Lee Edward J K, Khandwala Mona, Jones Carole A
The Eye Ear and Mouth Unit, Maidstone Hospital, Barming, Kent ME169QQ, UK.
Orbit. 2009;28(6):388-91. doi: 10.3109/01676830903071240.
Ptosis surgery is performed under local anaesthetic to allow intra-operative assessment of lid positioning. Most commonly the anaesthetic is administered as a subcutaneous infiltration at the surgical site. Ptosis surgery using a regional nerve block has also been described, with reported advantages for minimising levator paralysis and disruption of the surgical landmarks. This study was designed to compare patient satisfaction with the two techniques of local anaesthetic administration.
32 patients undergoing ptosis surgery were enrolled into a randomised controlled trial to receive local anaesthetic either by subcutaneous infiltration or by regional nerve block. Patient satisfaction was measured postoperatively with a self-administered vertical response column questionnaire, the Iowa Satisfaction with Anaesthesia Scale (ISAS).
Of the 32 patients who were recruited 3 patients were excluded from analysis due to incomplete questionnaires or deviation from the trial protocol. Patient groups were well matched in terms of age, sex, time on waiting list, anaesthetic risk score, and operating grade of surgeon. Comparison of ISAS scores with the Mann Whitney test demonstrated an equal level of patient satisfaction with the two techniques.
This randomised controlled trial found regional nerve blocks to be associated with equal levels of patient satisfaction as the more standard technique of diffuse infiltration of local anaesthetic along the upper eyelid. This result supports the use of regional nerve blocks as a valid alternative for anaesthesia in ptosis surgery.
上睑下垂手术在局部麻醉下进行，以便术中评估眼睑位置。最常见的麻醉方式是在手术部位进行皮下浸润。也有文献描述了使用区域神经阻滞进行上睑下垂手术，据报道其优点是可将提上睑肌麻痹和手术标志破坏降至最低。本研究旨在比较患者对两种局部麻醉给药技术的满意度。
32例行上睑下垂手术的患者被纳入一项随机对照试验，分别接受皮下浸润或区域神经阻滞局部麻醉。术后采用自行填写的垂直反应栏问卷即爱荷华麻醉满意度量表（ISAS）来测量患者满意度。
在招募的32例患者中，3例因问卷不完整或偏离试验方案而被排除在分析之外。患者组在年龄、性别、等待手术时间、麻醉风险评分和手术医生的操作级别方面匹配良好。采用曼-惠特尼检验比较ISAS评分，结果显示两种技术的患者满意度水平相当。
这项随机对照试验发现，区域神经阻滞与沿上睑弥漫性浸润局部麻醉这种更标准的技术相比，患者满意度相当。这一结果支持将区域神经阻滞作为上睑下垂手术麻醉的一种有效替代方法。
