Application of local anesthesia in ophthalmic surgery

Abstract

Introduction: To compare effects of local anesthesia alone and local anesthesia combined with intravenous intensive anesthesia in adult strabismus surgery.
Methods: This study was a prospective study. Forty patients who underwent strabismus surgery at our Hospital were included in study. General information of patients was collected including age, gender, duration of disease, trigeminal prescription, weight, strabismus diagnosis type and other indicators. Patients were numbered according to their admission order, and a computer-generated random number was used to randomly divide 40 patients into two groups: A was operated with local anesthesia alone, and B was operated with local anesthesia + intravenous intensive anesthesia. All patients were operated by same chief ophthalmologist, and all patient data were recorded and collected by one person:
(1) To compare systolic blood pressure, diastolic blood pressure, heart rate, Percutaneous oxygen saturation (SpO2) and incidence of surgical complications such as oculocardiacreflex (OCR), postoperative nausea and vomiting (OCR) at T1, T2, T3 and T4. Postoperative nausea and vomiting (PONV), and respiratory depression;
(2) To compare pain scores of intraoperative, 2h, 4h and 8h postoperatively;
(3) To compare time required for surgical muscle;
(4) To compare efficiency of surgical treatment of strabismus at 1 day and 1 week after surgery.
Results: 1. General data: There was no difference in age, gender, weight, duration of disease, visual acuity, trigeminal prescription and strabismus diagnosis type.
2. In comparison, there were no statistical differences in blood pressure, heart rate and SpO2 at T1, T2, T3 and T4, but in comparison within groups, differences in blood pressure and heart rate at each time point were significant (P<0.05), while differences in SpO2 were not significant (P>0.05). The results indicated that there was no interaction between time and in changes of blood pressure, heart rate and SpO2, that is, effect of time factors (T1, T2, T3, T4) did not vary (local anesthesia alone versus local anesthesia + intravenous intensive anesthesia). 3, The incidence of intraoperative OCR was higher in A (70%) than B (35%) . The incidence of PONV in B (25%) was higher than A (5%). No respiratory depression occurred. 4, Intraoperative, 2h postoperative and 4h postoperative pain scores in A were higher than B. Although pain scores in A were still slightly higher than B at 8h postoperatively. 5. In A and B, a total of 57 and 61 extraocular muscles were operated on, respectively, and average operating time required for each muscle was greater in A than B. When comparing different surgical methods (posterior migration of external rectus muscle and shortening of internal rectus muscle), average surgical time required per muscle was greater in A than B. Time required for posterior migration of external rectus muscle was shorter than shortening of internal rectus muscle. 6. The efficiency of surgical treatment of strabismus in A and B at 1 day and 1 week after surgery was higher than A (100%) than B (95%).
Conclusion: 1. There was no difference in effects of two anesthesia methods on intraoperative blood pressure, heart rate, SpO2 and respiratory depression, PONV, and strabismus surgical treatment effect, 2. Local anesthesia combined with intravenous intensive anesthesia is safe and effective in strabismus surgery. Compared with local anesthesia alone, it can not only reduce occurrence of OCR, improve intraoperative and early postoperative analgesia, but also shorten average operating time required for each muscle.
Keywords: strabismus; surgery; anesthesia; dexmedetomidine; sufentanil