Department of Anaesthesia, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK.
Br J Ophthalmol. 2012 Feb;96(2):189-92. doi: 10.1136/bjo.2010.198374. Epub 2011 May 5.
Total volume using a standard single inferonasal injection for sub-Tenon's anaesthesia is limited by an increase in intraocular pressure (IOP) and commonly requires the operating surgeon to top-up the block intraoperatively. This study compares the efficacy and safety of a two-quadrant technique that allows the use of a higher volume of local anaesthetic.
54 patients undergoing vitrectomy were randomised into two groups. The control group (n=27) received a standard 5 ml single inferonasal sub-Tenon injection of a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine with 150 IU hyaluronidase. The study group (n=27) received a 5 ml inferonasal and 5 ml superotemporal injection of the same mixture (10 ml total). The primary outcome measure was the number of intraoperative top-ups required. Secondary outcome measures were intraoperative and postoperative pain scores, IOP, block onset time, ocular akinesia, eyelid akinesia and chemosis.
24 patients required a top-up in the control group. No patients required a top-up in the study group (p<0.001). IOP measurements were similar in both groups. Block onset was shorter, eyelid akinesia was improved and pain scores were also reduced in the study group intraoperatively and at 0-2 h, 4-6 h, 10-14 h and 20-24 h postoperatively.
Two-quadrant sub-Tenon's anaesthesia using 10 ml of a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine with 150 IU hyaluronidase seems to be more effective than a single-quadrant technique at reducing intraoperative and postoperative pain during vitrectomy.
经下眼窝 Tenon's 囊麻醉的标准单鼻内注射的总容量受眼内压（IOP）升高的限制，通常需要手术医生在手术过程中补充阻滞。本研究比较了两种象限技术的疗效和安全性，这两种技术允许使用更高容量的局部麻醉剂。
54 例接受玻璃体切除术的患者被随机分为两组。对照组（n=27）接受 5 ml 标准单鼻内下眼窝 Tenon's 囊注射 50:50 混合 2%利多卡因和 0.5%布比卡因，含 150 IU 透明质酸酶。研究组（n=27）接受 5 ml 鼻内和 5 ml 上方颞部注射相同的混合物（总共 10 ml）。主要观察指标是术中需要补充的次数。次要观察指标为术中及术后疼痛评分、IOP、阻滞起效时间、眼球运动障碍、眼睑运动障碍和球结膜水肿。
对照组有 24 例患者需要补充。研究组无患者需要补充（p<0.001）。两组 IOP 测量值相似。研究组在术中及 0-2 h、4-6 h、10-14 h 和 20-24 h 时，阻滞起效时间更短，眼睑运动障碍改善，疼痛评分降低。
使用 10 ml 50:50 混合 2%利多卡因和 0.5%布比卡因，含 150 IU 透明质酸酶的双象限下眼窝 Tenon's 囊麻醉似乎比单象限技术更能有效减少玻璃体切除术中及术后疼痛。
