超音波白内障手術における，点眼麻酔，テノン嚢内麻酔とテノン嚢下麻酔の比較検討

Comparison of topical, intra-Tenonial and sub-Tenonial anesthesia in phacoemulsification cataract surgery

　超音波白内障手術と眼内レンズ挿入術の同時手術において，テノン嚢内麻酔とテノン嚢下麻酔の痔痛抑制効果を，点眼麻酔のみによる場合と比較した。麻酔深度の比較は，アセチルコリン剤（縮瞳剤）投与時の疼痛反応を指標とした。疼痛の程度は，まったく刺激を感じない0度から，強い痛みを感じる3度までの4段階に分類した。点眼麻酔群（114例，114眼）では，0度が1眼（0.9％），1度が43眼（37.7％），2度が48眼（42.1％），3度が22眼（19.3％）みられた。テノン嚢内麻酔群（116例，116眼）では，0度が34眼（29.3％），1度が66眼（56.9％），2度が15眼（12.9％），3度が1眼（0.9％）みられ，点眼麻酔群と比べて，疼痛は有意に軽減していた。テノン嚢下麻酔群（115例，115眼）では，テノン嚢内麻酔群とほぼ同等の結果を示し，点眼麻酔群と比べ痔痛の程度に有意な軽減をみた。しかし，テノン嚢内麻酔とテノン嚢下麻酔の比較では有意差をみなかった。また，両浸潤麻酔法ともに，今回用いた刺激に対する完全な疼痛抑制効果をみなかった。

We investigated the analgesic efficacy of intra-Tenonial and sub-Tenonial anesthesia in com-parison with that of topical instillation anesthesia in phacoemulsification cataract surgery with intraocular lens implantation. The assessment of analgesic efficacy was made according to the degree of pain induced with acetylcholine chloride solution (miotic agent). The degree of pain was classified into four grades, from score of 0 for patients experiencing no pain to a score of 3 for those experiencing strong pain. In the group given topical anesthesia (114 cases, 114 eyes), only one eye (0.9%) scored 0. Scores of 1, 2 and 3 were obtained in 43 (37.7%), 48 (42.1%) and 22 (19.3%) eyes, respectively. In contrast, respective scores in the intra-Tenonial group (116 cases, 116 eyes) were 34 (29.3%), 66 (56.9%), 15 (12.9%) and 1 (0.9%). Thus, the degree of pain reduction was significantly greater with the intra-Tenonial than with the topical anesthesia. The results in the sub-Tenonial group (115 cases, 115 eyes) was very similar to that in the intra-Tenonial group, with each showing a significantly greater degree of pain reduction than that in the topical anesthesia group. Nevertheless, no significant differences in the results were observed between these two infiltration methods. In addition, both of the infiltration anesthesias did not offer complete protection against pain induced by the stimulation used in this study.