Küçükyavuz Zuhal, Arici M Kemal
Department of Oral and Maxillofacial Surgery, Ankara University Faculty of Dentistry, Ankara, Turkey.
Reg Anesth Pain Med. 2002 Sep-Oct;27(5):487-90.
Peribulbar anesthesia (PBA) is widely used in cataract surgery, but the onset time of akinesia is not as rapid as with retrobulbar block. The aim of this study was to evaluate whether addition of low-dose atracurium to the local anesthetic mixture has any effects on akinesia in PBA.
Sixty adults undergoing cataract surgery were randomly allocated to receive either 8 mL of a lidocaine-bupivacaine mixture, plus 0.5 mL 0.9% NaCl (group I) or 8 mL of the same local anesthetic mixture plus 0.5 mL (5 mg) atracurium (group II). The level of akinesia was graded by a observer unaware of group assignment. The onset time and duration of akinesia were also recorded by an observer, again unaware of group assignment.
The onset time of complete akinesia in group II was significantly shorter than that in group I (P <.05). In group I, 86% of patients had an akinesia score of 0 (complete akinesia) in the first 10 minutes. The rate of complete akinesia was 93% in group II in the same period. This difference was not significant. The success rate of complete akinesia was 93% in group I and 100% in group II at the end of the measurement interval. None of the group II patients required supplementary block, while 2 patients in group I received additional injections for inadequate akinesia.
Atracurium added at a dose of 5 mg to a lidocaine-bupivacaine mixture for peribulbar block decreases the onset time of akinesia and provides better surgical conditions without obvious side-effects.
球周麻醉（PBA）在白内障手术中广泛应用，但运动不能的起效时间不如球后阻滞迅速。本研究旨在评估在局部麻醉混合液中添加低剂量阿曲库铵对球周麻醉中运动不能是否有影响。
60例接受白内障手术的成年人被随机分配，分别接受8毫升利多卡因-布比卡因混合液加0.5毫升0.9%氯化钠溶液（I组）或8毫升相同的局部麻醉混合液加0.5毫升（5毫克）阿曲库铵（II组）。由一名不知道分组情况的观察者对运动不能程度进行分级。同样由一名不知道分组情况的观察者记录运动不能的起效时间和持续时间。
II组完全运动不能的起效时间显著短于I组（P<.05）。在I组，86%的患者在最初10分钟时运动不能评分为0（完全运动不能）。同期II组完全运动不能的发生率为93%。这一差异不显著。在测量间隔结束时，I组完全运动不能的成功率为93%，II组为100%。II组患者均无需追加阻滞，而I组有2例患者因运动不能不足接受了额外注射。
在用于球周阻滞的利多卡因-布比卡因混合液中添加5毫克阿曲库铵可缩短运动不能的起效时间，并提供更好的手术条件，且无明显副作用。
