Calenda Emile, Quintyn Jean Claude, Brasseur Gérard
Department of Anesthesia Reanimation, Centre Hospitalier Universitaire de Rouen, 1 rue de Germont, 76031, Rouen, France.
Indian J Ophthalmol. 2002 Sep;50(3):205-8.
The efficacy and safety of peribulbar anaesthesia was assessed using a combination of lidocaine, bupivacaine and clonidine during eye surgery.
We prospectively studied 100 vitreo-retinal surgical procedures performed by several surgeons. The exclusion criteria included age below 30 years and, axial length of the orbit above 28 mm. Peribulbar was performed using Hamilton's technique. A mixed anaesthetic solution of equal quantity of lidocaine 2% and bupivacaine 0.5% with clonidine (1 mg/kg) was injected. Patients received a mean volume of 14.5 ml +/- 3.5 of the mixture. Akinesia and analgesia were assessed 15 minutes later by the surgeon. Whenever required, supplemental lidocaine 2% (3 ml) by sub-Tenon infiltration was added by the surgeon. Supplemental injections were given only to patients who failed to develop analgesia.
The mean age of patients (male 52%, female 48%) was 66 years +/- 10 (mean +/- SD, range 44-90). The 100 surgical procedures were made up of vitrectomy +/- gas +/- silicone oil (22/100), vitrectomy and lensectomy (6/100), vitrectomy and epiretinal membrane +/- laser coagulation +/- gas +/- silicone oil (35/100), scleral buckling or encircling +/- gas (36/100), and cryosurgery +/- gas (1/100). Analgesia was adequate throughout surgery without any supplementation in 85% of cases and with a sub-Tenon infiltration in 99%. Akinesia was complete in 84%, mild in 12% and absent in 4% of cases. The sub-Tenon injection was performed in 15% of cases. Three patients (3%) were agitated during surgery. No neurologic or cardiac complication was seen. In one patient, the systolic blood pressure decreased from 170 to 110 mmHg, 30 minutes after the institution of the peribulbar block.
Our results show that peribulbar anaesthesia in the proposed mixture offers excellent analgesia in 85% of patients, and in 99% of the patients when supplemented by a subtenon injection. The current mixture of lidocaine, bupivacaine and clonidine is an excellent alternative to the previously used mixture etidocaine, bupivacaine and hyaluronidase for vitreoretinal surgery. However, a randomized controlled clinical trial is needed to prove the efficacy and safety of these results.
在眼科手术期间，使用利多卡因、布比卡因和可乐定的组合评估球周麻醉的有效性和安全性。
我们前瞻性地研究了由几位外科医生进行的100例玻璃体视网膜手术。排除标准包括年龄低于30岁以及眼眶轴长超过28mm。采用汉密尔顿技术进行球周麻醉。注射等量的2%利多卡因、0.5%布比卡因与可乐定（1mg/kg）的混合麻醉溶液。患者接受的混合液平均体积为14.5ml±3.5ml。15分钟后由外科医生评估眼球运动麻痹和镇痛效果。必要时，外科医生通过Tenon囊下浸润追加2%利多卡因（3ml）。仅对未产生镇痛效果的患者进行追加注射。
患者的平均年龄为66岁±10岁（平均±标准差，范围44 - 90岁），男性占52%，女性占48%。100例手术包括玻璃体切除术±气体±硅油（22/100）、玻璃体切除术和晶状体切除术（6/100）、玻璃体切除术和视网膜前膜±激光凝固术±气体±硅油（35/100）、巩膜扣带术或环扎术±气体（36/100）以及冷冻手术±气体（1/100）。85%的病例在整个手术过程中镇痛效果良好无需追加药物，99%的病例通过Tenon囊下浸润实现良好镇痛。84%的病例眼球运动完全麻痹，12%的病例轻度麻痹，4%的病例无麻痹。15%的病例进行了Tenon囊下注射。3例患者（3%）在手术期间出现躁动。未观察到神经或心脏并发症。1例患者在球周阻滞实施30分钟后，收缩压从170mmHg降至110mmHg。
我们的结果表明，所提议混合液的球周麻醉在85%的患者中提供了良好的镇痛效果，在99%的患者中通过Tenon囊下注射追加药物后实现良好镇痛。目前利多卡因、布比卡因和可乐定的混合液是玻璃体视网膜手术中先前使用的依替卡因、布比卡因和透明质酸酶混合液的极佳替代方案。然而，需要进行随机对照临床试验来证实这些结果的有效性和安全性。
