This is an automatically translated article.
The article was professionally consulted by Specialist Doctor I Nguyen Duc Thong - Anesthesiologist - General Surgery Department - Vinmec Danang International Hospital. The doctor has 14 years of experience in the field of Anesthesia.Currently, there are many methods of anesthesia in ophthalmic surgery, but the technique of paraocular anesthesia is considered to be the most superior. Injecting local anesthetic near the eyeball brings high analgesia efficiency and few complications.
1. Overview
Today, the technique of paraocular anesthesia is considered to be less invasive than retrobulbar anesthesia, so in recent years this technique has been widely used to anesthetize ocular surgery.Indications:
Intraocular surgery. Extraocular surgery. Contraindications:
Uncoordinated patient. The patient is allergic to the anesthetic. The patient has an enlarged eye.
Gây tê cạnh nhãn cầu chỉ định khi tiến hành các phẫu thuật ở mắt
2. Pre-preparation for paraocular anesthesia
Before anesthesia to prepare for eye surgery, the patient needs to have some pre-operative examination steps:General assessment of the heart, lungs, liver, kidneys and nerves. Assess the patient's ability to respond to the method of anesthesia, surgery. Observe and examine the area to be anesthetized. Explain and advise the patient and family on the method of analgesia. Instruct the patient to fast and fast for the prescribed time. Give the patient fluids before entering the operating room. Prepare means, equipment to monitor pulse, blood pressure, SpO2,... Anesthesia technique
Anesthesia purpose: to numb the conjunctiva and eyeball, immobilize the eyeball and stabilize the eye pressure.
Patient position: put the patient in supine position, keep the head fixed on the pillow in the middle of the operating field so that the anesthesia can be easily manipulated.
Equipment and medicine:
Syringe 5ml. Local anesthetics: Lidocaine, Levobupivacaine, Ropivacaine. Antiseptic (Betadine 5%).
Chuẩn bị dụng cụ và thuốc sát trùng trước khi thực hiện gây tê
3. The procedure of anesthesia near the eyeball
Paraocular anesthesia is a form of anesthesia around the eyeball through the upper or lower orbit.Disinfect the upper eyelid, lower eyelid and around the eye. Locate the needle puncture: Anesthetize the lower periocular side: at the junction between the outer 1/3rd and the inner 2/3rd of the lower orbital margin, the needle point is directed upwards. Insert the needle into the lower border of the orbital bone, about 15-20mm deep. Anesthesia above the upper eyeball: the junction between the outer 2/3 and the inner 1/3 of the upper orbital border, the needle pointing downwards. Insert the needle at the superior edge of the orbital bone ridge, the needle goes upward about 5 degrees, after the needle tip passes through the equator of the eyeball, the needle direction is parallel to the axis of the eyeball. Once the needle is in the correct position, gently inject the medication behind the eyeball. Observe if the eyes feel full and appear droopy eyelids are signs of good paraocular injection. Place a pressure ball on top to help spread the anesthetic and reduce pressure and swelling in the eye. Remove the balloon and check for movement of the eyelids and eyeballs. If the eye is motionless and the pupil is slightly dilated, it is a sign that the technique of paraocular anesthesia is good. Apply antiseptic and antiseptic to the skin around the eyes to prepare for surgery.
Tra thuốc sát khuẩn quanh vùng da mắt để chuẩn bị cho phẫu thuật
Advantages: simple technique, good anesthetic effect, good analgesia, low cost, lower complication rate compared to other techniques. Post-ocular anesthesia. Disadvantage: unfortunate cases can be injected into the blood vessel or eyeball by mistake, glaucoma, more pain than subtenonal anesthesia. In eye surgery anesthesia, there are various anesthetic methods such as: post-ocular anaesthesia, paraocular anesthesia, subtenonous anesthesia, local anesthesia... Each technique has its advantages and disadvantages. It is suitable for each type of surgery and different patients.
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Refractive error screening package Cataract surgery consultation and examination package Ortho-K package
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