Antiinflammatory effect of pterygopalatine blockade for anesthetization in ophthalmic surgery

Purpose: to evaluate the effectiveness of analgesic and anti-inflammatory effects of pterygopalatine blockade in the surgical treatment of cataract in children. Materials and methods. A comparative analysis of the efficacy of intraoperative anesthesia and the course of the postoperative period was carried out in 52 patients of two clinical groups that were formed depending on the method of anesthesia. The first clinical group included 26 patients who underwent a pterygopalatine blockade as a regional component of general anesthesia, the second comparison group was formed of 28 patients undergoing retrobulbar blockade. To assess the adequacy of anesthesia, the concentration of plasma cortisol and oxidation-reduction profile was determined before and after the operation, the intensity of the pain syndrome, the extent of the inflammatory reaction of the eye after surgery were assessed. The results showed a decrease in the concentration of cortisol and increased antioxidant capacity of the organism after surgery in patients of the first group. In patients of the 1^st clinical group, the Tyndal phenomenon of the 1^st degree was revealed in 15.3 % of cases, the remaining patients had no signs of inflammation. Each second patient of 2^nd group had a moderate degree of inflammatory reaction, and in 7 % of cases significant exudative phenomena were noted in the form of the Tyndall II degree phenomenon. Conclusion. The use of vesicle blockade in the surgical treatment of cataracts allowed improving the quality of rehabilitation of a patient with congenital cataract, both in the early and late postoperative period.

pterygopalatine blockade, oxidation-reduction potential, congenital cataract

1. Боброва Н.Ф., Хмарук А.Н. Закономерности помутнения задней капсулы хрусталика после факоаспирации различных форм врожденных катаракт у детей различного возраста // Вестник ОГУ - 2004. -№ S. - С. 70-72

2. Заболотский Д.В., Корячкин В.А. Ребенок и регионарная анестезия - зачем? куда? и как? // Регионарная анестезия и лечение острой боли. - 2016. -№ 4. - С. 243-253

3. Олещенко И.Г., Юрьева Т.Н., Заболотский Д.В., Горбачев В.И. Блокада крылонебного узла, как компонента сочетанной анестезии при оперативных вмешательствах по поводу врожденной каратаркты глаза у детей // Регионарная анестезия и лечение острой боли. - 2017. - Т. 11, № 3. - С. 202-207

4. Сенченко Н.Я., Нагаева К.А., Аюева Е.К., Юрьева Т.Н. Врожденная катаракта. Сообщение Современные представления об этиологии и принципах классификации. Обзор литературы // Офтальмология. - 2013. - № 4 (10). - С. 16-20

5. Хватова А.В., Круглова Т.Б., Фильчикова Л.Н. Клинические особенности и патогенетические механизмы нарушения зрительных функций при врожденных катарактах // Зрительные функции и их коррекция у детей. - М.: Медицина, 2005. - С. 344-358

6. Щуко А.Г., Мищенко О.П., Сенченко Н.Я., Юрьева Т.Н. Факторы риска и осложнения, возникающие при поздних спонтанных дислокациях комплекса «заднекамерная ИОЛ капсульный мешок» в стекловидное тело // Офтальмохирургия. - 2017. - № 1. С. 21-26

7. Acworth I.N., McCabe D.R., Maher T.J., Baskin S., Salem H. (eds.). (1997). The analysis of free radicals, their reaction products, and antioxidants, in oxidants, antioxidants and free radicals. Oxidants, Antioxidants, and Free Radicals. Washington (DC), 23-77.

8. Boone C.H. (2017). Oxidative stress, metabolomics profiling, and mechanism of local anesthetic induced cell death in yeast. Redox Biol, 12, 139-149.

9. Cuzzocrea S., Riley D., Caputi A.P., Saivemini D. (2001). Antioxidant therapy: a new pharmacological approach in shock, inflammation, ischemia/reperfusion injury. Pharmacol Rev, 53, 153-159.

10. Ebbeling M.B., Oomen K.P., de Ru J.A., Hordijk G.J., Bleys R.L. (2011) Neurochemical characterization of pterygopalatine ganglion branches in humans. Am J Rhinol Allergy, 25 (1), 50-53.

11. Gottschalk A., Sharma S., Ford J., Durieux M.E., Tiouririne M. (2010). The role of the perioperative period in recurrence after cancer surgery. Anesth Analg, 110 (6), 1636-1643.

12. Kanigowska K. (2006). Influence of intraoperative complication on intraocular rigid lens fixation in pediatric cataract surgery. Klin Oczna, 108 (10-12), 401-404.

13. Khonsary S.A., Ma Q., Villablanca P., Emerson J., Malkasian D. (2013). Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: A review. Surg Neurol Int, 4 (Suppl 6), 422-S428.

14. Ledowski T. (2010). Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma levels. Anaesthesia, 65 (10), 1001-1006.

15. Ma F., Wang Q., Wang L. (2012). Advances in the management of the surgical complications for congenital cataract. Front Med, 6 (4), 360-365.

16. Moreno-Montanes J., Sainz C., Maldonado M.J. (2003). Intraoperative and postoperative complications of Cionni endocapsular ring implantation. J Cataract Refract Surg, 29 (3), 492-497.

17. Rusu M.C., Pop F. (2010). The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans. Ann Anat, 192 (1), 17-22.

18. Speeg-Schatz C. (2011). Results and complications of surgery of congenital cataract. J Fr Ophthalmol, 34 (3), 203-207.

19. Volkova N.V. Immunomodulatory therapy for keratitis complicated by corneal epithelial insufficiency. Available at: http://www.escrs.org/lisbon2017/programme/posters-details.asp?id=29053.