0.75％塩酸ロピバカイン（アナペイン®）を用いたテノン囊下麻酔による硝子体手術

Vitreous surgery under subtenon anesthesia by 0.75％ ropivacaine

要約　目的：作用が長時間持続するとされるロピバカインによるテノン囊下麻酔で硝子体手術を行った報告。対象と方法：過去25か月間に20ゲージ硝子体手術を行った73例74眼を対象とした。男性35眼，女性39眼で，年齢は42～89歳，平均67歳である。56眼では白内障と硝子体の同時手術，16眼では硝子体手術のみ，2眼では眼内レンズ縫着と硝子体の同時手術が行われた。患者を無作為に3群に分け，27眼には0.75％塩酸ロピバカイン，17眼には0.5％塩酸ブピバカイン，30眼には2％塩酸リドカイン各4mlによるテノン囊下麻酔を行った。術中の痛みは100段階のvisual analog scaleと，術者が5段階で主観的に判定した。結果：平均手術時間は，3群間に差がなかった。Visual analog scaleによる術中の疼痛は，3群間に差がなかった。術者の主観では，リドカイン群よりもロピバカイン群の手術が容易であった（p＝0.0058）。局所麻酔による全身の副作用はなかった。結論：白内障と硝子体の同時手術，または硝子体単独手術で，0.75％塩酸ロピバカインによるテノン囊下麻酔は，0.5％塩酸ブピバカインまたは2％塩酸リドカインと同等な鎮痛効果が得られた。

Abstract.　Purpose：To report the outcome of vitreous surgery under subtenon analgesia using ropivacaine. Cases and Method：This study was made on 74 eyes of 73 cases who received 20 G vitreous surgery during the past 25 months. The series comprised 35 males and 39 females eyes. The age ranged from 42 to 89 years, average 67 years. Vitreous surgery was performed simultaneously to cataract surgery in 56 eyes and as independent procedure in 16 eyes. The 74 eyes were randomly divided into 3 groups. One group of 27 eyes received 0.75％ ropivacaine, another group of 17 eyes received 0.5％ bupivacaine, and the other group of 30 eyes 2％ lidocaine for analgesia. Pain during surgery was assessed as visual analogue scale by the patients and as grading into 5 scales by the surgeons. Results：There was no significant difference in duration of surgery among the 3 groups. There was no difference regarding intraoperative pain assessed by the patients among the 3 groups. Surgery was significantly easier to perform using ropivacaine than lidocaine according to the impression of surgeons（p＝0.0058）. Systemic complication of analgesia was absent throughout. Conclusion：Analgetic effect was similar among 0.75％ ropivacaine, 0.5％ bupivacaine and 2％ lidocaine during vitreous surgery.