Регионарная блокада для продленного обезболивания при энуклеации и эвисцерации

Abstract

Regional anesthesia is widely used in ophthalmology both as an independent method and in combination. Retrobulbar anesthesia has risks of complications and is undesirable in the surgical treatment of choroidal melanoma due to the risk of metastasis of tumor cells when it is performed. Therefore, it is necessary to search for alternative methods of regional blockades in order to create prolonged anesthesia. Purpose. To develop and evaluate the clinical efficacy of pterygopalatine blockade as a component of combined method of anesthesia for evisceration or enucleation of the eyeball. Methods. A comparative analysis of the effectiveness of intraoperative anesthesia and the course of postoperative period was carried out in patients of two clinical groups formed depending on the method of anesthesia. Results. Intraoperative monitoring of hemodynamics in the groups did not differ. The nature of pain in the patients of the compared groups in the postoperative period had significant differences in presence and intensity of pain on the scale of verbal sensations. Discussion. Use of pterygopalatine blockade with levobupivacaine in combination with dexamethasone as an adjuvant allows getting a prolonged analgesic, anti-inflammatory and decongestant effect. This makes it possible to avoid the use of opioid analgesics in the early postoperative period, that is, to avoid such systemic side effects as nausea, dizziness, and in rare cases vomiting, which generally improves the quality of the postoperative period. Conclusions. Use of pterygopalatine ganglion blockade with local prolonged-acting anesthetic levobupivacaine and dexamethasone as an adjuvant based on inhaled anesthesia with sevoflurane provides safe and effective anesthesia in patients with evisceration or enucleation of the eyeball, both in the intra- and postoperative period. Key words: enucleation; evisceration; pterygopalatine blockade; dexamethasone.