98th Annual Meeting DOG 2000

P 755

Sedation and analgesia in cataract surgery: Piritramid reduces the endocrine stress response and the subjective pain perception during the peribulbar injection

A. Nestler1, K. U. Burkhardt2, F. Schlichtenbrede1, S. Reinhardt1, R. Wiedemann1

Background: Peribulbar injection is routinely used for local anesthesia in cataract surgery. Often the patient experiences the moment of injection as the most unpleasant situation of the operation. The release of catecholamines caused by psychological distress and pain results in an increased risc of cardiac complications in patients suffering from cardiovascular diseases. We tested the effect of the opioid piritramid on the release of catecholamines and the subjective pain perception.

Patients and Methods: 20 patients scheduled for cataract operation were randomised in two groups. All patients received Midazolam for Premedication and a standardised peribulbar anesthesia. Patients in group 1 were additionally treated with piritramid intravenously 5 minutes prior to the peribulbar injection. Blood pressure, heart rate and oxygen saturation were monitored perioperatively in all patients. The 12-hour urinary excretion of Vanillyl mandelic acid (VMA) was measured in the night before the operation and than compared with the excretion during the day of operation. Also patients provided a subjective pain score ranging from 0 (no pain) up to 10 (maximal pain).

Results: All cataract operations were performed without complication. In group 1 the amount of VMA excreted during the operation day was 10 % less then the amount of VMA excreted during the night before, in group 2 the VMA excretion increased by 5 %. The mean blood pressure did not change significantly after the peribulbar injection in group 1, but in group 2 it rose by 8,1%. The mean pain level was 1,4 in group 1 compared with 3,3 in group 2.

Conclusion: By the use of Piritramid for sedation and analgesia in cataract surgery the endocrine stress response and the subjective pain perception during the peribulbar injection are clearly reduced. This lowers the risc of cardiac complications and improves the patients comfort.

1Klinik und Poliklinik für Augenheilkunde, Liebigstr. 10-14, 2Klinik für Anästhesiologie und Intensivtherapie, Liebigstr. 20a, D-04103 Leipzig