眼科局所麻酔の無痛前処置の試み

Preliminary analgesia in cataract surgery under local anesthesia

　白内障手術時の局所麻酔の痛みを軽減する目的で，白内障手術患者100名（102眼）の局所麻酔（瞬目麻酔・球後麻酔）前に笑気・酸素混合ガスの吸入，diazepamの静注（0.1 mg／kg），neur-oleptanalgesia （NLA）変法のいずれかの無痛前処置を施行し，前処置を行わなかった対照群と，痛みに対する自覚症状および局所麻酔前後の血圧・脈拍数・呼吸数・眼圧・瞳孔径の変動について比較検討した。

　この結果無痛前処置群全てで，痛みの自覚症状が，対照群と比べ有意に軽減し，NLA変法＞di-azepamの静注≧笑気・酸素の混合ガスの順であった。

　血圧・脈拍数に関しても，前処置を施した群では，対照群と比較し変動が少なかった。これらの各無痛前処置は，局所麻酔の痛みや恐怖を軽減するのに非常に有用であると思われた。

We evaluated the value of analgetic proceduresprior to local injection of anesthetics in 102 cases undergoing cataract surgery.

The patients were divided into four groups. In group 1, nitrous oxide was inhaled for 10 minutes before performing local anesthesia. In group 2, diazepam was given intravenously 5 minutes before local anesthesia. In group 3, neuroleptanalgesia was performed by intravenous injection of fentanyl and levallorphan 5 minutes before local anesthesia. Patients in group 4 received local anesthesia with-out prior medication and served as control.

In the immediate postoperative period, patients were asked to describe the amount of pain during local injection of anesthetics. The amout of pain was remarkably less in groups 1, 2 and 3 in ascend-ing order than in group 4.

We also evaluated the clinical parameters includ-ing blood pressure pulse rate, respiratory rate, intraocular pressure and pupil diameter. Subjects in groups 1, 2 and 3 and over 70 years of age manifest-ed stability in blood pressure and pulse rate ascompared with those in group 4.

The preliminary analgetic measures were thus useful in alleviating fear as well as actual pain induced by local injection of anesthetics in cataract surgery.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(11) : 1263-1267, 1987