Local anesthesia is used as a component of general anesthesia or self-sufficient technique of perioperative analgesia at the vitreo-retinal surgery. Its popularity originates from safety and simplicity of regional techniques which provide efficient analgesia, perfect surgical field and fast recovery. Most of injection techniques of ophthalmic regional anesthesia are single shot methods which could not provide effective analgesia in some patients who required anesthesia for a prolonged period. Implementation of catheter technique in daily practice could be solution to this problem. Infusion of local anesthetic through catheter possesses all advantages of single-shot techniques and provides virtually unlimited duration of analgesia.
The problem of rehabilitation of patients with cataract, analysis of effectiveness of surgical treatment, restoration of professional activity and obtaining a high quality of life after cataract surgery is of great medical and social importance. The basic principles of modern medicine are patient orientation, personalized and multidisciplinary approach. Attention is focused not on an individual disease and its symptoms, but on the patient as a whole person with all life’s concerns and problems. The study of the quality of life (QOL) of the patients with cataract allows us to assess the influence of cataract and surgical treatment on the psychological, emotional state of the patient, his functioning in the social environment. However, cataract surgery is a rehabilitation treatment aimed at restoring functions lost due to cataract. International classification of functioning (ICF), limitation of vital activity and health is a generally accepted classification in rehabilitation medicine. In accordance with new trends, the possibility of using ICF for the study of visual impairments and limitation of vital activity in patients with cataract before and after surgical treatment is becoming relevant.
The purpose of this study was to compare efficiency and safety of the prolonged Sub-Tenon block in comparison with IV 100 mg tramadol for long vitreoretinal surgery ander general anesthesia. 74 patients were undergoing microinvasive vitrectomy. For the prolonged Sub-Tenon block 1% solution of lidocaine at the speed of 2 ml/hour was used. The value of block of oculovisceral reflexes, HR and MAP, the need for muscle relaxants, time of awakening and time of removal of a laryngeal mask, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In prolonged Sub-Tenon block group there was more effective blocking of oculocardiac and oculovasomotor reflexes, a smaller average dose of muscle relaxants, shorter awakening time and removal of a laryngeal mask, and also lower pain syndrome in the first 24 hours after surgery. Postoperative nausea and vomiting also was in Sub-Tenon block group considerably less frequent than in tramadol group. Use of the prolonged Sub-Tenon block with the general anesthesia is an effective and safe technique for vitreoretinal surgery.
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