Dong Ping, Wang Li-Fang, Zhang Li-Xiang, Li Fang, Yin Hui-Su, Dou Zhi-Xia, Huang Xiu-Ju, Xu Rui, Zhang Wu-Lin
Department of Acupuncture and Rehabilitation, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China.
Department of Surgical Anesthesia, Hebei Eye Hospital, Xingtai 054001, Hebei Province, China.
World J Clin Cases. 2023 Jul 26;11(21):5073-5082. doi: 10.12998/wjcc.v11.i21.5073.
During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.
To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.
A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups.
More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety.
Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.
在白内障手术麻醉过程中，丙美卡因的低pH值可能会引发疼痛或诸如角膜损伤和伤口愈合不良等并发症，术中使用额外滴眼液会增加并发症风险。因此，临床上需要局部麻醉辅助手段来提高麻醉效率并减少术中丙美卡因的用量。
确定一种用于老年白内障超声乳化手术的麻醉方法，该方法能提供更有效的镇痛并提高临床疗效。
本研究纳入了2020年12月至2022年12月期间到河北眼科医院就诊的130例老年白内障患者。患者被分为丙美卡因表面麻醉（SA）组（65例）和复合针灸药物麻醉组（CAMA组，65例）。CAMA组患者除表面麻醉外还接受针灸镇痛。比较两组患者术前焦虑程度[自评焦虑量表（SAS）评分和状态焦虑量表（SAI）评分]、术中应激反应、生命体征、镇痛效果及配合情况，以及术后不良事件。
CAMA组患者焦虑程度降低更为显著，SAS和SAI评分相应降低。手术过程中，CAMA组患者E、NE或Cor的分泌与术前相比无变化，明显低于SA组。CAMA组术中心率、血压和呼吸频率更稳定。此外，CAMA组术中疼痛发生率和所需额外麻醉剂量明显低于SA组。因此，CAMA组患者在手术过程中能够避免眼球运动和眼睑闭合，从而更配合手术医生。此外，CAMA组术中不良反应明显减少，表明总体安全性更高。
在老年白内障超声乳化手术中，与丙美卡因表面麻醉相比，丙美卡因表面麻醉联合针灸作为镇痛方法可提供更好的镇痛效果且安全性更高。
