia & Acute Pain Management(EDRA) の実施要綱の中で区域麻酔と解剖に関する学習教材として推薦されている図書一覧 タイトル著者発行年 Hadzic's Textbook of Regional Anesthesia and Acute Pain Management Admir Hadzic 2017 Anesthesia of the Upper Limb Fernando Alemanno Mario Bosco Aldo Barbati 2014 Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound Guided Regional Anesthesia Admir Hadzic 2012 Essentials of Regional Anesthesia 2010 Alan David Kaye Richard D. Urman Nalini Vadivelu 2012 Reverse Ultrasound Anatomy Project RUAP TM RUAP TM USGNB 図 2 NYSORA educational poster 図 3 RUAP TM 4 USGNB 図 3 NYSORA educational poster PDF YouTube USGNB NYSORA USGNB YouTube YouTube ultrasound guided nerve block 18, ultrasound guided brachial plexus block 4,400 図 2 Reverse Ultrasound Anatomy Project TM で作成されたイラストの 1 例 intraneural hematoma intrafascicular injection NYSORA USGNB
4 624 Vol.37 No.5/Sep 図 3 NYSORA educational posters の一部 Reverse Ultrasound Anatomy Project TM NYSORA NYSORA website YouTube social networking service SNS Facebook Ⅲ ハンズオンワークショップ 2018 USGNB
5 USGNB 図 1 Ⅳ ファントム Blue Phantom TM sliding rotation rocking tilting compression 5 USGNB 6 align sliding rotation tilting ART see see tilt align rotation 4 STAR maneuver 7 USGNB Blue Phantom TM 8 Blue Phantom TM 18 21G 8 Blue Phantom TM 図 4A F 8 hydrodissection hydrolocation 9 図 4C F Thiel fresh cadaver 10 fresh cadaver 11 Ⅴ 施設の環境整備 off-the-job training on-the-job training USGNB
6 626 Vol.37 No.5/Sep A B C D E F 図 4 手作りファントムによるトレーニング実例 A B A C D C E D F E USGNB USGNB USGNB USGNB
7 627 Ⅵ 施設見学 USGNB おわりに USGNB USGNB USGNB USGNB USGNB USGNB 参考文献 1) Peng PW, Narouze S:Ultrasound-guided interventional procedures in pain medicine:a review of anatomy, sonoanatomy, and procedures:part I:nonaxial structures. Reg Anesth Pain Med 34: , ) Narouze S, Peng PW:Ultrasound-guided interventional procedures in pain medicine:a review of anatomy, sonoanatomy, and procedures. Part II:axial structures. Reg Anesth Pain Med 35: , ) Sites BD, Macfarlane AJ, Sites VR, et al.:clinical sonopathology for the regional anesthesiologist:part 1: vascular and neural. Reg Anesth Pain Med 35: , ) Sites BD, Macfarlane AJ, Sites VR, et al.:clinical sonopathology for the regional anesthesiologist:part 2: bone, viscera, subcutaneous tissue, and foreign bodies. Reg Anesth Pain Med 35: , ) Marhofer P, Chan VW:Ultrasound-guided regional anesthesia:current concepts and future trends. Anesth Analg 104: , ) Niazi AU, Haldipur N, Prasad AG, et al.:ultrasoundguided regional anesthesia performance in the early learning period:effect of simulation training. Reg Anesth Pain Med 37:51-54, ) Lam NC, Fishburn SJ, Hammer AR, et al.:a Randomized Controlled Trial Evaluating the See, Tilt, Align, and Rotate(STAR)Maneuver on Skill Acquisition for Simulated Ultrasound-Guided Interventional Procedures. J Ultrasound Med 34: , ) Hocking G, Hebard S, Mitchell CH:A review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 36: , ) Brull R, Chan VW:The corner pocket revisited. Reg Anesth Pain Med 36:308, )Munirama S, Eisma R, Columb M, et al.:physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia. Br J Anaesth 116: , )Chuan A, Lim YC, Aneja H, et al.:a randomised controlled trial comparing meat-based with human cadaveric models for teaching ultrasound-guided regional anaesthesia. Anaesthesia 71: , 2016
8 628 Vol.37 No.5/Sep Efficient Training Methods for Ultrasound-guided Nerve Blockade Hiroaki MURATA Department of Anesthesiology, Nagasaki University School of Medicine In order to achieve efficient learning of ultrasound-guided nerve blockade(usgnb), we should make maximum use of various sources. Textbooks provide knowledge about indications and anatomical information relevant to each USGNB procedure. Learners should integrate the knowledge of gross anatomy with that of sonoanatomy to confidently visualize ultrasound images. One of the best sources for web-based learning in regional anesthesia is NYSORA.com. High-resolution movies and pictures help learners understand the procedure intuitively. Numerous educational movies are also shared on YouTube. During hands-on scanning of healthy volunteers, learners can experience ultrasound probe manipulation techniques such as sliding, rotation, tilting and rocking. The Blue Phantom TM is useful in the early stages of learning needle insertion, but it provides high needle visibility, which can mislead learners into false confidence regarding their clinical ability. Meat phantoms are inexpensive and provide a more realistic simulation of needle guidance in actual clinical practice. With a meat phantom, learners can practice all three techniques of a USGNB procedure, that is, ultrasound probe manipulation, needle insertion and local anesthetic injection. After acquiring this knowledge and mastering these techniques, learners can advance to clinical training under the supervision of experienced anesthesiologists. Key Words : Ultrasound-guided nerve block, Sonoanatomy, Hands-on workshop, Phantom The Journal of Japan Society for Clinical Anesthesia Vol.37 No.5, 2017
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