The Glaucoma Service of Harkness Eye Institute, Columbia University Medical Center, New York, NY.
J Glaucoma. 2018 Jan;27(1):28-32. doi: 10.1097/IJG.0000000000000834.
The purpose of this study was to compare the required supplemental anesthesia and postoperative patient pain score in individuals undergoing glaucoma surgery under topical anesthesia (TA) versus retrobulbar anesthesia (RB).
A retrospective, interventional, comparative cohort study of 261 eyes of 225 patients undergoing glaucoma and combined glaucoma with cataract surgery were included in the study. The main outcome measures were the amount of supplemental, systemic intraoperative anesthesia used and the postoperative pain scale between patients undergoing TA versus RB anesthesia. A secondary analysis was performed between combined glaucoma and cataract surgery versus glaucoma surgery alone.
About 6.2% patients complained of pain after glaucoma surgery (8.1% among TA group and 3.1% among RB group; P=0.049). Overall, pain tended to be mild with a mean score of 0.32 of 10 for TA and 0.08 of 10 for RB (P=0.027). The amount of IV anesthetics used intraoperatively was lower in the RB anesthesia compared with the TA group (midazolam, P=0.042; fentanyl, P<0.001; propofol, P<0.001). In addition, patients undergoing RB anesthesia were less likely to use postoperative pain medication (P<0.001). There was no difference in pain score (P=0.707) or in the amount of IV anesthetics (all P>0.350) between eyes undergoing combined versus glaucoma surgery alone.
Although supplemental anesthesia and pain scores were statistically increased in the topical group, the prevalence and the severity of pain was low. Therefore, TA is feasible and a reasonable option for glaucoma surgery. Furthermore, this conclusion applies when glaucoma surgery is performed alone or in combination with the other eye surgery.
本研究旨在比较局部麻醉（TA）与球后麻醉（RB）下接受青光眼手术的患者所需的辅助麻醉和术后疼痛评分。
本研究为回顾性、介入性、对照队列研究，共纳入 225 名患者的 261 只眼，这些患者接受青光眼和联合白内障的青光眼手术。主要观察指标为接受 TA 与 RB 麻醉的患者之间术中使用的辅助全身麻醉剂的量和术后疼痛评分。对联合白内障和青光眼手术与单纯青光眼手术之间也进行了二次分析。
约 6.2%的患者在青光眼手术后出现疼痛（TA 组为 8.1%，RB 组为 3.1%；P=0.049）。总体而言，疼痛程度较轻，TA 组平均评分为 10 分中的 0.32 分，RB 组为 10 分中的 0.08 分（P=0.027）。与 TA 组相比，RB 麻醉术中使用的静脉麻醉剂较少（咪达唑仑，P=0.042；芬太尼，P<0.001；丙泊酚，P<0.001）。此外，接受 RB 麻醉的患者术后使用止痛药的可能性较低（P<0.001）。联合白内障与单纯青光眼手术相比，疼痛评分（P=0.707）或静脉麻醉剂用量（所有 P>0.350）均无差异。
尽管局部麻醉组的辅助麻醉和疼痛评分在统计学上有所增加，但疼痛的发生率和严重程度较低。因此，TA 是可行的，也是青光眼手术的合理选择。此外，当单独或联合其他眼部手术进行青光眼手术时，这一结论适用。
