[透明质酸酶对球后麻醉后球后区域麻醉药分布的影响]

Surbatović Maja, Kendrisić Mirjana, Jevtić Miodrag, Filipović Nikola, Popović Nada, Slavković Zoran

Vojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd, Srbija.

Vojnosanit Pregl. 2008 Jul;65(7):525-31. doi: 10.2298/vsp0807525s.

BACKGROUND/AIM: Sub-Tenon's block is nowadays commonly used in ophthalmic surgery because of its safety and efficacy. The aim of this study was to investigate the distribution of the anaesthetic solution with different amounts of hyaluronidase in the retrobulbar space, following an injection into the Sub-Tenon's space.

METHODS

In this experimental study, 40 pig cadaver heads were used (80 eyeballs). The material was divided into four groups (of 20 eyeballs each). Each group was administered 4.5 ml of a mixture of 2% lignocaine, 0.5% bupivacaine, and 0.5 ml of Indian ink, with different amounts of hyaluronidase--15 IU/ml, 75 IU/ml, 150 IU/ml, except the control one. Samples of retrobulbar tissue were analysed using the standard histopathological procedure. After that, they were also analysed using the Adobe Photoshop program (Windows, USA). The retrobulbar space was divided into eight zones by four perpendicular lines, which crossed in the centre of the optic nerve. The presence of ink in fat and muscle tissues and in the sheath of the optic nerve was observed.

RESULTS

The presence of the local anaesthetic solution was significantly higher in inferonasal and superonasal quadrants of the fat and muscle tissues (p < 0.01). The distribution in optic nerve sheath is similar in each quadrant. Distribution of local anesthetic in each zone of the muscle tissue (I-VIII) was strongly influenced by the amount of hyaluronidase added. In the fat tissue, the distribution of local anesthetic under the influence of hyaluronidase was significantly higher (p < 0.05) in the areas which were distant from the place of injection (I-IV). The distribution in the optic nerve sheath is significantly higher (p < 0.01) in the group with 150 IU/ml of hyaluronidase.

CONCLUSIONS

Following a sub-Tenon block local anaesthetic was present in the retrobulbar space in a high percentage of the cases. The presence of local anaesthetic solution in retrobulbar space depends on the amount of hyaluronidase previously added to the local anaesthetic.

背景/目的：由于其安全性和有效性，球后Tenon囊下阻滞如今在眼科手术中被广泛应用。本研究的目的是在向Tenon囊下间隙注射后，研究不同剂量透明质酸酶的麻醉溶液在球后间隙的分布情况。

方法

在本实验研究中，使用了40个猪尸头（80只眼球）。材料被分为四组（每组20只眼球）。除对照组外，每组均给予4.5毫升由2%利多卡因、0.5%布比卡因和0.5毫升印度墨水组成的混合物，并添加不同剂量的透明质酸酶——15国际单位/毫升、75国际单位/毫升、150国际单位/毫升。使用标准组织病理学程序对球后组织样本进行分析。之后，还使用Adobe Photoshop程序（美国，Windows系统）进行分析。通过四条在视神经中心交叉的垂直线将球后间隙分为八个区域。观察脂肪和肌肉组织以及视神经鞘中墨水的存在情况。

结果

脂肪和肌肉组织的鼻下象限和鼻上象限中局部麻醉溶液的存在显著更高（p < 0.01）。视神经鞘中的分布在每个象限相似。添加的透明质酸酶量对肌肉组织每个区域（I - VIII）中局部麻醉剂的分布有强烈影响。在脂肪组织中，在远离注射部位的区域（I - IV），透明质酸酶影响下局部麻醉剂的分布显著更高（p < 0.05）。透明质酸酶含量为150国际单位/毫升的组中，视神经鞘中的分布显著更高（p < 0.01）。