Bloqueio pericoal guiado por ultrassom: ensaio clínico randonizado

• Ano de defesa: 2014
• Autor(a) principal: Najman, Ilana Esquenazi [UNESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: Anestesia em oftalmologia; Olhos - Cirurgia; Anestesia local; Ultrassom; Local anesthesia; Anesthesia in ophthalmology
• Link de acesso: http://hdl.handle.net/11449/123945; http://www.athena.biblioteca.unesp.br/exlibris/bd/cathedra/13-05-2015/000823232.pdf

Background and Goal of study: Periconal anesthesia has long been the choice technique for ophthalmic surgery. Currently, there is limited published data on ultrasound-guided ophthalmic anesthesia. Nevertheless, as in other areas of regional anesthesia, ultrasonography may contribute to improve the safety of ophthalmic blocks, particularly by reducing globe perforation or penetration incidence associated with the needle-based techniques. This study aimed to evaluate the benefits of the ultrasound-guided periconal block in comparison to the blind periconal technique with regard to the feasibility, positioning of the needle and occurrence of complications, in patients with healthy eyes. Methods: Upon the approval of the Institutional Ethics Committee, a prospective clinical study was carried out. One hundred and twenty-nine patients (ASA I-II) undergoing cataract surgery were randomly assigned to have their eyes anesthetized using either the Real-Time Ultrasound-Guided Periconal Blockade (USGblock, n=69) or the Conventional Periconal Blockade Technique (Cblock, n=60), followed by ultrasound examination of the eye. Patients with single eye and with high myopia (axial length greater than 26 mm) with the presence of staphyloma were excluded. The Chi-square and Fisher's exact tests were used for qualitative variables and the Student's t-test for quantitative variables. The significance level was 5%. Results: There was a higher incidence of unintentional intraconal needle placement (n=12) in Cblock than in USGblock (n=1) (P<0.0001). The distance between the needle tip and the optic nerve was 12.1±4.4 mm (mean±SD) in USGblock and 8.2±3.7 mm in Cblock (P<0.0001). Needle insertion depth was 25.1±1.6 mm in USGblock and 26.7±2.4 mm in Cblock (P<0.0001). Needle length displayed in the ultrasound image was 11.7±2.6 mm in USGblock and 14.7±3.5 mm in Cblock (P<0.0001). Only one patient presented with conjunctival edema (chemosis). No further ...