表面麻醉和球结膜下麻醉与单纯表面麻醉在老年性白内障患者行超声乳化术中的比较：一项双盲随机对照试验。

Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial.

机构信息

Department of Ophthalmology, Sawanpracharak Hospital, Nakhon Sawan, Thailand.

Center of Excellent in Glaucoma, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.

出版信息

BMC Ophthalmol. 2024 Jan 12;24(1):20. doi: 10.1186/s12886-024-03284-1.

DOI:10.1186/s12886-024-03284-1

PMID:38216983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10785538/

Abstract

BACKGROUND

This study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification.

METHODS

This double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher's exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors.

RESULTS

In total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique.

CONCLUSIONS

The addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage.

TRIAL REGISTRATION

Trial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.

摘要

背景

本研究比较了表面麻醉与表面麻醉联合球结膜下麻醉在白内障超声乳化术中的应用。

方法

这是一项双盲平行安慰剂对照随机试验，纳入了 2022 年 5 月至 12 月期间计划行白内障超声乳化术的老年性白内障患者。患者随机分为接受 0.5%盐酸丁卡因和球结膜下平衡盐溶液注射的表面麻醉（对照组）或表面麻醉和 2%利多卡因球结膜下注射（利多卡因组）。记录基线参数、白内障分级和各种结果，包括特定时间点的疼痛评分、患者合作评分、对额外麻醉的要求和并发症。统计方法包括 Fisher 确切检验、t 检验、有序逻辑回归和稳健标准误差的线性回归。

结果

在排除 33 例患者后，共有 176 例患者纳入研究。利多卡因组患者术后即刻疼痛明显减轻（p<0.001），并持续 2 小时（p=0.011）。此外，该组患者的合作情况更好（p=0.038）。然而，利多卡因组患者在球结膜下注射时疼痛更明显（p=0.001），且与注射相关的球结膜下出血明显增加（p<0.001）。尽管如此，两组手术并发症发生率相当，所有超声乳化术均成功完成，采用了分配的麻醉技术。