Patel B C, Clinch T E, Burns T A, Shomaker S T, Jessen R, Crandall A S
Moran Eye Center, University of Utah School of Medicine, Salt Lake City 84132, USA.
J Cataract Refract Surg. 1998 Jun;24(6):853-60. doi: 10.1016/s0886-3350(98)80143-0.
To evaluate and compare the efficacy of topical versus retrobulbar anesthesia for cataract surgery performed by a surgeon newly converting to the topical technique.
Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
Ninety patients were prospectively assigned by permuted block restricted randomization to receive topical (Group 1; n = 45) or retrobulbar (Group 2; n = 45) anesthesia. Group 1 received topical bupivacaine 0.75% and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of lidocaine 2% and bupivacaine 0.75% plus hyaluronidase 150 units. A visual pain analog scale was used to assess the degree of pain during anesthesia administration and surgery and postoperatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Intraoperative conditions and complications were recorded.
Intraoperative operating conditions were significantly better in Group 2 (P < .05). There was a small but statistically significant difference in the degree of discomfort during anesthesia administration and surgery (P < .05). There was no difference in postoperative discomfort. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage occurred only in Group 2, in which there was one retrobulbar hemorrhage. Although eyelid squeezing and ocular motility were present more frequently in Group 1, neither was a problem to the surgeon.
Cataract surgery was safely performed by a surgeon converting to topical anesthesia. After a distinct learning curve, the procedure was performed with minimal patient discomfort. Surgical training and patient preparation are the key to safe use of topical anesthesia.
评估并比较表面麻醉与球后麻醉对于一位新改用表面麻醉技术的外科医生所施行的白内障手术的疗效。
美国犹他州盐湖城犹他大学莫兰眼科中心眼科。
90例患者通过置换区组受限随机化法被前瞻性地分配接受表面麻醉（第1组；n = 45）或球后麻醉（第2组；n = 45）。第1组接受0.75%布比卡因表面麻醉及静脉注射咪达唑仑和芬太尼用于麻醉。第2组先静脉注射甲己炔巴比妥，随后行球后阻滞，使用2%利多卡因和0.75%布比卡因加150单位透明质酸酶的等量混合液。采用视觉模拟疼痛量表评估麻醉给药期间、手术期间及术后的疼痛程度。评估眼球运动、触摸及光线导致患者不适的程度。记录术中情况及并发症。
第2组术中操作条件明显更好（P < 0.05）。麻醉给药期间及手术期间的不适程度存在微小但具有统计学意义的差异（P < 0.05）。术后不适无差异。结膜水肿、结膜下出血及眼睑出血仅发生于第2组，其中有1例球后出血。虽然第1组中眼睑紧闭和眼球活动更频繁出现，但对手术医生而言均不是问题。
一位改用表面麻醉的外科医生安全地施行白内障手术。经过明显的学习曲线后，该手术在患者最小不适的情况下完成。手术培训和患者准备是安全使用表面麻醉的关键。
