Chakraborty Arunangshu, Bandyopadhyay Samir K, Mukhopadhyay Somnath
Regional Institute of Ophthalmology, Medical College, Kolkata, India.
Saudi J Ophthalmol. 2013 Jan;27(1):37-40. doi: 10.1016/j.sjopt.2011.12.002. Epub 2012 Jan 30.
To determine whether the combination of topical, intracameral and facial nerve blocks would produce adequate analgesia for repair of open globe injuries without increasing intraocular tension.
A comparison of combined O'Brien's block (facial nerve block), topical ropivacaine and intracameral lignocaine versus peribulbar block in 100 randomly selected cases of traumatic corneal rupture. Patients were randomly divided in two groups of 50 each based on those receiving the combined approach (Group T) and those undergoing peribulbar block (Group P). Patients were excluded if there was rupture with significant scleral extension, the interval between trauma and presentation greater than 2 h, presence of hypopyon, rupture with significant corneal oedema, expulsion of intraocular contents with a collapsed globe and monocular cases. The effect of the anaesthetic was compared by patient comfort and surgeon comfort, the incidence of vitreous prolapse and the requirement of incremental sedation. The Student's "t" test, the "Z" test, and Chi Square tests were used where appropriate. P < 0.05 was considered statistically significant.
The average patient comfort in Group P was 5.67% greater than Group T (P > 0.05). The average surgeon comfort and patient comfort between groups were similar (P > 0.05, both comparisons). Incremental sedation was required in 16% of patients in Group T compared to 8% in Group P (P = 0.218363). The total sedation dosage required for each group was similar. The incidence of vitreous prolapse was statistically significantly higher by 14% in Group P compared to Group T (P = 0.03731).
Our combined technique proved as efficacious as peribulbar block in providing adequate local anaesthesia and reducing the incidence of vitreous prolapse. We recommend greater use of this technique for repair of open globe injuries especially in locations where full time anaesthesia services are not available.
确定局部、前房内及面神经阻滞联合应用是否能在不增加眼压的情况下为开放性眼球损伤修复提供充分的镇痛效果。
在100例随机选取的外伤性角膜破裂病例中，比较奥布赖恩阻滞（面神经阻滞）、局部应用罗哌卡因和前房内应用利多卡因联合与球周阻滞的效果。根据接受联合方法（T组）和接受球周阻滞（P组）将患者随机分为两组，每组50例。若存在巩膜明显延伸的破裂、创伤与就诊间隔大于2小时、存在前房积脓、伴有明显角膜水肿的破裂、眼球塌陷伴眼内容物脱出以及单眼病例，则将患者排除。通过患者舒适度和外科医生舒适度、玻璃体脱出发生率以及追加镇静的需求来比较麻醉效果。在适当情况下使用学生“t”检验、“Z”检验和卡方检验。P<0.05被认为具有统计学意义。
P组患者的平均舒适度比T组高5.67%（P>0.05）。两组之间外科医生的平均舒适度和患者的平均舒适度相似（P>0.05，两项比较均如此）。T组16%的患者需要追加镇静，而P组为8%（P=0.218363）。每组所需的总镇静剂量相似。P组玻璃体脱出的发生率比T组统计学上显著高14%（P=0.03731）。
我们的联合技术在提供充分局部麻醉和降低玻璃体脱出发生率方面被证明与球周阻滞一样有效。我们建议更多地使用该技术来修复开放性眼球损伤，尤其是在没有全职麻醉服务的地方。
