The Use of Pterugoplatine Blockade with Dexamethasone for Anesthetization in Enucleation and Evisceration

I.G. Oleshchenko1, О.P. Mishchenko1, М.А. Gasparyan1, Т.N. Iureva2

Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk

Irkutsk Institute of postgraduate medical education, Irkutsk

For correspondence: Irina G. Oleshchenko — Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk; e-mail: Iga.oleshenko@mail.ru

For citation: Oleshchenko IG, Mishchenko ОP, Gasparyan МА, Iureva ТN. The Use of Pterugoplatine Blockade with Dexamethasone for Anesthetization in Enucleation and Evisceration. Intensive Care Herald. 2017;2:50–54.


Traditionally the well proven retrobulbar anesthesia as an independent method of pain relief is used in ophthalmology, but there are also disadvantages of this type of anesthesia. To develop and evaluate the clinical efficacy of the combined method of pain relief during evisceration or enucleation of the eyeball, including the blockade of the pterygopalatine ganglion by local anesthetic and dexamethasone as an adjuvant, and inhalation anesthesia with sevorane. A comparative analysis of the effectiveness of intraoperative anesthesia and course of postoperative period in patients of two clinical groups, which were formed according to the method of anesthesia, were held. The nature of pain sensation in patients of comparable groups had significant differences; except the presence and intensity of pain, the degree of edema and conjunctival injection were assessed. The use of pterygopalatine blockade with lidocaine and naropin in combination with dexamethasone as adjuvant provides a prolonged analgesic, anti-inflammatory and anti-edematous effect. This makes it possible to avoid the use of opioid analgesics in early postoperative period, i. e. to avoid systemic side effects such as nausea, dizziness, vomiting, in rare cases, which generally improves the quality of the postoperative period. Application of the pterygopalatine ganglion blockade with mixture of local anesthetics with different durations of action and dexamethasone as an adjuvant based on inhalation anesthesia with sevorane provides safe and effective analgesia in patients during evisceration or enucleation of eyeball, both intra- and postoperatively.

Keywords: enucleation, evisceration, pterygopalatine blockade, dexamethasone

Received: 03.03.2017


References

  1. Балашова П.М., Гололобов В.Т., Козина Е.В. и др. Посттравматическая энуклеация глазного яблока среди взрослого населения Красноярского края. Тихоокеанский медицинский журнал. 2016; 61(3): 36–39. [Balashova M., Gololobov V.T., Kozina E.V. et al. Posttravmaticheskaya enukleatsiya glaznogo yabloka sredi vzroslogo naseleniya Krasnoyarskogo kraya. Tihookeanskij medicinskij zhurnal. 2016; 61(3): 36–39. (In Russ)]
  2. Бровкина А.Ф., Лохманов В.П. О некоторых особенностях техники энуклеации глаза при меланомах хориоидеи. Вестник офтальмологии. 1983; 2: 7–9. [Brovkina A.F., Lohmanov V.P. O nekotoryh osobennostyah tehniki enukleatsii glaza pri melanomah horioidei. Vestnik oftal’mologii. 1983; 2: 7–9. (In Russ)]
  3. Гнездилов А.В., Загорулько О.И., Сыровегин А.В., Медведева Л.А. Терапия острого корешкового синдрома с использованием глюкокортикоидных препаратов в практике отделения терапии боли. Терапевтический архив. 2004; 4: 75–77. [Gnezdilov A.V., Zagorulko O.I., Syrovegin A.V., Medvedeva L.A. Terapiya ostrogo koreshkovogo sindroma s ispol’zovaniem glukokortikoidnyh preparatov v practike otdeleniya terapii boli. Terapevticheskij arhiv. 2004; 4: 75–77. (In Russ)]
  4. Осипова Н.А., Арбузова Г.Р. Клинические рекомендации Федерального государственного бюджетного учреждения Московского научно исследовательского онкологического института им. П.А. Герцена. М.: Медицина, [Osipova N.A., Arbuzova G.R. Klinicheskie rekomendacii Federal’nogo gosudarstvennogo byudzhetnogo uchrezhdeniya Moskovsko- go nauchno issledovatel’skogo onkologicheskogo instituta im. P.A. Gertsena. Moscow: Medicina; 2011. (In Russ)]
  5. Пасечникова Н.В., Боброва Н.Ф., Науменко В.А. и др. Совершенствование методов абластики при энуклеации глазного яблока в случаях ретинобластомы. Офтальмологический журнал. 2013; 6(455): 62–67. [Pasechnikova N.V., Bobrova N.F., Naumenko V.A. Sovershenstvovanie metodov ablastiki pri enukleatsii glaznogo yabloka v sluchayah retinoblastomy. Oftal’mologicheskii zhurnal. 2013; 6(455): 62–67. (In Russ)]
  6. Филатова И.А., Вериго Е.Н., Пряхина И.А. Удаление глаза: характер офтальмопатологии, клинические проявления механической травмы, сроки и методы операций. Голова-шея. 2014; 3: 30–35. [Filatova I.A., Verigo E.N., Pryahina I.A. Udalenie glaza: harakter oftal’mopatologii, klinicheskie proyavleniya mehanicheskoi travmy, sroki i metody operatsii. Golova-sheya. 2014; 3: 30–35. (In Russ)]
  7. Филатова И.А., Вериго Е.Н., Пряхина И.А., Садовская Е.П. Роль анатомо-клинических проявлений травмы в выборе метода удаления глаза. Российский офтальмологический журнал. 2014; 7(4): 52–59. [Filatova I.A., Verigo E.N., Pryahina I.A., Sadovskaya E.P. Rol’ anatom-klinicheskih proyavlinii travmy v vybore metoda udaleniya glaza. Rossiiskii oftal’molog- icheskii zhurnal. 2014; 7(4): 52–59. (In Russ)]
  8. Coloma M., Duffy L.L., White F. et al. Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesth. An- alg. 2001; 92: 85–88.
  9. Cummings K.C., Napierkowski D.E., Parra-Sanchez I. et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. J. Аnaesth. 2011; 107: 446–453.
  10. Koppert W., Ostermeier N., Sittl R. et al. M. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain. 2000; 85: 217–224.
  11. Leduc C., Gentili M.E., Estebe P. et al. The effect of local an- esthetics and amitriptyline on peroxidation in vivo in an inflam- matory rat model: preliminary reports. Anesth. Analg. 2002; 95: 992–996.
  12. Shrestha B.R., Maharjan S.K., Shrestha S. et al. Comparative study between tramadol and dexamethasone as anadmixture to bupivacaine in supraclavicular brachial plexus J. Nepal Med. Assoc. 2007; 46: 158–164.
  13. Williams B.A., Hough K.A., Tsui B.Y. et al. Neurotoxicity of ad- juvants used in perineural anesthesia and analgesia in com- parison with ropivacaine. Reg. Anesth. Pain Med. 2011; 36(3): 225–230.