Välimäki J O
Department of Ophthalmology, Central Hospital of Lahti, Lahti, Finland and Department of Ophthalmology, University of Tampere, Tampere, Finland.
Eur J Ophthalmol. 2007 May-Jun;17(3):332-5. doi: 10.1177/112067210701700309.
To evaluate the usefulness of intracameral lidocaine in cataract surgery under topical anesthesia and especially if the patient wanted intravenous sedation preoperatively.
In this prospective study 96 patients were randomly assigned to receive 0.5 cc of balanced salt solution (Group 1) or 1% unpreserved lidocaine (Group 2). Patients who wanted sedation received intravenous midazolam hydrochloride. All surgery was done by one surgeon using a clear corneal technique.
Mean pain scores were 0.73 (of a maximum 3) in Group 1 and 0.54 in Group 2; the difference between groups was not statistically significant. Forty patients in Group 1 (83%) and 44 patients in Group 2 (92%) reported no discomfort or only mild discomfort. The two study groups were comparable in need for intravenous midazolam. Logistic regression analysis showed a significant relationship between pain scores and intravenous sedation (p=0.02) but not with intracameral lidocaine or other tested variables. However, odds ratio for pain increased to 5.1 (95% CI; 1.29-20.41) in participants without intravenous sedation compared to those with sedation.
The results of the present study suggest that intravenous sedation preoperatively seems to be an important determinant to relieve the sensation of discomfort/pain during small incision cataract surgery, but intracameral lidocaine was shown not to have a clinically useful role.
评估前房内注射利多卡因在表面麻醉下白内障手术中的效用，特别是在患者术前需要静脉镇静的情况下。
在这项前瞻性研究中，96例患者被随机分配接受0.5毫升平衡盐溶液（第1组）或1%无防腐剂的利多卡因（第2组）。需要镇静的患者接受静脉注射盐酸咪达唑仑。所有手术均由一名外科医生采用透明角膜技术完成。
第1组平均疼痛评分为0.73（满分3分），第2组为0.54；两组之间的差异无统计学意义。第1组40例患者（83%）和第2组44例患者（92%）报告无不适或仅有轻微不适。两个研究组在静脉注射咪达唑仑的需求方面具有可比性。逻辑回归分析显示疼痛评分与静脉镇静之间存在显著关系（p = 0.02），但与前房内注射利多卡因或其他测试变量无关。然而，与接受镇静的参与者相比，未接受静脉镇静的参与者疼痛的优势比增加到5.1（95%置信区间；1.29 - 20.41）。
本研究结果表明，术前静脉镇静似乎是减轻小切口白内障手术中不适/疼痛感觉的重要决定因素，但前房内注射利多卡因未显示出具有临床有用作用。
