Ripart J, Prat-Pradal D, Vivien B, Charavel P, Eledjam J J
Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nimes, France.
Clin Anat. 1998;11(6):390-5. doi: 10.1002/(SICI)1098-2353(1998)11:6<390::AID-CA4>3.0.CO;2-H.
Medial canthus single injection periocular anesthesia is an alternative technique to classical regional anesthesia techniques for cataract surgery. The occurrence of a chemosis at the end of this injection has made us question ourselves about the real site of injection. The purpose of this anatomic study was to identify this site with precision, and to describe the spreading of the injected solution. Various volumes of colored liquid latex were injected when using this technique on 10 human orbits. They were deeply frozen and sectioned in thin slices. The site of injection is clearly the episceral (sub-Tenon) space. This is a gliding space through which pass the ciliary nerves supplying the globe sensitivity. This could explain the high quality of the analgesia of the globe. With the larger volumes injected, spreading of the latex was detected in the orbicularis palpebra. This probably explains the good akinesia of the lids obtained without any facial block. Spreading of the latex to the rectus muscles sheaths should explain the good akinesia of the globe, but was only partially proved in this study. We conclude that the medial canthus single injection periocular anesthesia is an episcleral (sub-Tenon) injection which may explain good anesthesia.
内眦单次注射眼周麻醉是白内障手术经典区域麻醉技术的一种替代技术。在这种注射结束时出现球结膜水肿使我们对实际注射部位产生了疑问。这项解剖学研究的目的是精确确定该部位，并描述注射溶液的扩散情况。在10个人类眼眶上使用该技术时，注射了不同体积的有色液体乳胶。将眼眶深度冷冻并切成薄片。注射部位明显是巩膜上（Tenon囊下）间隙。这是一个滑动间隙，供应眼球感觉的睫状神经从中穿过。这可以解释眼球镇痛的高质量效果。随着注射体积增大，在睑轮匝肌中检测到乳胶扩散。这可能解释了在没有任何面部阻滞的情况下获得的良好眼睑运动不能。乳胶扩散到直肌鞘应可解释眼球的良好运动不能，但在本研究中仅得到部分证实。我们得出结论，内眦单次注射眼周麻醉是一种巩膜上（Tenon囊下）注射，这可能解释了良好的麻醉效果。
