背景随着年龄的增长,眶周区域发生了变革性的变化,影响眼睑的美学外观和功能方面。与年龄相关的改变涉及体积损失,眼睑折痕位置的变化,下垂的眉毛,皮肤弹性降低,和皮肤松弛症的存在。皮肤松弛症,以多余的上眼睑皮肤褶皱为特征,带来了美学和功能上的挑战,影响视力和眼睑提升效率。上眼睑成形术解决了这些与年龄相关的变化。尽管上眼睑成形术具有选择性,该程序会引起术前焦虑和不适。各种用药前策略,包括苯二氮卓类药物,旨在缓解焦虑,增强整体患者体验。然而,关于最佳实施战略的辩论仍在继续。该研究旨在深入了解不同的术前用药方法在上眼睑成形术期间和之后优化患者舒适度的有效性。方法研究设计182例患者,分为三组:对照组(CG)(n=45),不接受术前用药。第1组(n=98)口服咪达唑仑(苯二氮卓类药物),和第2组(n=39)接受咪达唑仑的组合,局部麻醉药(EMLA)眼睑软膏的低共熔混合物,和口服扑热息痛与磷酸可待因半水合物。这项研究评估了焦虑水平,局部麻醉药注射过程中的疼痛感知,手术,术后,以及使用止痛药和不良反应。该研究获得了伦理批准。结果在局部麻醉药注射过程中,各组之间存在显着差异(p<0.0001),手术(p<0.0001),和手术后(p<0.0197)。与第1组和第2组相比,CG患者在局部麻醉药注射和手术期间的疼痛程度更高。第1组报告的手术过程中疼痛多于第2组。术前观察到实质性差异(p<0.0001),手术期间(p<0.0001),和术后焦虑水平(p<0.0001)。与第1组相比,CG显示出较高的术前焦虑,而与CG相比,第1组手术期间的焦虑较低。第1组还报告了比CG和第2组更低的手术后焦虑。两组术后止痛药的使用存在显着差异(p=0.0003)。与第1组(p=0.0004)和CG(p=0.0006)相比,第2组显示出显著较低的使用率。手术后使用止痛药的持续时间存在显着差异(p<0.0014)。CG的持续时间长于第1组(p=0.0049)和第2组(p=0.0495)。结论咪达唑仑单独作为术前用药可有效降低术前焦虑,during,手术后。注射疼痛的EMLA给药没有产生优异的结果,可能是由于其延迟发作。对乙酰氨基酚与磷酸可待因半水合物有效地减少了手术疼痛和术后疼痛持续时间,并减少了对止痛药的需求。
Background The periorbital area undergoes transformative changes with age, influencing both aesthetic appearance and functional aspects of the eyelids. Age-related alterations involve volume loss, shifts in eyelid crease position, drooping eyebrows, reduced skin elasticity, and the presence of dermatochalasis. Dermatochalasis, characterized by redundant upper eyelid skin folds, poses aesthetic and functional challenges, impacting visual acuity and eyelid elevation efficiency. Upper blepharoplasty addresses these age-related changes. Despite the elective nature of upper blepharoplasty, the procedure can evoke preoperative anxiety and discomfort. Various
premedication strategies, including benzodiazepines, aim to alleviate anxiety and enhance the overall patient experience. However, ongoing debates persist regarding the optimal strategy for implementation. The study aims to contribute insights into the effectiveness of different
premedication approaches in optimizing patient comfort during and after upper blepharoplasty. Methods The research design involves 182 patients divided into three groups: control group (CG) (n = 45) receiving no
premedication, Group 1 (n = 98) receiving oral midazolam (a benzodiazepine), and Group 2 (n = 39) receiving a combination of midazolam, eutectic mixture of local anesthetics (EMLA) eyelid ointment, and oral paracetamol with codeine phosphate hemihydrate. The study assesses anxiety levels, pain perception during local anesthetic injection, surgery, and postoperatively, as well as the use of painkillers and adverse effects. Ethical approval was obtained for the study. Results Significant differences were noted among the groups during local anesthetic injection (p < 0.0001), surgery (p < 0.0001), and post surgery (p < 0.0197). CG patients experienced higher pain levels during local anesthetic injection and surgery compared to Groups 1 and 2. Group 1 reported more pain during surgery than Group 2. Substantial differences were observed in preoperative (p < 0.0001), during-surgery (p < 0.0001), and after-surgery (p < 0.0001) anxiety levels. The CG exhibited higher preoperative anxiety compared to Group 1, while Group 1 had lower anxiety during surgery compared to the CG. Group 1 also reported lower anxiety after surgery than both the CG and Group 2. A significant difference was found in post-surgery painkiller usage among the groups (p = 0.0003). Group 2 showed significantly lower usage compared to Group 1 (p = 0.0004) and the CG (p = 0.0006). A significant difference was observed in the duration of painkiller use after surgery (p < 0.0014). The CG had a longer duration than Group 1 (p = 0.0049) and Group 2 (p = 0.0495). Conclusions Midazolam alone as
premedication effectively reduced anxiety before, during, and after surgery. EMLA administration for injection pain did not produce superior results, likely due to its delayed onset. Paracetamol with codeine phosphate hemihydrate effectively reduced surgical pain and postoperative pain duration and decreased the need for painkillers.