Офтальмохирургия. 2021; : 52-57
Ретробульбарная блокада при энуклеации глазного яблока у детей с ретинобластомой
https://doi.org/10.25276/0235-4160-2021-2-52-57Аннотация
Ретинобластома (РБ) – злокачественная опухоль эмбриональной нервной сетчатки.
Цель. Определение эффективности ретробульбарной блокады (РбБ) ропивакаином 0,5% для интра- и послеоперационной аналгезии, а также профилактики окулокардиального рефлекса (ОКР), послеоперационной тошноты и рвоты (ПОТР) при энуклеации глазного яблока.
Материал и методы. На базе НИИ ДОиГ ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» России было выполнено проспективное рандомизированное клиническое исследование в период с 2016 по 2019 г. среди пациентов от 0 до 10 лет, подвергшихся энуклеации по поводу РБ, которые были рандомизированы на группу РбБ (РбБ ропива- каином 0,5% на фоне общей анестезии, ОА) (n=40) и группу контроля ОА (общая анестезия) (n=40).
Результаты. Осложнений в группе РбБ, обусловленных методикой проведения, отмечено не было. В интраоперационном периоде средняя доза фентанила в группе РбБ составила 4,7±0,7 мкг/кг, что существенно ниже, чем в группе ОА – 10,1±1,9 мкг/кг (р<0,05). ОКР в группе РбБ отмечался в 5% случаев против 100% в группе ОА (р=0,002), из них атропин в группе ОА применяли у 20% детей. Средний балл по визуальной аналоговой шкале: 1,8 балла против 3,7 балла через 60 мин после операции (p<0,001). Время до введения пер- вой дозы анальгетика в группе РбБ составило 234±37,5 мин, а в группе ОА – 45,5±19,4 мин (р<0,05). В первые 12 ч после оперативного вмешательства ПОТР в группе РбБ не отмечалась, а в группе контроля наблюдалась у 45% пациентов.
Заключение. Исследование выявило, что интраоперационное проведение ретробульбарной блокады раствором ропивакаина 0,5% у детей с РБ эффективно и безопасно, обеспечивает стабильную интраоперационную гемодинамику и уменьшает потребность в опиоидах, способствует профилактике ОКР и ПОТР, а также улучшению послеоперационной аналгезии при операции энуклеации глазного яблока в педиатрической практике.
Список литературы
1. Leahey A, Lanzkowsky P. Retinoblastoma. Manual of pediatric hematology and oncology. 5th ed. Amsterdam: Elsevier; 2016.
2. Козлова Т.П., Казубская И.Н., Соколова Е.А., Алексеева О.В., Бабенко Е.А., Близнец Т.Л., Ушакова С.Н., Михайлова Л.Н., Любченко В.Г., Поляков В.Г. Ретинобластома. Диагностика и генетическое консультирование. Онкопедиатрия. 2015;2(1): 30–38.
3. Kozlova TP, Kazubskaya IN, Sokolova EA, Alekseeva OV, Babenko EA., Bliznets TL, Ushakova SN, Mikhailova LN, Lyubchenko VG, Polyakov VG. Retinoblastoma. Diagnosis and genetic counseling. Oncopediatrics. 2015;2(1): 30–38. (In Russ.)
4. Albert & Jakobiec’s principles and practice of ophthalmoloby. 3rd ed. Philadelphia: Saunders; 2008. 4. Nunery WR, Hetzler KJ. Enucleation. In Ноrnblаss, A, Hanig, CJ. (eds): Oculoplastic, orbital, and reconstructive saurgery. Vol. 2. London, Williams and Wilkins; 1990.
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6. Gottfreothsclothir MS, Gislason I, Stefanson E, Sigurjonsdothi S, Nielsen SC. Effect of retrobulbar bupivacaine on postoperative pain and nausea in retinal detachment surgery. Acta Ophthalmologica. 1993;71: 544–547. doi: 10.1111/j.1755-3768.1993.tb04633.x
7. Малрой М.Ф. и др. Местная анестезия: практическое руководство; пер. с англ. под ред. проф. Е.А. Евдокимова. 4-е изд. М.: «БИНОМ»; 2014.
8. Lu JE, Francis JH, Dunkel IJ, Shields CL, Yu MD, Berry JL, Kogachi K, Skalet AH, Miller AK, Santapuram PR, Daniels AB, Abramson DH. Metastases and death rates after primary enucleation of unilateral retinoblastoma in the USA 2007–2017. Br J Ophthalmol. 2018. doi: 10.1136/bjophthalmol-2018-312915
9. Lübbers HT, Zweifel D, Grätz KW, et al. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2010;68: 1317–1321.
10. Gayer S, Tutiven J. Anesthesia for pediatric ocular surgery. Ophthalmol Clin North Am. 2006;19: 269–278.
11. Blanc VF, Hardy JF, Milton J, Jacob JL. The occulo cardiac reflex. A statistical analysis in infants and children. Can Anaesth Soc J. 1993;30: 360–369.
