Cintra Léssia P, Lucena Levy R, Da Silva José A, Costa Rogério A, Scott Ingrid U, Jorge Rodrigo
Ribeirão Preto School of Medicine, São Paulo, Brazil.
Ophthalmic Surg Lasers Imaging. 2009 Jan-Feb;40(1):13-8. doi: 10.3928/15428877-20090101-05.
To compare the analgesic effectiveness and aesthetic appearance associated with topical, subconjunctival, and peribulbar anesthesia for intravitreal bevacizumab injection.
Sixty consecutive patients undergoing their first intravitreal bevacizumab injection were randomized to receive one of three forms of anesthesia: proxymetacaine eye drops, subconjunctival injection of 2% xylocaine, and peribulbar injection of 2% xylocaine. Pain associated with the intravitreal injection and with the entire procedure (including anesthesia administration) was recorded using a Visual Analog Scale 15 minutes after intravitreal injection. Anterior segment evaluation was performed 24 hours after injection to measure the number of clock hours of subconjunctival hemorrhage.
Median injection-related pain score was significantly lower in the peribulbar group compared with the topical and subconjunctival groups (P < .05). Median entire procedure pain score was significantly higher in the peribulbar group compared with the topical and subconjunctival groups (P < .05). The median extent of subconjunctival hemorrhage was significantly lower in the topical group compared with the other groups (P < .05).
Among the three anesthetic techniques, peribulbar anesthesia was associated with greater effectiveness in controlling injection-related pain but was least effective in controlling entire procedure pain. There was no significant difference in pain scores between the topical and subconjunctival groups, and topical anesthesia was associated with less subconjunctival hemorrhage.
比较玻璃体内注射贝伐单抗时局部麻醉、结膜下麻醉和球周麻醉的镇痛效果及美观程度。
连续60例首次接受玻璃体内注射贝伐单抗的患者被随机分为接受三种麻醉方式之一：丙美卡因滴眼液、结膜下注射2%利多卡因、球周注射2%利多卡因。玻璃体内注射15分钟后，使用视觉模拟评分法记录与玻璃体内注射及整个操作过程（包括麻醉给药）相关的疼痛。注射24小时后进行眼前节评估，测量结膜下出血的钟点数。
与局部麻醉组和结膜下麻醉组相比，球周麻醉组的注射相关疼痛评分中位数显著更低（P < .05）。与局部麻醉组和结膜下麻醉组相比，球周麻醉组的整个操作过程疼痛评分中位数显著更高（P < .05）。与其他组相比，局部麻醉组结膜下出血的中位数范围显著更低（P < .05）。
在这三种麻醉技术中，球周麻醉在控制注射相关疼痛方面效果更佳，但在控制整个操作过程疼痛方面效果最差。局部麻醉组和结膜下麻醉组的疼痛评分无显著差异，且局部麻醉与较少的结膜下出血相关。
