Hessemer V, Jacobi B, Kaufmann H
Augenklinik, Universität Giessen.
Ophthalmologe. 1995 Jun;92(3):307-10.
The aim of this study was to analyze quantitatively the phenomenology and mechanisms of motor blockade induced by retrobulbar anesthesia (RETRO).
Prior to cataract surgery, 34 patients received RETRO using the intraconal technique of Atkinson. Four milliliters of mepivacaine 2% (Scandicain), prilocaine 2% (Xylonest) or lidocaine 2% (Xylocain) were injected in randomized order. Prior to injection, as well as 5, 30, 90, 120, 180, 300 and 420 min after injection, the following variables were determined: deviation of the eye from the primary position (Krimsky test), horizontal and vertical ocular motility (Kestenbaum limbustest), and rotatory ocular motility (presence of in- or excycloductions).
The directions in which the eye deviated after RETRO were abduction and depression. The maximum deviations amounted to 7-8 degrees abduction and 3-4.5 degrees depression and were observed 30 min after injection. Horizontal and vertical ocular motility was nearly completely and symmetrically reduced 30 min after RETRO. There were no significant differences between the three local anesthetics used.
The present findings may be interpreted as temporary palsy of N.III and N.VI during RETRO (symmetrical blockade of horizontal and vertical recti eye muscles) with unaffected function of N.IV and superior oblique muscle (maintained incycloduction ability; hypotropia and exotropia). An additional possible mechanism to account for the observed downward deviation is that the eye assumes its physiological divergent resting position during RETRO.
本研究的目的是定量分析球后麻醉（RETRO）引起的运动阻滞的现象学和机制。
在白内障手术前，34例患者采用阿特金森肌锥内技术接受球后麻醉。随机顺序注射4毫升2%的甲哌卡因（斯堪迪卡因）、2%的丙胺卡因（赛罗卡因）或2%的利多卡因（赛罗卡因）。在注射前以及注射后5、30、90、120、180、300和420分钟，测定以下变量：眼球偏离初始位置的程度（克里姆斯基试验）、水平和垂直眼球运动（凯斯滕鲍姆肢体试验）以及眼球旋转运动（有无内旋或外旋）。
球后麻醉后眼球偏离的方向为外展和下转。最大偏差为外展7 - 8度和下转3 - 4.5度，在注射后30分钟观察到。球后麻醉后30分钟，水平和垂直眼球运动几乎完全且对称地减弱。所用的三种局部麻醉剂之间无显著差异。
目前的研究结果可解释为球后麻醉期间动眼神经和外展神经暂时麻痹（水平和垂直眼直肌对称阻滞），而滑车神经和上斜肌功能未受影响（保持内旋能力；下斜视和外斜视）。解释观察到的向下偏差的另一种可能机制是，在球后麻醉期间眼球处于其生理散开的静止位置。