12. Misurya VK, Singh SP, Kulshrestha VK. Prevention of oculocardiac reflex during extraocular muscle surgery. Indian J Ophthalmol. 1990;38: 85–87.
13. Gürkan Y, Kiliçkan L, Toker K. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth. 1999;9: 495–499.
14. Espahbodi E, Sanatkar M, Sadrossadat H et al. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran. 2015;53: 158–161.
15. Oh JN, Lee SY, Lee JH, et al. Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery. Korean J Anesthesiol. 2013;64: 500–504.
16. Ghai B, Ram J, Makkar JK, Wig J, Kaushik S. Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. Anesth Analg. 2009;108: 1132–1138.
17. Subramaniam R, Subbarayudu S, Rewari V, Singhal RD, Madan R. Usefulness of pre‐emptive peribulbar block in pediatric viteroretinal surgery: a prospective study. Reg Anesth Pain Med. 2003;28: 43– 47. doi: 10.1053/rapm.2003.50032
18. Allen LE, Sudesh S, Sandramouli S, Cooper G, McFarlane D, Willshaw HE. The association between the oculocardiac reflex and postoperative vomiting in children undergoing strabismus surgery. Eye (Lond). 1998;12: 193–196.
19. Weir PM, Mumo HM, Reynolds PI, Lewis IH, Wilton NC. Propofol infusion and incidence of emesis in paediatric outpatient strabismus surgery. Anesth Analg. 1993;76: 760. doi: 10.1213/00000539-199304000-00013
20. Howward R, Carter J, Curry J, Morton N, Rivett K, Rose M, et al. Association of paediatric anaesthetists of Great Britain and Ireland. Postoperative pain. Paediatr Anaesth. 2008;18: 36–63.
21. Vishalakshi Patil, Allauddin Farooqy, Balaraju Thayappa Chaluvadi, Vinayak Rajashekhar, Ashwini Malshetty. Effect of the addition of rocuronium to 2% lignocaine in peribulbar block for cataract surgery. J Anaesth Clin Pharmacol. 2017;33(4): 520–523. doi: 10.4103/joacp.JOACP_383_16.
Fyodorov Journal of Ophthalmic Surgery. 2021; : 52-57
Retrobulbar blockade during eyeball enucleation surgery in children with retinoblastoma
https://doi.org/10.25276/0235-4160-2021-2-52-57Abstract
Retinoblastoma (RB) is a malignant tumor of the embryonic nerve retina.
Purpose. To determine the effectiveness of retrobulbar blockade (RbB) with ropivacaine 0.5% for intra- and postoperative analgesia, as well as for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV) during enucleation.
Material and methods. A prospective randomized controlled clinical trial was performed. Eighty patients aged 0 to 10 years were included, who were randomly assigned to the RbB group (retrobulbar blockade with ropivacaine 0.5% with general anesthesia) (n=40) and the GA control group (general anesthesia) (n=40).
Results. There were no complications in the RbB group caused by the methodology. In the intraoperative period, the average dose of fentanyl in the RbB group was 4.7±0.7 μg/kg, which is significantly lower than in the OA group of 10.1±1.9 μg/kg (p<0.05). OCR in the RbB group was observed in 5% of cases versus 100% in the GA group (p=0.002). The average VAS score was 1.8 vs. 3.7 60 minutes after surgery (p<0.001). For the first time 12 hours after surgery, PONV was not observed in the RBB group, and in the control group it was observed in 45% of patients.
Conclusion. The study revealed that intraoperative retrobulbar blockade with 0.5% ropivacaine solution in children with RB is effective and safe. Provides stable intraoperative hemodynamics and reduces the need for opioids. Promotes the prevention of OCD and PONV, as well as the improvement of postoperative analgesia during the operation of enucleation of the eyeball i n pediatric.
References
1. Leahey A, Lanzkowsky P. Retinoblastoma. Manual of pediatric hematology and oncology. 5th ed. Amsterdam: Elsevier; 2016.
2. Kozlova T.P., Kazubskaya I.N., Sokolova E.A., Alekseeva O.V., Babenko E.A., Bliznets T.L., Ushakova S.N., Mikhailova L.N., Lyubchenko V.G., Polyakov V.G. Retinoblastoma. Diagnostika i geneticheskoe konsul'tirovanie. Onkopediatriya. 2015;2(1): 30–38.
