皇家眼科医师学院国家眼科数据库白内障手术研究：报告 11，英国白内障手术局部麻醉的技术和并发症。
Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 11, techniques and complications of local anesthesia for cataract surgery in the United Kingdom.
机构信息
From the Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Neo); The Royal College of Ophthalmologists' National Ophthalmology Audit, London, United Kingdom (Gruszka-Goh, Donachie, Buchan); Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom (Gruszka-Goh, Donachie); Worcestershire Acute Hospitals NHS Trust, Worchester, United Kingdom (Braga); Manchester University NHS Foundation Trust, Manchester, United Kingdom (de Klerk); Royal Surrey NHS Foundation Trust, Guildford, United Kingdom (Lindfield); Northern Devon Healthcare NHS Trust, Devon, United Kingdom (Nestel); Belfast Health and Social Care Trust, Belfast, United Kingdom (Stewart); Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom (Stewart); International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (Buchan); Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom (Buchan).
出版信息
J Cataract Refract Surg. 2023 Dec 1;49(12):1216-1222. doi: 10.1097/j.jcrs.0000000000001289.
PURPOSE
To describe variation in local anesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom.
SETTING
Reporting centers to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD).
DESIGN
Retrospective cross-sectional register-based study.
METHODS
Data from the RCOphth NOD were used. Eligible for analysis were 1 195 882 cataract operations performed using local anesthesia between April 1, 2010, and March 31, 2020, in 80 centers.
RESULTS
Overall, topical anesthesia alone was used in 152 321 operations (12.7%), combined topical and intracameral in 522 849 (43.7%), sub-Tenon in 461 175 (38.6%), and peribulbar/retrobulbar in 59 537 (5.0%). In National Health Service (NHS) institutions, 48.3% of operations were topical with/without intracameral vs 88.7% in independent sector treatment centers (ISTCs). 45.9% were sub-Tenon in NHS vs 9.6% in ISTCs. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTCs. Anesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTCs). Overall anesthetic complication rates were 0.3%, 0.3%, 3.5%, and 3.1% for topical alone, combined topical/intracameral, sub-Tenon, and peribulbar/retrobulbar, respectively. Complication rates were higher for sharp-needle anesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; P = .024). Considerable variation was observed between centers on anesthetic choices and anesthetic complication rates.
CONCLUSIONS
Combined topical and intracameral is the most common choice of anesthesia for cataract surgery in the United Kingdom and is associated with lower anesthetic-related complication rates than sub-Tenon and peribulbar/retrobulbar anesthesia. Variation in the anesthetic choice exists between centers and between NHS and ISTC sectors.
目的
描述 10 年间英国白内障手术中局部麻醉技术和并发症的变化。
背景
向皇家眼科医师学院（RCOphth）国家眼科数据库（NOD）报告中心报告。
设计
回顾性横断面基于登记的研究。
方法
使用 RCOphth NOD 的数据。在 80 个中心中，对 2010 年 4 月 1 日至 2020 年 3 月 31 日期间使用局部麻醉进行的 1195882 例白内障手术进行了分析。
结果
总体而言，单独使用表面麻醉的手术有 152321 例（12.7%），联合使用表面和眼内麻醉的手术有 522849 例（43.7%），行颞浅筋膜下麻醉的手术有 461175 例（38.6%），行球后/肌间麻醉的手术有 59537 例（5.0%）。在国民保健制度（NHS）机构中，48.3%的手术为表面麻醉加/不加眼内麻醉，而独立治疗中心（ISTC）的比例为 88.7%。NHS 中颞浅筋膜下麻醉的比例为 45.9%，而 ISTC 中为 9.6%。NHS 中球后/肌间麻醉的比例为 5.8%，而 ISTC 中为 1.7%。麻醉并发症的发生率从 2010 年 NHS 年份的 2.7%下降到 2019 年 NHS 年份的 1.5%（总体而言，NHS 为 2.1%；ISTC 为 0.2%）。单独使用表面麻醉、联合使用表面/眼内麻醉、颞浅筋膜下麻醉和球后/肌间麻醉的麻醉并发症发生率分别为 0.3%、0.3%、3.5%和 3.1%。接受华法林治疗而非直接口服抗凝剂的患者中，使用锐针麻醉（球后/肌间）的麻醉并发症发生率更高（4.8%比 3.1%；P=0.024）。在麻醉选择和麻醉并发症发生率方面，不同中心之间存在显著差异。
结论
联合表面和眼内麻醉是英国白内障手术中最常见的麻醉选择，与颞浅筋膜下和球后/肌间麻醉相比，与麻醉相关的并发症发生率较低。不同中心之间以及 NHS 和 ISTC 之间存在麻醉选择的差异。
Zotero 插件