Çok Oya Yalçin, Eker Hatice Evren, Cantürk Silay, Yaycioğlu Rana, Ariboğan Aniş, Arslan Gülnaz
Department of Anaesthesiology and Reanimation, Başkent University, Ankara, Turkey.
Agri. 2011 Jan;23(1):43-6.
Ocular pain is often difficult to treat and may be caused by many eye diseases. The first step in pain management is medical therapy combined with analgesics; however, severe and resistant cases may require neurolytic eye blocks or definitive surgery. Retrobulbar block with neurolytic agents such as alcohol may be preferred, if the eye is cosmetically normal or the patient is medically or psychologically unsuitable for enucleation or evisceration. Here, we present our successful and efficient pain management using retrobulbar alcohol injection in 4 patients with painful blind eyes. Patients with neovascular glaucoma presenting with painful blind eyes were accepted to our clinic for pain management. The patients had continuous pain with an increasing severity in the recent months. We planned to perform retrobulbar alcohol injection as the pain of the patients was resistant to medical therapy. We noted measurement of verbal analogue scale for pain (VAS) before the block (7, 9, 9 and 10, respectively), after retrobulbar lidocaine and alcohol injection, at the postoperative 1st day, 1st, 2nd 3rd and 4th weeks, and 3rd, 4th, 5th, 6th and 12th months. Early and late complications were also recorded. On the first day after injection, no patient required additive analgesic therapy and their VAS scores were 0, 0, 0, and 3, respectively. Except for one patient who underwent enucleation because of a bacterial infection, the other three patients' VAS scores were 1, 0 and 1 at the 12th month assessment. We suggest that neurolytic retrobulbar block is an efficient pain management strategy in blind painful eyes.
眼痛通常难以治疗，可能由多种眼部疾病引起。疼痛管理的第一步是药物治疗联合使用镇痛药；然而，严重且难治的病例可能需要进行眼神经溶解阻滞或确定性手术。如果眼睛外观正常，或者患者在医学或心理上不适合眼球摘除术或眼内容剜除术，使用酒精等神经溶解剂进行球后阻滞可能是更好的选择。在此，我们介绍我们使用球后酒精注射对4例疼痛性盲眼患者进行成功且有效的疼痛管理的经验。因新生血管性青光眼导致疼痛性盲眼的患者被收入我们的诊所进行疼痛管理。这些患者在最近几个月一直感到疼痛，且疼痛程度不断加重。由于患者的疼痛对药物治疗无效，我们计划进行球后酒精注射。我们记录了阻滞前（分别为7、9、9和10）、球后利多卡因和酒精注射后、术后第1天、第1、2、3和4周以及第3、4、5、6和12个月时的疼痛视觉模拟量表（VAS）测量值。还记录了早期和晚期并发症。注射后的第一天，没有患者需要额外的镇痛治疗，他们的VAS评分分别为0、0、0和3。除了一名因细菌感染而接受眼球摘除术的患者外，其他三名患者在第12个月评估时的VAS评分分别为1、0和1。我们认为，眼神经溶解球后阻滞是治疗疼痛性盲眼的一种有效的疼痛管理策略。
