Bunke Josefine, Merdasa Aboma, Stridh Magne, Rosenquist Pernilla, Berggren Johanna, Hernandez-Palacios Julio E, Dahlstrand Ulf, Reistad Nina, Sheikh Rafi, Malmsjö Malin
Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden.
Department of Physics, Lund University, Lund, Sweden.
Ophthalmic Plast Reconstr Surg. 2022;38(5):462-468. doi: 10.1097/IOP.0000000000002163. Epub 2022 Apr 25.
Epinephrine is used in local anesthetics to induce vasoconstriction and thus reduce bleeding and prolong the anesthetic effect. Finding the optimal delay between the administration of the anesthetic and skin incision to ensure vasoconstriction and minimize bleeding is important and has recently become the subject of debate. This is the first study to assess blood perfusion and oxygen saturation (sO 2 ) simultaneously in response to a local anesthetic containing epinephrine in human oculoplastic surgery.
A local anesthetic consisting of lidocaine and epinephrine (20 mg/ml + 12.5 μg/ml) was injected in the eyelids of 9 subjects undergoing blepharoplasty. The perfusion and sO 2 of the eyelids were monitored using laser speckle contrast imaging and hyperspectral imaging, respectively.
Laser speckle contrast imaging monitoring showed a decrease in perfusion over time centrally at the site of injection. Half-maximum effect was reached after 34 seconds, and full effect after 115 seconds, determined by exponential fitting. The drop in perfusion decreased gradually further away from the injection site and hypoperfusion was less prominent 4 mm from the injection site, with a spatially dependent half-maximum effect of 231 seconds. Hyperspectral imaging showed only a slight decrease in sO 2 of 11 % at the injection site.
The optimal time delay for skin incision in oculoplastic surgery is approximately 2 minutes after the injection of lidocaine with epinephrine. Longer delay does not lead to a further decrease in perfusion. As sO 2 was only slightly reduced after injection, the results indicate that the use of epinephrine is safe in the periocular region.
肾上腺素用于局部麻醉剂以诱导血管收缩，从而减少出血并延长麻醉效果。找到麻醉给药与皮肤切口之间的最佳延迟时间以确保血管收缩并使出血最小化很重要，并且最近已成为争论的主题。这是第一项在人类眼部整形手术中评估含肾上腺素的局部麻醉剂作用下同时进行血液灌注和氧饱和度（sO₂）评估的研究。
将由利多卡因和肾上腺素（20mg/ml + 12.5μg/ml）组成的局部麻醉剂注射到9名接受眼睑成形术的受试者的眼睑中。分别使用激光散斑对比成像和高光谱成像监测眼睑的灌注和sO₂。
激光散斑对比成像监测显示，注射部位中心的灌注随时间减少。通过指数拟合确定，34秒后达到最大效应的一半，115秒后达到完全效应。灌注下降在远离注射部位处逐渐减小，在距注射部位4mm处灌注不足不太明显，最大效应的一半在空间上的依赖时间为231秒。高光谱成像显示注射部位的sO₂仅轻微下降11%。
眼部整形手术中皮肤切口的最佳延迟时间约为注射含肾上腺素的利多卡因后2分钟。更长的延迟不会导致灌注进一步降低。由于注射后sO₂仅轻微降低，结果表明在眼周区域使用肾上腺素是安全的。
