Objective: To explore the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) combined with medial canthus peribulbar block for postoperative pain in patients with thyroid-associated ophthalmopathy (TAO) after orbital decompression. Methods: This study was a single-center, single-blind, randomized controlled study. From June 2020 to December 2020, sixty TAO patients in Zhongshan Ophthalmic center, Sun Yat-sen University who were allocated to receive orbital decompression under general anesthesia, were randomly and equally divided into two groups (n=30): the control group (group C) and the medial canthus peribulbar block group (group PB). All patients received intravenous infusion of flurbiprofen axetil 50 mg at 15 min before the end of surgery. In PB group, patients received peribulbar block via caruncular approach for postoperative pain management upon completion of wound closure, while patients in group C did not receive the peribulbar block. If patient sufferred significant postoperative pain (NRS score≥4), Ketorolac 10 mg would be prescribed as analgesic rescue. Postoperative NRS pain scores were recorded at 2, 4, 8, 24, 48 h after the surgery. The usage of Ketorolac during 0-24 h and 24-48 h postoperatively were also recorded. Postoperative complications during the hospital stay were recorded. Severity of orbital swelling would also be evaluated at 24 h after surgery. Results: The NRS pain scores [M(Q1, Q3)] in group PB were 2.50(2.00, 3.00)and 2.00(1.75, 3.00), which were both significantly lower than those in group C of 4.50(3.00,5.00), 3.00(2.00,4.25)at 2 h, 4 h after surgery respectively(P=0.001,0.045). During the first 24 h, the usage rate of Ketorolac in group C was 40%(12/30), which was higher than that in the group PB (13.3%, 4/30) with statistical significance (P=0.041). There was no significant difference in the incidences of postoperative nausea, vomiting, dizziness during the first 48 h, as well as the moderate to severe intensity of orbital swelling at 24 h after surgery (all P>0.05). There were no obvious complications of medial canthus peribulbar block in group PB. Conclusions: NSAIDs combined with medial canthus peribulbar block can provide satisfactory analgesia for TAO patients after orbital decompression, which is safe with little complications, and is beneficial to enhanced recovery after surgery.
目的： 探讨非甾体类抗炎药联合泪阜入路球周阻滞用于甲状腺相关性眼病（TAO）患者眼眶减压术后镇痛的效果与安全性。 方法： 本研究为单中心、单盲、随机对照试验。选择2020年6至12月中山大学中山眼科中心于全身麻醉下接受眼眶减压手术的TAO患者60例，采用随机数字表法分为两组（n=30）：对照组（C组）和泪阜入路球周阻滞组（PB组）。两组患者均在手术结束前15 min静脉滴注氟比洛芬酯50 mg；PB组患者在切口缝合完成后进行单次泪阜入路球周阻滞作为术后镇痛，C组患者不进行球周阻滞。两组患者若术后疼痛数字分级法（NRS）评分≥4 分，则给予口服镇痛药酮咯酸氨丁三醇10 mg作为补救镇痛。记录两组患者术后2、4、8、24、48 h的疼痛NRS 评分，术后 0~24 h、24~48 h内酮咯酸氨丁三醇补救镇痛率。观察并记录患者术后48 h内的不良反应与操作相关并发症发生情况，评估术后24 h患者眼眶肿胀度分级。 结果： PB组患者术后2、4 h的疼痛NRS评分［M（Q1，Q3）］分别为2.50（2.00，3.00）、2.00（1.75，3.00）分，低于C组的4.50（3.00，5.00）、3.00（2.00，4.25）分（P=0.001、0.045）。术后24 h内，C组使用酮咯酸氨丁三醇的补救镇痛率为40.0%（12/30），显著高于PB组的13.3%（4/30）（P=0.041）。两组患者术后48 h内恶心、呕吐、头晕，以及术后24 h内中重度眼睑肿胀发生率差异均无统计学意义（均P>0.05）。PB组未出现泪阜入路球周阻滞相关并发症。 结论： 非甾体类抗炎药联合泪阜入路球周阻滞在TAO患者眼眶减压术后早期具有良好的镇痛效果，且安全性高、不良反应少，有助于患者术后早期康复。.