Ghali Ashraf M, Mahfouz Abdulkader, Hafez Amr
Department of Anesthesiology, Magrabi Eye & Ear Hospital, Muscat, Oman.
Saudi J Anaesth. 2011 Apr;5(2):138-41. doi: 10.4103/1658-354X.82780.
This study compared the efficacy of single-injection percutaneous peribulbar anesthesia (PBA) with a short needle with sub-Tenon's anesthesia (STA) to produce optimal operating conditions for cataract extraction in patients with complicated cataract.
Two hundred patients with complicated cataract were enrolled in this prospective, double-blinded, randomized study. Adequate akinesia was a surgical requisite for all cases included in the study because of the expected difficult surgery. The patients were divided into two equal groups to receive either peribulbar anesthesia (PBA) with a 16-mm needle or sub-Tenon's anesthesia. Surgical akinesia (as a primary end point), analgesia, incidence of complications, as well as patient and surgeon satisfaction (as secondary end points) were assessed.
Both techniques provided similar analgesia during the operation and similar rates of incidence of chemosis with no serious complications; while the PBA group provided higher degree of akinesia 10 minutes after injection of the local anesthetic, a lower incidence of subconjunctival hemorrhage (SCH) and higher patient and surgeon satisfaction compared to the STA group.
We concluded that when globe akinesia is necessary during surgery, the single-injection technique for percutaneous peribulbar anesthesia with a short needle proved to be more suitable than the STA in providing akinesia for cataract surgery. Also, this PBA technique demonstrated a lower incidence of SCH and was preferred to STA by the patients and surgeon.
本研究比较了短针单次注射经皮球周麻醉(PBA)与球后 Tenon 囊下麻醉(STA)在为复杂白内障患者进行白内障摘除术时创造最佳手术条件方面的疗效。
200 例复杂白内障患者纳入了这项前瞻性、双盲、随机研究。由于预计手术难度较大,充分的眼球运动阻滞是本研究所有病例的手术必要条件。患者被分为两组,每组人数相等,分别接受 16 毫米针的球周麻醉(PBA)或球后 Tenon 囊下麻醉。评估手术中的眼球运动阻滞情况(作为主要终点)、镇痛效果、并发症发生率以及患者和外科医生的满意度(作为次要终点)。
两种技术在手术过程中提供了相似的镇痛效果,结膜水肿发生率相似,且无严重并发症;与 STA 组相比,PBA 组在注射局部麻醉剂 10 分钟后提供了更高程度的眼球运动阻滞,结膜下出血(SCH)发生率更低,患者和外科医生的满意度更高。
我们得出结论,当手术过程中需要眼球运动阻滞时,短针单次注射经皮球周麻醉技术在为白内障手术提供眼球运动阻滞方面比 STA 更合适。此外,这种 PBA 技术的 SCH 发生率更低,患者和外科医生更倾向于选择它而非 STA。