Ezra Daniel G, Nambiar Anil, Allan Bruce D
Department of External Disease, Moorfields Eye Hospital, London, United Kingdom.
Ophthalmology. 2008 Mar;115(3):455-87. doi: 10.1016/j.ophtha.2007.09.021. Epub 2007 Dec 3.
We consider a meta-analysis of randomized controlled trials (RCTs) comparing topical anesthesia alone with topical and intracameral anesthesia for phacoemulsification.
Topical anesthesia has become an increasingly popular option for day-case cataract surgery. Many surgeons now use supplementary intraoperative intracameral lidocaine, but the evidence base for the supplementary use of intracameral anaesthetic during cataract surgery has never been reviewed systematically.
METHODS/LITERATURE REVIEWED: The primary objective is to compare intraoperative pain for phacoemulsifications under topical anesthesia with and without intracameral anesthesia. The secondary objectives are to assess both adverse effects and complications attributable to choice of anesthesia and the need for additional anesthesia during surgery. Searches were made from the Cochrane Central Register of Controlled Trials, Medline, Excerpta Medica database, and Latin American and Caribbean Health Science Information Database up to and including June 8, 2006.
Eight RCTs, recruiting a total of 1281 patients, were identified. Our data comparison showed significantly lower intraoperative pain perception in patient groups using supplementary intracameral lidocaine. No significant difference in intraoperative adverse events, corneal toxicity, or the need for supplemental anesthesia was identified.
Intraoperative pain during cataract surgery under topical anaesthetic is reduced by intracameral lidocaine. Possible adverse effects of intracameral lidocaine cannot be excluded due to significant heterogeneity in outcome measures between different RCTs. Although a statistically significant reduction in intraoperative pain has been demonstrated, it is not yet possible to recommend this additional intervention without reservations.
我们对比较单纯表面麻醉与表面联合前房内麻醉用于白内障超声乳化手术的随机对照试验（RCT）进行了一项荟萃分析。
表面麻醉已成为日间白内障手术越来越受欢迎的选择。现在许多外科医生在术中使用补充性前房内利多卡因，但白内障手术中补充使用前房内麻醉剂的证据基础从未得到系统回顾。
方法/文献回顾：主要目的是比较有和无前房内麻醉的表面麻醉下白内障超声乳化手术的术中疼痛。次要目的是评估因麻醉选择导致的不良反应和并发症以及手术期间额外麻醉的需求。检索了截至2006年6月8日的Cochrane对照试验中央登记册、Medline、医学文摘数据库以及拉丁美洲和加勒比健康科学信息数据库。
确定了8项RCT，共纳入1281例患者。我们的数据比较显示，使用补充性前房内利多卡因的患者组术中疼痛感知显著更低。未发现术中不良事件、角膜毒性或补充麻醉需求方面的显著差异。
前房内利多卡因可减轻表面麻醉下白内障手术的术中疼痛。由于不同RCT之间结局指标存在显著异质性，前房内利多卡因可能的不良反应不能排除。尽管已证明术中疼痛有统计学显著降低，但目前还不能毫无保留地推荐这种额外干预措施。
