Bergman Louise, Bäckmark Ingrid, Ones Håkon, von Euler Christopher, Olivestedt Göran, Kvanta Anders, Stéen Björn, Seregard Stefan, Nilsson Bo, Berglin Lennart
Department of Vitreoretinal Diseases, St. Erik's Eye Hospital, Stockholm, Sweden.
Ophthalmology. 2007 Nov;114(11):2055-60. doi: 10.1016/j.ophtha.2006.12.031. Epub 2007 Apr 18.
To evaluate the effects of preoperative sub-Tenon's capsule injection of ropivacaine on intraoperative hemodynamics, postoperative pain, nausea, and recovery in patients undergoing scleral buckling surgery under general anesthesia (GA).
Randomized double-masked controlled clinical trial.
Ninety-eight patients with primary rhegmatogenous retinal detachment undergoing scleral buckling surgery under GA.
Random allocation to either preoperative sub-Tenon's capsule injection of 3 ml of 0.75% ropivacaine or sub-Tenon's capsule injection of 3 ml of saline (controls) immediately before a scleral buckling procedure under GA. Intraoperative monitoring of hemodynamic parameters, need of analgesia with sevoflurane and alfentanil, time in the recovery unit, measurements of pain and nausea on the visual analog scale (VAS) up to 12 hours postoperatively, and consumption of analgesics and antiemetics was recorded.
Intraoperative systolic blood pressure (BP); bradycardia; minimum alveolar concentration (MAC) of sevoflurane; maximum postoperative VAS scores of pain and nausea; time in recovery unit; and total need of alfentanil, ketobemidone, dextropropoxyphene, and dixyrazine.
Ninety-seven patients were analyzed (48 in the ropivacaine group and 49 controls). A significantly lower intraoperative systolic BP (104+/-6 vs. 112+/-7 mmHg; P = 0.004), less need of sevoflurane (1.33+/-0.19 vs. 1.56+/-0.23; P = 0.03), and shorter time in the recovery unit (67+/-9 vs. 76+/-16 minutes; P = 0.01) were observed in the ropivacaine group. Maximum VAS pain scores were 50+/-21 in the control group and 36+/-25 in the ropivacaine group (P = 0.05), with a significantly lower consumption of opioids (ketobemidone) in the ropivacaine group (3.6+/-3.5 vs. 1.3+/-2.0 mg). No significant difference was observed regarding nausea or need of dixyrazine or dextropropoxyphene postoperatively.
Preoperative sub-Tenon's capsule injection of ropivacaine in scleral buckling surgery under GA lowers the intraoperative systolic BP, reduces the amount of inhalable sevoflurane needed, and enhances postoperative vigilance through reduction of pain and need of opioids.
评估全麻下行巩膜扣带术患者术前球后Tenon囊注射罗哌卡因对术中血流动力学、术后疼痛、恶心及恢复情况的影响。
随机双盲对照临床试验。
98例全麻下行巩膜扣带术的原发性孔源性视网膜脱离患者。
随机分为两组，一组在全麻下行巩膜扣带术前即刻球后Tenon囊注射3ml 0.75%罗哌卡因，另一组注射3ml生理盐水（对照组）。记录术中血流动力学参数、七氟醚和阿芬太尼的镇痛需求、在恢复室的时间、术后12小时内视觉模拟量表（VAS）的疼痛和恶心评分以及镇痛药和止吐药的使用情况。
术中收缩压（BP）；心动过缓；七氟醚的最低肺泡浓度（MAC）；术后疼痛和恶心的最大VAS评分；在恢复室的时间；以及阿芬太尼、凯托米酮、右丙氧芬和地西拉嗪的总需求量。
分析了97例患者（罗哌卡因组48例，对照组49例）。罗哌卡因组术中收缩压显著降低（104±6 vs. 112±7 mmHg；P = 0.004），七氟醚需求量减少（1.33±0.19 vs. 1.56±0.23；P = 0.03），在恢复室的时间缩短（67±9 vs. 76±16分钟；P = 0.01）。对照组VAS疼痛最大评分50±21，罗哌卡因组为36±25（P = 0.05），罗哌卡因组阿片类药物（凯托米酮）使用量显著降低（3.6±3.5 vs. 1.3±2.0 mg）。术后恶心、地西拉嗪或右丙氧芬的需求无显著差异。
全麻下行巩膜扣带术患者术前球后Tenon囊注射罗哌卡因可降低术中收缩压，减少所需吸入性七氟醚量，并通过减轻疼痛和阿片类药物需求提高术后警觉性。