3. Kozlova TP, Kazubskaya IN, Sokolova EA, Alekseeva OV, Babenko EA., Bliznets TL, Ushakova SN, Mikhailova LN, Lyubchenko VG, Polyakov VG. Retinoblastoma. Diagnosis and genetic counseling. Oncopediatrics. 2015;2(1): 30–38. (In Russ.)
4. Albert & Jakobiec’s principles and practice of ophthalmoloby. 3rd ed. Philadelphia: Saunders; 2008. 4. Nunery WR, Hetzler KJ. Enucleation. In Nornblass, A, Hanig, CJ. (eds): Oculoplastic, orbital, and reconstructive saurgery. Vol. 2. London, Williams and Wilkins; 1990.
5. Olutoye O, Watcha MF. Management of postoperative vomiting in pediatric patients. Int Anesthesiol Clin. 2003;41: 99–117. doi: 10.1097/00004311-200341040-00009
6. Gottfreothsclothir MS, Gislason I, Stefanson E, Sigurjonsdothi S, Nielsen SC. Effect of retrobulbar bupivacaine on postoperative pain and nausea in retinal detachment surgery. Acta Ophthalmologica. 1993;71: 544–547. doi: 10.1111/j.1755-3768.1993.tb04633.x
7. Malroi M.F. i dr. Mestnaya anesteziya: prakticheskoe rukovodstvo; per. s angl. pod red. prof. E.A. Evdokimova. 4-e izd. M.: «BINOM»; 2014.
8. Lu JE, Francis JH, Dunkel IJ, Shields CL, Yu MD, Berry JL, Kogachi K, Skalet AH, Miller AK, Santapuram PR, Daniels AB, Abramson DH. Metastases and death rates after primary enucleation of unilateral retinoblastoma in the USA 2007–2017. Br J Ophthalmol. 2018. doi: 10.1136/bjophthalmol-2018-312915
9. Lübbers HT, Zweifel D, Grätz KW, et al. Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2010;68: 1317–1321.
10. Gayer S, Tutiven J. Anesthesia for pediatric ocular surgery. Ophthalmol Clin North Am. 2006;19: 269–278.
11. Blanc VF, Hardy JF, Milton J, Jacob JL. The occulo cardiac reflex. A statistical analysis in infants and children. Can Anaesth Soc J. 1993;30: 360–369.
12. Misurya VK, Singh SP, Kulshrestha VK. Prevention of oculocardiac reflex during extraocular muscle surgery. Indian J Ophthalmol. 1990;38: 85–87.
13. Gürkan Y, Kiliçkan L, Toker K. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth. 1999;9: 495–499.
14. Espahbodi E, Sanatkar M, Sadrossadat H et al. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran. 2015;53: 158–161.
15. Oh JN, Lee SY, Lee JH, et al. Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery. Korean J Anesthesiol. 2013;64: 500–504.
16. Ghai B, Ram J, Makkar JK, Wig J, Kaushik S. Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. Anesth Analg. 2009;108: 1132–1138.
17. Subramaniam R, Subbarayudu S, Rewari V, Singhal RD, Madan R. Usefulness of pre‐emptive peribulbar block in pediatric viteroretinal surgery: a prospective study. Reg Anesth Pain Med. 2003;28: 43– 47. doi: 10.1053/rapm.2003.50032
18. Allen LE, Sudesh S, Sandramouli S, Cooper G, McFarlane D, Willshaw HE. The association between the oculocardiac reflex and postoperative vomiting in children undergoing strabismus surgery. Eye (Lond). 1998;12: 193–196.
19. Weir PM, Mumo HM, Reynolds PI, Lewis IH, Wilton NC. Propofol infusion and incidence of emesis in paediatric outpatient strabismus surgery. Anesth Analg. 1993;76: 760. doi: 10.1213/00000539-199304000-00013
20. Howward R, Carter J, Curry J, Morton N, Rivett K, Rose M, et al. Association of paediatric anaesthetists of Great Britain and Ireland. Postoperative pain. Paediatr Anaesth. 2008;18: 36–63.
21. Vishalakshi Patil, Allauddin Farooqy, Balaraju Thayappa Chaluvadi, Vinayak Rajashekhar, Ashwini Malshetty. Effect of the addition of rocuronium to 2% lignocaine in peribulbar block for cataract surgery. J Anaesth Clin Pharmacol. 2017;33(4): 520–523. doi: 10.4103/joacp.JOACP_383_16.
