Eke Tom, Thompson John R
Norfolk and Norwich University Hospitals NHS Trust, Colney Lane, Norwich NR4 7UY, UK.
Br J Ophthalmol. 2007 Apr;91(4):470-5. doi: 10.1136/bjo.2006.106005. Epub 2006 Nov 23.
The techniques of sub-Tenon's, topical and topical-intracameral local anaesthesia (LA) have become common in routine practice.
This study aimed (i) to estimate the frequency of various LA techniques used in cataract surgery, (ii) to estimate the incidence of severe adverse events associated with each LA technique, and (iii) to document these adverse events.
This was a prospective, 13 month observational study of routine practice in the UK in 2002-2003. The British Ophthalmological Surveillance Unit sent a monthly mailing to UK ophthalmologists, asking for reports of "potentially sight-threatening or life-threatening complications of LA for cataract surgery". Current LA practice was assessed by questionnaire.
Cataract surgery comprised 4.1% general anaesthesia, 92.1% LA without sedation and 3.9% LA with sedation. Of the estimated 375 000 LAs 30.6% were peribulbar, 3.5% retrobulbar, 42.6% sub-Tenon's, 1.7% sub-conjunctival, 9.9% topical and 11.0% topical-intracameral LA. "Potentially sight-threatening complications" were mostly associated with retrobulbar and peribulbar techniques and "potentially life-threatening" complications with all techniques except topical/intracameral LA. Eight neurological complications consistent with brainstem anaesthesia were reported: 7 with peribulbar or retrobulbar LA. Poisson regression analysis strongly indicated that rates vary with technique (p<0.001 for "potentially sight-threatening" complications, p = 0.03 for "neurological" complications). Because of likely under-reporting, further complications probably occurred during the survey period.
This large survey found a lower rate of reported serious complications with sub-Tenon's, topical and topical-intracameral LA compared with retrobulbar and peribulbar techniques. These "newer" methods may be preferable for routine cataract surgery.
球后、局部及前房内局部麻醉（LA）技术在常规手术中已很常见。
本研究旨在（i）评估白内障手术中各种局部麻醉技术的使用频率，（ii）评估每种局部麻醉技术相关严重不良事件的发生率，以及（iii）记录这些不良事件。
这是一项对2002 - 2003年英国常规手术进行的为期13个月的前瞻性观察研究。英国眼科监测单位每月向英国眼科医生发送邮件，索要“白内障手术局部麻醉潜在威胁视力或危及生命的并发症”报告。通过问卷调查评估当前局部麻醉的使用情况。
白内障手术中，4.1%为全身麻醉，92.1%为无镇静的局部麻醉，3.9%为有镇静的局部麻醉。在估计的375000例局部麻醉中，30.6%为球周麻醉，3.5%为球后麻醉，42.6%为球后下麻醉，1.7%为结膜下麻醉，9.9%为表面麻醉，11.0%为前房内表面麻醉。“潜在威胁视力的并发症”大多与球后和球周麻醉技术相关，“潜在危及生命的并发症”与除表面/前房内麻醉外的所有技术相关。报告了8例与脑干麻醉相符的神经并发症：7例与球周或球后局部麻醉有关。泊松回归分析强烈表明发生率因技术而异（“潜在威胁视力的”并发症p<0.001，“神经”并发症p = 0.03）。由于可能存在报告不足的情况，在调查期间可能还发生了其他并发症。
这项大规模调查发现，与球后和球周麻醉技术相比，球后下、表面及前房内表面麻醉报告的严重并发症发生率较低。这些“更新的”方法可能更适合常规白内障手术。
