Sekundo W, Dick H B, Schmidt J C
Department of Ophthalmology, Philipps University, Marburg, Germany.
Eur J Ophthalmol. 2004 Mar-Apr;14(2):111-6. doi: 10.1177/112067210401400205.
To compare the effect of xylocaine jelly and intracameral lidocaine with one quadrant instant sub-Tenon infiltration for self-sealing sclerocorneal phacoemulsification.
One hundred patients were enrolled into a prospective randomized study, receiving either a combination of topical 2% xylocaine jelly and 0.5 ml of intracameral 1% lidocaine or sub-Tenon infiltration with 2 ml of 2% xylocaine on the operating table. All patients underwent a standard divide and conquer phacoemulsification procedure through a superior sclerocorneal frown incision followed by implantation of a polymethylmethacrylate intraocular lens. Intraoperative pain was indicated by the patient by squeezing the bedside nurse's hand, who allocated it to particular stages of surgery on a chart. After surgery, patients assessed the pain experienced using a 10-unit visual analogue scale.
Pain was indicated on 31 occasions during the operation in the sub-Tenon group (mainly the injection itself) and 67 times in the topical group. The median overall subjective pain score was 3 in the jelly group and 0 in the sub-Tenon. Five eyes (10%) had to be converted to sub-Tenon during the surgery because of intolerable pain.
Whereas lidocaine supported xylocaine jelly anesthesia provided acceptable analgesia for 90% of patients operated, sub-Tenon anesthesia proved to deliver better intraoperative comfort in all patients receiving sclerocorneal incision cataract surgery.
比较利多卡因凝胶联合前房内注射利多卡因与象限性即刻球周浸润麻醉用于自闭式巩膜隧道白内障超声乳化手术的效果。
100例患者纳入一项前瞻性随机研究，在手术台上分别接受2%利多卡因凝胶联合0.5ml前房内1%利多卡因或2ml 2%利多卡因球周浸润麻醉。所有患者均通过上方巩膜隧道皱眉切口行标准分而治之法超声乳化手术，随后植入聚甲基丙烯酸甲酯人工晶状体。术中疼痛由患者通过挤压床边护士的手来表示，护士在图表上记录疼痛发生的具体手术阶段。术后，患者使用10分视觉模拟评分法评估疼痛程度。
球周浸润麻醉组术中31次出现疼痛（主要是注射时），表面麻醉组为67次。利多卡因凝胶组总体主观疼痛评分中位数为3分，球周浸润麻醉组为0分。5只眼（10%）因无法忍受的疼痛在手术中改为球周浸润麻醉。
尽管利多卡因辅助利多卡因凝胶麻醉可为90%的手术患者提供可接受的镇痛效果，但球周浸润麻醉在所有接受巩膜隧道切口白内障手术的患者中均能提供更好的术中舒适度。
