Carino N S, Slomovic A R, Chung F, Marcovich A L
Department of Ophthalmology, Toronto Hospital-Western Division, Canada.
J Cataract Refract Surg. 1998 Dec;24(12):1602-8. doi: 10.1016/s0886-3350(98)80350-7.
To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation.
The Toronto Hospital-Western Division, Toronto, Canada.
Fifty-nine consecutive patients (60 eyes) having phacoemulsification with implantation of a foldable acrylic IOL (AcrySof) were randomized into 1 of 2 groups: The intracameral balanced salt solution (BSS) group received topical tetracaine 0.5% plus intracameral BSS; the intracameral lidocaine group received topical tetracaine 0.5% with preservative-free intracameral lidocaine 1%. The patients' subjective experience of pain was measured at 4 points during surgery using a 4-point pain scale. Patient and surgeon satisfaction with the anesthesia used was measured using a 5-point satisfaction scale. Central endothelial cell counts were obtained preoperatively and 1 month postoperatively. Best corrected visual acuity (BCVA) was measured preoperatively and 1 hour, 1 day, 1 week, and 1 month postoperatively.
The mean pain score after phacoemulsification was significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.63 +/- 0.7 [SD] and 0.23 +/- 0.4, respectively, P < .019). The mean pain score at the end of surgery was also significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.60 +/- 0.6 and 0.21 +/- 0.4, respectively; P < .014). The surgeon satisfaction score was significantly lower for the intracameral BSS group than for the intracameral lidocaine group (3.90 +/- 1.2 and 4.73 +/- 0.8, respectively; P < .0007). There was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 +/- 0.6 and 4.70 +/- 0.8). Endothelial cell loss 1 month postoperatively was similar between the 2 groups (6.1% +/- 8% and 6.7% +/- 6%). Ninety-seven percent of patients (29/30) in each group noted BCVA improvement from preoperatively. The rate of potential visual acuity recovery was similar in both groups.
Topical tetracaine 0.5% with intracameral lidocaine was safe and effective in patients having phacoemulsification with IOL implantation. The advantage of using intracameral lidocaine 1% over a placebo was a significant decrease in the patients' subjective experience of pain and in the surgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups.
比较单独使用0.5%丁卡因滴眼液以及联合前房内注射1%利多卡因作为局部麻醉剂在白内障超声乳化吸除联合人工晶状体（IOL）植入术中的效果。
加拿大多伦多市多伦多医院西区。
59例连续患者（60只眼）接受白内障超声乳化吸除并植入可折叠丙烯酸人工晶状体（AcrySof），随机分为2组：前房内平衡盐溶液（BSS）组接受0.5%丁卡因滴眼液联合前房内BSS；前房内利多卡因组接受0.5%丁卡因滴眼液联合无防腐剂的前房内1%利多卡因。在手术过程中的4个时间点使用4分疼痛量表测量患者的主观疼痛体验。使用5分满意度量表测量患者和外科医生对所用麻醉的满意度。术前及术后1个月获取中央内皮细胞计数。术前及术后1小时、1天、1周和1个月测量最佳矫正视力（BCVA）。
白内障超声乳化吸除术后，前房内BSS组的平均疼痛评分显著高于前房内利多卡因组（分别为0.63±0.7[标准差]和0.23±0.4，P<.019）。手术结束时，前房内BSS组的平均疼痛评分也显著高于前房内利多卡因组（分别为0.60±0.6和0.21±0.4；P<.014）。前房内BSS组的外科医生满意度评分显著低于前房内利多卡因组（分别为3.90±1.2和4.73±0.8；P<.0007）。前房内BSS组和前房内利多卡因组患者满意度无差异（分别为4.60±0.6和4.70±0.8）。两组术后1个月内皮细胞丢失情况相似（分别为6.1%±8%和6.7%±6%）。每组97%的患者（29/30）指出BCVA较术前有所改善。两组潜在视力恢复率相似。
0.5%丁卡因滴眼液联合前房内利多卡因在白内障超声乳化吸除联合IOL植入术中对患者安全有效。前房内注射1%利多卡因相对于安慰剂的优势在于显著降低了患者的主观疼痛体验以及外科医生对所用麻醉的满意度。本研究中测量的其他参数在两组之间无显著差异。
