泪器扩张辅助下无切口与标准经Tenon 囊下阻滞：一项随机、前瞻性、非劣效性比较研究。

Lacrimal dilator-facilitated incisionless vs. standard sub-Tenon's block: a randomized, prospective and non-inferiority comparative study.

机构信息

Department of Ophthalmology, Nigde Omer Halisdemir University, Bor Yolu Uzeri, 51240, Nigde, Turkey.

Department of Anaesthesiology and Pain Medicine, Baskent University, School of Medicine, Adana Research and Education Centre, 01250, Adana, Turkey.

出版信息

Eye (Lond). 2021 Jul;35(7):1961-1966. doi: 10.1038/s41433-020-01207-0. Epub 2020 Oct 1.

DOI:10.1038/s41433-020-01207-0

PMID:33005046

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8225894/

Abstract

BACKGROUND/OBJECTIVES: Standard sub-Tenon's block (STB) involves incision (dissection) of conjunctiva and Tenon's capsule with the help of blunt scissors and forceps, insertion of a blunt sub-Tenon's cannula under the Tenon's capsule and injection of local anaesthetic agent. STB is frequently associated with minor complications such as chemosis and postoperative subconjunctival haemorrhage but rare sight and life-threatening complications. To reduce these minor complications, several variations of incisionless STB have been described however, there are no comparative data. One such incisionless STB involves the use of lacrimal dilator which is easily available in the operating theatre. We compared incisionless lacrimal dilator-facilitated with the standard STB for effectiveness, chemosis, and postoperative subconjunctival haemorrhage.

SUBJECTS/METHODS: After obtaining ethical approval, patients scheduled to undergo elective phacoemulsification cataract surgery were enroled to receive incisionless lacrimal dilator-facilitated STB (Group LD) or a standard STB using Wescott scissors and blunt forceps (Group WS). All patients received 3 mL 2% lidocaine without any adjuvant. No sedation was administered. Demographics of the patients, duration of the procedure, analgesia, akinesia, duration of the procedure intraoperative chemosis, and postoperative subconjunctival haemorrhage were compared.

RESULTS

Both groups were comparable for demographic data, duration of the procedure, analgesia, and akinesia (p > 0.05). The severity of chemosis and postoperative subconjunctival haemorrhage were significantly lower in Group LD (n = 32) in comparison to Group WS (n = 31) (p < 0.001).

CONCLUSIONS

Incisionless lacrimal dilator-facilitated STB decreases intraoperative chemosis and postoperative conjunctival haemorrhage in comparison to standard STB. Analgesia and akinesia are comparable in both techniques.

摘要

背景/目的：标准的经结膜下Tenon 囊（STB）阻滞需要在钝性剪刀和镊子的帮助下切开（分离）结膜和 Tenon 囊，将钝性的经结膜下 Tenon 套管插入 Tenon 囊下，并注入局部麻醉剂。STB 常伴有轻微并发症，如结膜水肿和术后球结膜下出血，但很少出现视力和危及生命的并发症。为了减少这些轻微的并发症，已经描述了几种无切口的 STB 改良方法，但是没有比较数据。其中一种无切口的 STB 改良方法涉及使用泪道扩张器，这种扩张器在手术室中很容易获得。我们比较了无切口泪道扩张器辅助下的标准 STB 阻滞在有效性、结膜水肿和术后球结膜下出血方面的差异。

受试者/方法：在获得伦理批准后，招募计划接受白内障超声乳化吸除术的患者，接受无切口泪道扩张器辅助下的 STB（LD 组）或使用 Wescott 剪刀和钝性镊子的标准 STB（WS 组）。所有患者均接受 3ml 2%利多卡因，不添加任何佐剂。未给予镇静。比较两组患者的人口统计学资料、手术时间、镇痛、运动障碍、术中结膜水肿、术后球结膜下出血的严重程度。