Tuzcu Kasim, Coskun Mesut, Tuzcu Esra Ayhan, Karcioglu Murat, Davarci Isil, Hakimoglu Sedat, Aydın Suzan, Turhanoglu Selim
Department of Anesthesiology and Reanimation, Medical Faculty of the Mustafa Kemal University, Hatay, Turkey.
Department of Ophthalmology, Medical Faculty of the Mustafa Kemal University, Hatay, Turkey.
Braz J Anesthesiol. 2015 Sep-Oct;65(5):349-52. doi: 10.1016/j.bjane.2014.02.003. Epub 2014 Mar 11.
Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.
Forty patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.
There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05).
In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.
斜视手术是一种常见的小儿眼科手术。接受该治疗的患者中经常出现的一个主要问题是眼心反射。这种反射与术后恶心、呕吐和疼痛的发生率增加有关。本研究的目的是探讨球后阻滞对眼心反射、疼痛以及术后恶心和呕吐的影响。
本研究纳入了40例年龄在5至16岁、美国麻醉医师协会分级为I-II级、接受择期斜视手术的患者。采用密封信封法将纳入的患者随机分为两组。第1组（n = 20）患者未接受球后麻醉。第2组（n = 20）患者在插管后，对手术眼进行球后麻醉。比较两组之间阿托品的使用情况、疼痛评分、眼心反射以及术后恶心和呕吐的发生率。
两组在眼心反射和阿托品使用方面无显著差异（p>0.05）。术后30分钟时，第2组的疼痛评分显著低于第1组（p<0.05）。与第1组相比，第2组术后所需的额外镇痛药显著更少（p<0.05）。
总之，我们认为球后阻滞联合全身麻醉在降低眼心反射和术后恶心呕吐方面效果不佳且不可靠。然而，这种方法在减轻小儿斜视手术术后疼痛及减少所需额外镇痛方面是安全的。
