Ajay K, Subhasree Revuru Kanaka, Poka Avinash
Department of Ophthalmology, The Oxford Medical College Hospital and Research Center, Bengaluru, Karnataka, India.
Department of Ophthalmology, P. E. S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India.
J Curr Ophthalmol. 2021 Oct 22;33(3):266-271. doi: 10.4103/2452-2325.329083. eCollection 2021 Jul-Sep.
To compare the effectiveness of anterior subconjunctival anesthesia (ASCA) with sub-tenon's anesthesia (STA) for manual small incision cataract surgery (MSICS), regarding pain, akinesia, surgeon comfort, and complications.
This trial randomized 164 patients into two groups. Group 1 received ASCA, and Group 2 received STA. MSICS was performed on all patients. Any complications of anesthesia were noted before starting surgery. Patient ocular motility during surgery was scored between 0 and 4 based on the number of directions of gaze in which movement persisted. Following surgery, patients scored pain felt during surgery on a visual pain-score analog, and the surgeon graded for "discomfort" felt during surgery from 0 (Nil) to 4 (additional anesthesia needed).
Chemosis due to anesthesia and persistence of ocular motility in all four gaze directions were seen in all 82 patients of Group 1, but these did not prevent the surgeon from performing MSICS. Seventy-seven patients (94%) in Group 1 and 79 (96.4%) in Group 2 had no or mild pain during surgery. The surgeon had moderate-to-severe discomfort in 14 (17.2%) Group 1 patients and 3 (3.6%) Group 2 patients, most of whom had deep-set eyes or exhibited excessive eye movements. Two patients in Group 1 and one patient in Group 2 were converted to peribulbar block.
ASCA is a safe and effective alternative for performing MSICS. It does not induce akinesia but provides adequate anesthesia for the surgery in most patients, except those with deep-set eyes, especially if displaying increased anxiety.
比较结膜下浸润麻醉（ASCA）与球周麻醉（STA）用于手法小切口白内障手术（MSICS）时在疼痛、眼球运动麻痹、术者舒适度及并发症方面的效果。
本试验将164例患者随机分为两组。第1组接受结膜下浸润麻醉，第2组接受球周麻醉。所有患者均接受手法小切口白内障手术。在手术开始前记录麻醉的任何并发症。根据手术中眼球仍能转动的注视方向数量，对患者手术期间的眼球运动进行0至4分的评分。手术后，患者根据视觉模拟疼痛评分法对手术期间感受到的疼痛进行评分，术者对手术期间感受到的“不适”程度从0（无）至4（需要追加麻醉）进行分级。
第1组的所有82例患者均出现了麻醉导致的结膜水肿以及在所有四个注视方向上均存在眼球运动，但这些情况并未妨碍术者进行手法小切口白内障手术。第1组77例患者（94%）和第2组79例患者（96.4%）在手术期间无疼痛或仅有轻微疼痛。第1组有14例患者（17.2%）、第2组有3例患者（3.6%）术者有中度至重度不适，其中大多数患者眼窝深陷或眼球运动过度。第1组有2例患者、第2组有1例患者改为球周阻滞麻醉。
结膜下浸润麻醉是进行手法小切口白内障手术的一种安全有效的替代方法。它不会导致眼球运动麻痹，但在大多数患者中可为手术提供足够的麻醉，除了眼窝深陷的患者，尤其是那些焦虑情绪增加的患者。
