堀田 訓久

BACKGROUND: Postherpetic itch has not commonly received attention as a complication of herpes zoster because pain predominates over itch in most patients with herpes zoster. Most cases of postherpetic itch are mild; however, cases of severe postherpetic itch reducing quality of life are rare. CASE PRESENTATION: A 52-year-old woman complained of severe itch in her left pinna and cheek 1 month after the first onset of herpes zoster at the same site. Owing to her scratching, she developed ulcers on her left pinna and cheek. Pregabalin was prescribed, and the itch subsided immediately, with the ulcers disappearing within 1 month. DISCUSSION: Severe itch was thought to be caused by neural injury from herpes zoster. Pregabalin may be a useful treatment option for neuropathic itch induced by herpes zoster.

BACKGROUND: Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. CASE PRESENTATION: A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother's vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. CONCLUSIONS: This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.

肺がんによる難治性胸部痛に対し，オピオイド，放射線治療にアルコールを用いた超音波ガイド下胸部傍脊椎ブロック（US-TPVB）を併用し，良好な除痛効果が得られた症例を経験した．症例は右下葉肺がんの61歳，女性．原発巣の増大，右肋骨転移，胸膜播種に伴う右胸部痛を認めた．オピオイドの増量，肋間神経ブロック，間欠的硬膜外ブロックでは対処困難であったため，アルコールを用いたUS-TPVBを行い，いったんは鎮痛が得られた．しかし，痛みが悪化し，病巣の拡大が判明したため，放射線照射と1回目より尾側でのアルコールによるUS-TPVBを行った．以後6カ月間，痛みとオピオイド投与量は減少し，患者の活動性は改善した．TPVBは，体幹片側を除痛でき，術後鎮痛では硬膜外ブロックと鎮痛効果が同等で，合併症が少ないことが示されている．これらの特徴を考慮すると，神経破壊薬を用いたUS-TPVBは適切な症例を選べば，がん性痛治療の選択肢になると考えられる．進行肺がんによる難治性がん性痛に対し，アルコールによるUS-TPVBを併用することで良好な除痛効果が得られた．