Jonas J B, Hemmerling T M, Budde W M, Dinkel M
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Am J Ophthalmol. 2000 Jan;129(1):54-8. doi: 10.1016/s0002-9394(99)00256-1.
To evaluate an indwelling retrobulbar catheter for repeatable postoperative retrobulbar injections of local anesthetics for titratable analgesia after intraocular surgery.
The prospective study included all 124 patients (124 eyes) who consecutively underwent retinal or cyclocryocoagulation (n = 22), pars plana vitrectomy, or retinal detachment surgery (n = 102), and who were operated on by the same surgeon with local anesthesia within a period of 12 months. Using commercially available retrobulbar needles with a diameter of 0.60 mm or 0.80 mm and a length of 38 mm, 5 ml of mepivacaine 2% with hyaluronidase were injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place. When the patients started to feel pain after surgery, 2 ml of mepivacaine 2% or 2 ml of bupivacaine 0.75% were reinjected through the catheter. The catheter was removed 24 to 72 hours after surgery.
Because of increasing pain in the postoperative period, 93 patients (93 of 124, or 75%) received a reinjection 4.2+/-2.0 hours after the preoperative injection. Seventy patients received a second reinjection after an additional 2.7+/-1.9 hours, and 42 patients received a third reinjection 3.1+/-2.0 hours later. After each reinjection, the patients became pain free. Removal of the catheter after surgery was unremarkable.
An indwelling retrobulbar catheter for repeatable postoperative injection of short-acting local anesthetics is useful and effective for titratable postoperative analgesia after intraocular surgery, and it allows patients to avoid the side effects of systemic analgesics and sedatives.
评估一种球后留置导管，用于眼内手术后重复进行球后局部麻醉剂注射以实现可滴定镇痛。
前瞻性研究纳入了连续接受视网膜或睫状体冷凝术（n = 22）、玻璃体切除术或视网膜脱离手术（n = 102）的所有124例患者（124只眼），这些患者在12个月内由同一位外科医生在局部麻醉下进行手术。使用直径0.60毫米或0.80毫米、长度38毫米的市售球后针，注射5毫升含透明质酸酶的2%甲哌卡因。通过同一根针，将一根28号市售柔性导管插入球后间隙，拔出针，将导管固定到位。当患者术后开始感到疼痛时，通过导管再次注射2毫升2%甲哌卡因或2毫升0.75%布比卡因。术后24至72小时取出导管。
由于术后疼痛加剧，93例患者（124例中的93例，即75%）在术前注射后4.2±2.0小时接受了再次注射。70例患者在另外2.7±1.9小时后接受了第二次再次注射，42例患者在3.1±2.0小时后接受了第三次再次注射。每次再次注射后，患者疼痛消失。术后取出导管过程顺利。
用于术后重复注射短效局部麻醉剂的球后留置导管对于眼内手术后可滴定镇痛是有用且有效的，并且能使患者避免全身镇痛药和镇静剂的副作用。
