眼后节手术中利多卡因及布比卡因混合液球后麻醉与罗哌卡因Tenon囊下麻醉的对比研究

Comparison of subtenon anaesthesia with 1% ropivacaine with retrobulbar anaesthesia with a mixture of 2% lignocaine and 0.5% bupivacaine for posterior segment surgery

目的通过临床随机选取病例对比眼后节手术中罗哌卡因Tenon囊下麻醉与利多卡因及布比卡因混合液球后麻醉的安全性及有效性。方法189例眼,行眼后节手术病人随机采用1%罗哌卡因Tenon囊下麻醉与2%利多卡因及0.75%布比卡因混合液球后麻醉的方法麻醉,对比麻醉过程中、术中及术后4小时的疼痛感觉,麻醉6分钟后眼球运动、球结膜水肿及结膜下出血等其它并发症。结果180位病人中94个Tenon囊下麻醉组病人中61(64.9%)人诉麻醉过程中无疼痛,95个球后麻醉组病人全部(100%)诉麻醉过程中疼痛,术中及术后4小时疼痛无明显差异。给药6分钟后Tenon囊下麻醉组94人(98.9%)、球后麻醉组89人(94.7%)眼球运动完全受限。Tenon囊下麻醉组中3人(3.2%)发生球结膜水肿,2人(2.1%)发生球结膜下出血。结论在眼后节手术中,1%罗哌卡因Tenon囊下麻醉麻醉效果同2%利多卡因及0.75%布比卡因混合液球后麻醉一样有效,并且更安全,更舒适。

Objective To compare the safety and efficacy of subtenon anaesthesia with 1% ropivacaine with retrobulbar anaesthesia with a mixture of 2% lignocaine and 0.5% bupivacaine for posterior segment surgery using a randomised control clinical trial. Methods 189 patients were mndomised to subtcon and retmbulbar group with preset criteria. Pain during administration of anaesthesia ,during sugery, and 4h after surgery was graded, akinesia, sub-conjunctival lmemorrhage, chris were also compared, patients were followed up for 1 day postoperatively. Results 180 patients completed follow up.61 out of 94 （64.9%） patients of the subtenon group and none of the retrobulbar group experienced completely no pain during administration of anaesthesia. There was no significant difference in pain during and 4 h after sugery. About 98.9% patients of the subteon group and 94.7 % of the retrobulbar group had absolute akinesia after 6 minutes of administration . 3 patients of subtenon group had ehemosis and 2 patient had sub-con- junetival lmemorrhage. Conclusion Sub-tenon amaesthesia is safe and as effective as retmbulbar anaesthesia and is more comfortable to the patient at the time of administration.