Zhu Y L, Mai Y J, Ye H J, Gan X L
State key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
Zhonghua Yi Xue Za Zhi. 2022 Jun 7;102(21):1579-1583. doi: 10.3760/cma.j.cn112137-20220307-00470.
To explore the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy (TAO) after orbital decompression. This study was a single-center, single-blind, randomized controlled study. From June 2020 to December 2020, sixty TAO patients in Zhongshan Ophthalmic center, Sun Yat-sen University who were allocated to receive orbital decompression under general anesthesia, were randomly and equally divided into two groups (=30): the control group (group C) and the medial canthus peribulbar block group (group PB). All patients received intravenous infusion of flurbiprofen axetil 50 mg at 15 min before the end of surgery. In PB group, patients received peribulbar block via caruncular approach for postoperative pain management upon completion of wound closure, while patients in group C did not receive the peribulbar block. If patient sufferred significant postoperative pain (NRS score≥4), Ketorolac 10 mg would be prescribed as analgesic rescue. Postoperative NRS pain scores were recorded at 2, 4, 8, 24, 48 h after the surgery. The usage of Ketorolac during 0-24 h and 24-48 h postoperatively were also recorded. Postoperative complications during the hospital stay were recorded. Severity of orbital swelling would also be evaluated at 24 h after surgery. The NRS pain scores [(, )] in group PB were 2.50(2.00, 3.00)and 2.00(1.75, 3.00), which were both significantly lower than those in group C of 4.50(3.00,5.00), 3.00(2.00,4.25)at 2 h, 4 h after surgery respectively(=0.001,0.045). During the first 24 h, the usage rate of Ketorolac in group C was 40%(12/30), which was higher than that in the group PB (13.3%, 4/30) with statistical significance (=0.041). There was no significant difference in the incidences of postoperative nausea, vomiting, dizziness during the first 48 h, as well as the moderate to severe intensity of orbital swelling at 24 h after surgery (all >0.05). There were no obvious complications of medial canthus peribulbar block in group PB. NSAIDs combined with medial canthus peribulbar block can provide satisfactory analgesia for TAO patients after orbital decompression, which is safe with little complications, and is beneficial to enhanced recovery after surgery.
探讨非甾体类抗炎药（NSAIDs）联合内眦球周阻滞用于甲状腺相关眼病（TAO）患者眼眶减压术后疼痛的镇痛效果及安全性。本研究为单中心、单盲、随机对照研究。2020年6月至2020年12月，中山大学中山眼科中心60例拟行全身麻醉下眼眶减压术的TAO患者，随机等分为两组（每组 =30例）：对照组（C组）和内眦球周阻滞组（PB组）。所有患者在手术结束前15分钟静脉输注氟比洛芬酯50mg。PB组患者在伤口缝合完成后经泪阜途径行球周阻滞用于术后疼痛管理，而C组患者未接受球周阻滞。若患者术后疼痛明显（数字分级法[NRS]评分≥4分），则给予酮咯酸10mg作为镇痛补救。记录术后2、4、8、24、48小时的NRS疼痛评分。记录术后0 - 24小时及24 - 48小时酮咯酸的使用情况。记录住院期间的术后并发症。术后24小时评估眼眶肿胀的严重程度。PB组术后2小时、4小时的NRS疼痛评分[（中位数，四分位数间距）]分别为2.50（2.00，3.00）和2.00（1.75，3.00），均显著低于C组的4.50（3.00，5.00）、3.00（2.00，4.25）（P =0.001，0.045）。术后24小时内，C组酮咯酸使用率为40%（12/30），高于PB组的13.3%（4/30），差异有统计学意义（P =0.041）。术后48小时内恶心、呕吐、头晕的发生率以及术后24小时眼眶肿胀的中重度发生率差异均无统计学意义（均P>0.05）。PB组未出现明显的内眦球周阻滞并发症。NSAIDs联合内眦球周阻滞可为TAO患者眼眶减压术后提供满意的镇痛效果，安全且并发症少，有利于促进术后康复。
