Ibrahim M, Gomaa E
Department of Anesthesiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Al Jedaani Hospital - AL Safa Dist., Prince Moteb Street, P.O.Box 7500, 21462, Jeddah, Saudi Arabia.
Anaesthesist. 2019 Mar;68(3):143-151. doi: 10.1007/s00101-018-0525-3. Epub 2019 Jan 9.
Peribulbar block is considered a safe option for patients undergoing cataract surgery. The limited duration of regional eye blocks was shown to be the main problem. The objective of this study was to evaluate the effects of adjuvant midazolam (in two concentrations) to lidocaine in the peribulbar block.
This study included 90 adult patients aged 40-70 years undergoing cataract surgery. Each patient was appointed to one of three groups. Group C received a single injection of a peribulbar block using a combination of lidocaine 2% and hyaluronidase 15 IU/ml, group M1 received a combination of lidocaine 2%, hyaluronidase 15 IU/ml plus midazolam 50 µg/ml and group M2 received lidocaine 2%, hyaluronidase 15 IU/ml plus midazolam 100 µg/ml.
The quality of the peribulbar block showed significant improvement among groups by one-way ANOVA (p = 0.002). The mean onset time of the sensory block was significantly shorter in the M2 and M1 groups (1.66 min and 2.17 min, respectively) compared to the control group C (2.52 min), while the onset of lid and globe akinesia lacked significance between the three groups (p = 0.23 and 0.06, respectively). Significance in mean values was found between the control (C) and M2 groups regarding orbicularis oculi function, digital spear pressure, topical anesthetic sting and the total score (P-values = 0.004, 0.016, 0.033 and 0.001, respectively). The duration of lid akinesia and sensory anesthesia were significantly different between the three groups (P = 0.048 and P<0.001, respectively) whereas the duration of globe akinesia was insignificant (P = 0.432).
Addition of midazolam to local anesthetic significantly improved the quality of peribulbar block, hastened the onset of sensory anesthesia, lid and globe akinesia and increased the duration of analgesia without notable side effects.
球周阻滞被认为是白内障手术患者的一种安全选择。区域眼阻滞持续时间有限被证明是主要问题。本研究的目的是评估辅助使用咪达唑仑（两种浓度）与利多卡因用于球周阻滞的效果。
本研究纳入90例年龄在40 - 70岁接受白内障手术的成年患者。每位患者被分配到三组中的一组。C组接受单次注射由2%利多卡因和15 IU/ml透明质酸酶组成的球周阻滞，M1组接受由2%利多卡因、15 IU/ml透明质酸酶加50 μg/ml咪达唑仑组成的联合用药，M2组接受由2%利多卡因、15 IU/ml透明质酸酶加100 μg/ml咪达唑仑组成的联合用药。
通过单因素方差分析，球周阻滞质量在各组间有显著改善（p = 0.002）。与C组（2.52分钟）相比，M2组和M1组感觉阻滞的平均起效时间显著缩短（分别为1.66分钟和2.17分钟），而三组间眼睑和眼球运动不能的起效时间无显著差异（分别为p = 0.23和0.06）。在眼轮匝肌功能、指压觉、表面麻醉刺痛和总分方面，C组和M2组之间的平均值有显著差异（P值分别为0.
