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目的客观分析和判定在玻璃体视网膜手术中布比卡因和罗哌卡因分别与利多卡因混合进行球后麻醉的效果。设计前瞻性比较性病例系列。研究对象93例接受23G玻璃体切除术的患者通过随机数字表法平均分入A、B、C三组,每组31例(31眼)。方法对每组患者球后麻醉注射不同局麻药物,其中A组注射2%利多卡因2.25 ml和0.5%布比卡因2.25 ml混合溶液,B组注射2%利多卡因3 ml和1%罗哌卡因1.5 ml混合溶液,C组注射2%利多卡因溶液4.5 ml,观察术中麻醉效果和术后疼痛情况。主要指标术中感觉阻断时间、运动失能开始时间、术后疼痛开始时间、麻醉效果评价。结果 A、B、C三组的平均感觉阻断时间分别为(2.10±0.10)分钟、(2.13±0.11)分钟、(2.14±0.13)分钟,组间比较无统计学差异(F=0.800,P=0.456)。三组的平均运动失能开始时间分别为(3.10±1.16)分钟、(3.63±1.11)分钟、(3.24±1.63)分钟,组间比较无统计学差异(F=2.000,P=0.138)。三组的术后疼痛开始时间分别为(140.57±22.23)分钟、(134.44±26.34)分钟、(87.34±26.53)分钟,组间比较有统计学差异(F=3.500,P=0.035),其中A组和B组较C组明显延长(t=8.5626,7.0146,P均=0.0001)。A、B、C三组中麻醉效果评级达到5级的患者人数分别为18例、14例和9例(A组与B组比较:χ~2=1.0300,P=0.3090;A组与C组比较:χ~2=5.3100,P=0.0210;B组与C组比较:χ~2=1.7300,P=0.1890)。结论罗哌卡因联合利多卡因进行玻璃体视网膜手术的麻醉,具有和布比卡因联合利多卡因基本同等的麻醉效果和持续时间,优于单独使用利多卡因进行麻醉。
Objective To objectively analyze and determine the effect of post-retrobulbar anesthesia by mixing bupivacaine and ropivacaine respectively with lidocaine during vitreoretinal surgery. Design prospective comparative case series. Participants 93 patients undergoing 23G vitrectomy were randomly divided into three groups A, B and C by random number table (31 eyes in each group). Methods Each group of patients received retrobulbar anesthesia with different local anesthetics. Group A received injection of 2% lidocaine 2.25 ml and 0.5% bupivacaine 2.25 ml mixed solution, group B injected 2% lidocaine 3 ml and 1% Ropivacaine 1.5 ml mixed solution, C group injected 2% lidocaine solution 4.5 ml, observed intraoperative anesthesia and postoperative pain. The main indicators of intraoperative sensory block time, onset of motor failure, postoperative pain start time, anesthesia evaluation. Results The mean sensory block time in group A, B and C were (2.10 ± 0.10) minutes, (2.13 ± 0.11) minutes and (2.14 ± 0.13) minutes, respectively. There was no significant difference between the two groups (F = 0.800, P = 0.456). The mean onset of motor failure in the three groups was (3.10 ± 1.16) minutes, (3.63 ± 1.11) minutes and (3.24 ± 1.63) minutes, respectively. There was no significant difference between the two groups (F = 2.000, P = 0.138). The onset time of postoperative pain in the three groups was (140.57 ± 22.23) minutes, (134.44 ± 26.34) minutes and (87.34 ± 26.53) minutes, respectively. There was a statistically significant difference between the two groups (F = 3.500, P = 0.035) Group and B group than the C group was significantly prolonged (t = 8.5626,7.0146, P = 0.0001). There were 18 cases, 14 cases and 9 cases in group A, B and C respectively. The number of patients with grade 5 anesthesia rating was (group A vs group B: χ ~ 2 = 1.0300, P = 0.3090; Comparison: χ ~ 2 = 5.3100, P = 0.0210; B group and C group: χ ~ 2 = 1.7300, P = 0.1890). Conclusion Ropivacaine plus lidocaine for vitreoretinal anesthesia has the same anesthetic effect and duration as bupivacaine plus lidocaine, which is superior to the anesthesia with lidocaine alone.