RU2408393C1 - Peribulbar anaesthesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and namely to ophthalmology, and can be used as an anaesthesia care in extended ophthalmic surgeries or in impossible endotracheal narcosis of the patients suffering a severe accompanying pathology. That is ensured by needle stick-in through skin of an upper eyelid in a projection of frontal incisure in a superonasal region. Then the needle is moved further tangentially to the eyeball. An anaesthetic is introduced in subcutaneous fat between optic canal and superior orbital fissure in amount 2-3 ml.

EFFECT: method allows fast and long-term anaesthetic effect simultaneously with reduced dosage of the anaesthetic due to its delivery to the basic motor and sensory nerve trunks of the eyeball.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used in anesthetic practice when performing peribulbar blockade to provide anesthesia during long operations or when endotracheal anesthesia is impossible in patients with severe concomitant pathology.

There is a method of performing peribulbar blockade (see the book "Local anesthesia. Illustrated practical guidance" edited by M. Malroy, Moscow, 2003, p.230), which consists in performing an injection in the upper nasal region with the introduction of a needle tangent to the eyeball, the introduction of anesthetic into fatty tissue. The disadvantage of this method is the lack of effectiveness in performing only one of this manipulation, therefore, it is used as an additional injection when performing peribulbar blockade (in total, two injections are performed). In addition, in the known method, in total, when performing anesthesia, a large amount (up to 10 ml) of a local anesthetic solution is injected into retrobulbar cellulose (fatty tissue). In this case, anesthesia occurs slowly, between the first and second injections should be at least 10 minutes, i.e. lengthens the preparation of the patient for surgery.

The present invention solves the problem of developing a new method for performing peribulbarnoy anesthesia used for obtaining a stable anesthetic effect during operations in patients with vitreoretinal pathology on retinal detachment, cyclophotocoagulation, i.e. with complex long operations. The resulting technical result is to effectively carry out the manipulation, allows using a single injection to provide rapid onset of anesthetic effect by summing anesthetic to the main motor and sensory nerve trunks eyeball. In addition, the supply of anesthetic between the optic canal and the upper orbital fissure allows you to enter only 2-3 ml of anesthetic. The proposed method is simple to implement, provides a good, fast onset anesthetic effect. One injection replaces two injections performed in a known method of anesthesia.

The specified technical result is achieved by the fact that with peribulbar anesthesia, consisting of an injection in the upper nasal area with the introduction of a needle tangentially to the eyeball, the introduction of anesthetic into the fatty tissue, the injection is performed through the skin of the upper eyelid in the projection of the frontal notch, the anesthetic is injected between the visual canal and the upper orbital fissure in an amount of 2-3 ml.

Peribulbar anesthesia is as follows.

The patient is laid on his back. The index finger of the right hand identifies the frontal notch located on the upper edge of the orbit. The skin of the forehead in the projection of the notch is marked with a marker. An aseptic treatment of the skin of the upper eyelid is carried out with the capture of the infraorbital region. A needle with a diameter of 24 G and a length of 45 mm is used to perform the injection. Injection is performed through the skin of the upper eyelid in the upper nasal region. The needle is injected below the mark with a marker under the upper edge of the orbit into the fold area of the upper eyelid. The needle is advanced at an angle of 90 ° to the skin surface tangentially to the eyeball to a depth of 35-40 mm for the introduction of anesthetic into the fatty tissue between the visual channel and the upper orbital fissure. In the course of advancement, the direction of the needle does not change. After immersing the needle to a predetermined depth, an anesthetic is introduced in an amount of 2-3 ml. In the same position, the needle is brought back.

After the injection with a gauze roller, pressure is applied along the entire length of the folds of the upper eyelid for better distribution of the anesthetic. The criteria for properly performed anesthesia are: incomplete closure of the eyelids, ptosis, immobility of the eyeball or limitation of movements, an enlarged pupil, lack of sensitivity in the distribution area of the first branch of the trigeminal nerve and ciliary node (eyeball, skin of the upper eyelid and forehead), small exophthalmos. After anesthesia, swelling of the skin of the upper eyelid may be observed.

Anesthesia occurs quickly, surgery can be performed after 5 minutes.

Clinical example.

Patient I., born in 1936, medical record No. 302422.

A diagnostic examination was carried out in the Volgograd branch of the Federal State Institution "Scientific and Technical Center" Eye Microsurgery "named after Academician S. N. Fedorov."

Diagnosis: OD - artifact, postoperative astigmatism, edematous fibroplastic syndrome. OS - total retinal detachment, initial cataract, state after laser coagulation.

VIS OD: 0.2

VIS OS: face count.

Concomitant pathology: IHD, cardiosclerosis, arterial hypertension II, risk 3; pneumosclerosis, DN II; discirculatory encephalopathy II.

After the examination, an operation on the OS is recommended - a compass, subtotal vitrectomy, subretinal fluid drainage, cryopexy.

08/19/2009, the patient underwent surgery. Before the operation, peribulbar anesthesia was performed according to the proposed technique. The patient was placed on a gurney in a horizontal position on his back, the patient's head in a position on the back of the head. The index finger of the right hand identified the frontal notch located on the upper edge of the orbit. The forehead skin in the projection of the notch was marked with a marker. We performed aseptic treatment of the skin of the upper eyelid with the capture of the infraorbital region. A needle with a diameter of 24 G and a length of 45 mm was used to perform the injection. The injection was performed through the skin of the upper eyelid. The needle was injected below the mark with a marker, in the projection of the frontal notch, into the fold area of the upper eyelid. The needle was inserted at an angle of 90 ° to the skin surface tangentially to the eyeball to a depth of 40 mm. In the course of advancement, the direction of the needle did not change. After immersing the needle to a predetermined depth, 3 ml of anesthetic was injected into the adipose tissue between the optic canal and the superior orbital fissure. As anesthetic used 2% solution of ultracaine. In the same position, the needle was brought back. After the manipulation, pressure was applied with a gauze roller on the region of the upper eyelid. Anesthesia came very quickly, after which the patient underwent surgery in the previously planned volume.

Claims (1)

Peribulbar anesthesia, consisting of an injection in the upper nasal area with the introduction of a needle tangentially to the eyeball, the introduction of anesthetic into fatty tissue, characterized in that the injection is performed through the skin of the upper eyelid in the projection of the frontal notch, the anesthetic is administered between the visual canal and the upper orbital fissure in an amount of 2-3 ml.