Estudo comparativo entre agulhas de 25 × 0,70 mm ou 20 × 0,55 mm para anestesia retrobulbar com baixo volume anestésico em tratamento de catarata por facoemulsificação
A comparative study between 25 × 0.70 mm and 20 × 0.55 mm needles for retrobulbar block with small volume of anesthetic for the treatment of cataracts by phacoemulsification*
Haroldo Maciel Carneiro; Kim Irsen Santos Teixeira; Marcos Pereira de Ávila; Onofre Alves Neto; Rosanna Zacharias Hannouche; Leopoldo Magacho
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Abstract
BACKGROUND AND OBJECTIVES: The objective of this study was to compare the quality and safety of retrobulbar block for the treatment of cataracts by phacoemulsification using needles of different sizes: 27 × 0.70 mm and 20 × 0.55 mm.
METHODS: Candidates for ophthalmic block for the treatment of cataracts by phacoemulsification were selected prospectively. After sedation and standardized monitoring, a retrobulbar block with 4 mL of 1% ropivacaine containing hyaluronidase was performed with a single inferolateral puncture. In Group I (GI), the 25 × 0.70 mm needle was used, while in Group II (GII) a 20 × 0.55 mm needle was used. All patients had a CT scan at the time of the blockade and five minutes after the administration of the anesthetic solution with radiologic contrast. Ocular mobility was assessed after three, five, and ten minutes. The incidence of complications in both groups and the satisfaction of patients and surgeons were compared by applying a standardized questionnaire.
RESULTS: Fifty-four adult patients were evaluated (27 per group). Patients did not complain of intraoperative pain or perception of light. The anesthetic procedure was considered very good (VG) or excellent (E) in 96.3% of the cases in both groups. All patients were subjected to the same assessment. The need of block repetition between both groups did not differ (p = 1.0). Patients in GI showed decreased ocular mobility at 3 minutes (p = 0.03). The intraconal retrobulbar placement of the needle was observed on both groups. Anesthetic dispersion at 5 minutes was similar in the two groups.
CONCLUSIONS: Retrobulbar block with a single inferolateral puncture with a 20 × 0.55 mm needle, using low doses of anesthetics, is an effective and safe option for the treatment of cataracts by phacoemulsification.
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Referencias
Garrett SK, McNeil JJ, Silagy C. Methodology of the VECAT study: vitamin E intervention in cataract and age-related maculopathy. Ophthalmic Epidemiol. 1999;6:195-208.
Kallio H. Advances in ophthalmic regional anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19:215-227.
Ripart J, Nouvellon E, Chaumeron A. Regional anesthesia for eye surgery. Reg Anesth Pain Med. 2005;30:72-82.
Venkastesan VG, Smith A. What's new in ophthalmic anaesthesia. Curr Opin Anaesthesiol. 2002;15:615-620.
Van den Berg AA. An audit of peribulbar blockade using 15mm, 25mm and 37,5 mm needles, and sub-tenons injection. Anaesthesia. 2004;59:775-780.
Freitas ACH, Espirandelli LC. Parada respiratória após bloqueio peribulbar: Relato de caso. Rev Bras Anestesiol. 1997;47:134-137.
Carneiro HM, Oliveira B, Ávila M. Anestesia do tronco encefálico após bloqueio retrobulbar extraconal: É possível evitar? Relato de caso. Rev Bras Anestesiol. 2007;57:391-400.
Hamilton RC. Techniques of orbital regional anaesthesia. Br J Anaesth. 1995;75:88-92.
Gayer R. Ophthalmic anesthesia: more than meet the eye. ASA Refresher Courses Anesthesiol. 2006;34:55-58.
Atkinson WS. Retrobulbar injection of anesthetic within the muscular cone (cone injection). Arch Ophthalmol. 1936;16:495-503.
Davis II DB, Mandel MR. Efficacy and complication rate of 16.244 consecutive peribulbar blocks: A prospective multicenter study. J Cataract Refract Surg. 1994;20:327-337.
Nicoll GMV, Acharya PA, Ahlen K. Central nervous system complications after 6.000 retrobulbar block. Saudi Bull Ophthalmol. 1987;2:13-17.
Naren G, Kavita V. Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department. Emerg Med. 2006;18:83-85.
Loken RG, Mervyn Krirker GE, Hamilton RC. Respiratory arrest following peribulbar anesthesia for cataract surgery: case report and review of literature. Can J Ophthalmol. 1998;33:225-226.
Davis DB, Mendel MR. Posterior peribulbar anesthesia: an alternative to retrobulbar anesthesia. J Cataract Refrect Surg. 1986;12:182-184.
Kimble JA, Morris RE, Witherspoon CD. Globe perforation from peribulbar injection. Arch Ophthalmol. 1987;105:749.
Ripart J, Lefrant JY, Jean E. Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections. Anesthesiology. 2001;94:56-62.
Gillart T, Dualé C, Curt I. Ophthalmic regional anaesthesia. Curr Opin Anaesthesiol. 2002;15:503-509.
Gayer S. Ophthalmic anesthesia: more than meets the eye. ASA Refresher Courses Anesthesiol. 2006;34:55-63.
Kishore K, Agarwal HC, Sood NN. A modified technique of anterior peribulbar anaesthesia. Indian J Ophthalmol. 1991;39:166-167.
Scott RA, Jakeman CM, Perry SR. Peribulbar anaesthesia and needle length. J R Soc Med. 1995;88:594P-596P.
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