氯胺酮与芬太尼用于玻璃体视网膜手术球周阻滞中局部麻醉药的辅助药物：随机对照研究

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氯胺酮与芬太尼用于玻璃体视网膜手术球周阻滞中局部麻醉药的辅助药物：随机对照研究

贵州医科大学 麻醉与心脏电生理课题组

翻译：陈锐  编辑：马艳燕  审校：曹莹

背景

在球周阻滞中使用辅助药可以改善阻滞效果。本研究旨在评估在局麻药中加用氯胺酮或芬太尼对球周单次注射麻醉效果的影响。

方法：该研究纳入 90 名接受玻璃体视网膜手术的成年患者。将患者随机分为三组，对照组、芬太尼组和氯胺酮组分别用含2%透明质酸酶的利多卡因4ml和0.5%布比卡因5ml加生理盐水1ml、芬太尼30μg、氯胺酮25 mg进行球周阻滞。主要观察指标包括麻醉和运动迟缓的开始和持续时间，并评估眼压、术后疼痛评分和是否需要镇痛剂。

结果：与对照组相比，使用芬太尼或氯胺酮作为局麻辅助药均能明显缩短麻醉起效时间（1.67±1.21 min）（1.93±1.36 min），延长眼睑运动迟缓时间（127.50±22.20 min） (127.00 ± 22.19 min)，增加眼球无力的持续时间 (156.00 ± 28.02min) (158.00 ± 31.18 min)，缩短手术开始所需时间 (6.57 ± 1.99 min) (6.57 ± 1.85 min)，并延迟术后首次要求镇痛的时间 (189.50 ± 34.92 min) (184.67 ± 35.37 min) (P < .05)。然而，芬太尼和氯胺酮对眼睑或眼球运动迟缓或眼压均无显著影响（P > .05）。

结论：芬太尼或氯胺酮可作为玻璃体视网膜手术患者球周阻滞的局部麻醉辅助药，两者均可改善麻醉阻滞效果且不增加眼压。

原始文献来源：Ameh Abdelkhalik Ahmeda,⁎, Mohamad Gamal Elmawya, Mohammed Awdb et.al .Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: Randomized controlled study.[J].Egyptian Journal of Anaesthesia.1110-1849.

Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: Randomized controlled study

Background: The use of an adjuvant to local anesthetics in the peribulbar block may improve the block characteristics. This study aimed to evaluate the effffect of the addition of either ketamine or fentanyl to local anesthetics in single injection peribulbar block on the quality of the block. 

Methods: The study included ninety adult patients presented for vitreoretinal surgeries. Patients were randomly allocated into three groups. All patients received peribulbar block with a local anesthetic mixture composed of 4 ml lidocaine 2% containing hyaluronidase, and 5 ml of plain bupivacaine 0.5% with an addition of either 1 ml of normal saline, 30 μg fentanyl, or 25 mg ketamine in Control group, Fentanyl group, and Ketamine group respectively. The measurements included the onset and duration of both anesthesia and akinesia with evaluation of intraocular pressure, postoperative pain score and need of analgesics. 

Results: As compared to control group, the use of either fentanyl or ketamine as local anesthetic adjuvant signifificantly fastened the onset of anesthesia (1.67±1.21min) (1.93±1.36 min), prolonged the duration of lid akinesia (127.50±22.20 min) (127.00±22.19 min), increased the duration of globe akinesia (156.00±28.02 min) (158.00±31.18 min), minimized the time required to start surgery (6.57 ± 1.99 min) (6.57±1.85 min), and increased the time for fifirst request of postoperative analgesia (189.50± 34.92min) (184.67±35.37min) (P < .05). However, neither fentanyl nor ketamine had a signifificant effffect on the onset of lid or globe akinesia or the intraocular pressure (P > .05). 

Conclusion: Fentanyl or ketamine can be used as a local anesthetic adjuvant in the peribulbar block in patients presented for vitreoretinal surgeries as both of them improved the quality of the block without increasing intraocular pressure.