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研究生:李辰涵
研究生(外文):Chen-Han Lee
論文名稱:評估以 0.8% nalbuphine 局部點眼對於犬隻白內障乳化術術後之疼痛與角膜敏感度之效果
論文名稱(外文):Effect of topical adminstration of 0.8% nalbuphine on signs of pain and corneal sensitivity after phacoemulsification in dogs
指導教授:林荀龍
指導教授(外文):Shiun-Long Lin
口試委員:林中天
口試日期:2011-07-28
學位類別:碩士
校院名稱:國立中興大學
系所名稱:獸醫學系暨研究所
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:英文
論文頁數:53
中文關鍵詞:白內障角膜敏感度
外文關鍵詞:nalbuphinephacoemulsificationcorneal sensitivity
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臨床上進行眼科學檢查流程時,眼用局部麻醉劑被用來減輕操作時產生的疼痛及不舒適感已有多年,但從未被當作治療用途使用。近年來有人將嗎啡類藥物局部點眼使用並研究其對於角膜止痛之效果,結果顯示這類藥物可以提供局部的止痛而且不會延遲角膜傷口癒合。其中,以 nalbuphine 粉末加上液體配製成具有適當酸鹼值的 1% nalbuphine 溶液,曾被評估在點眼使用後對於犬及馬的角膜是否能產生止痛效果。本實驗目的是將商品化的 nalbuphine 注射液進行鹼化及稀釋,評估此藥對於白內障超音波乳化手術所造成的術後疼痛是否能提供良好的止痛效果。此外,其對於角膜敏感度的影響也在本實驗評估的項目之中。本實驗對象為 11 隻患有白內障並至中興大學獸醫教學醫院就診之犬隻。將 12 個接受白內障超音波乳化術的眼睛以隨機分組的方式分為 saline 組 (n= 6) 與 nalbuphine 組(n=6),各組分別接受以 0.1 ml的 saline 或 nalbuphine 局部點眼。所有評估項目於術前及術後點藥前皆會先取得其
基本數值,再比較術前與術後及點藥前與點藥後的差異。於術後,角膜敏感度、眼瞼痙孿、角膜水腫、結膜充血及前房混濁程度、眨眼頻率及瞳孔大小皆在點藥前及點藥後的 15,30 及 60 分鐘後進行測量並記錄。於角膜敏感度部分,nalbuphine 組在術後第一及第二天於點藥前後皆出現顯著差異。兩組間的眼瞼痙孿程度在術後第一天並無顯著差異(p = 0.1),而於術後第二天則出現顯著差異(p =0.001)。眨眼頻率同樣是在術後第二天於點藥前及點藥後,兩組間皆出現顯著差異。由研究所得的數據顯示出 nalbuphine 組在術後第二天,其眼瞼痙孿程度及眨眼頻率相較於 saline 組皆有顯著減少。目前的研究結果顯示,0.8% nalbuphine 局部點眼的 15, 30 及 60 分鐘後可以使角膜敏感度減低。其對於白內障乳化術造成的術後疼痛,也具有些微緩解的效果。

Topical ophthalmic anesthetics have been used for many years to prevent pain and discomfort during ophthalmic tests and procedures, but never for therapeutic purposes. Recently, data have been obtained which suggest that topical application of opioids may
also provide localized analgesia with no delay in corneal wound healing. 1% nalbuphine solution prepared by adding powder nalbuphine to aqueous solution with an appropriate
pH level has been used topically for evaluating the analgesic effect in dogs and horses. The aim of this study was to evaluate the effect of diluted and alkalized commercial nalbuphine injection on signs of postoperative pain and corneal sensitivity in dogs
undergoing phacoemulsification. Twelve eyes from eleven dogs undergoing phacoemulsification cataract surgery at veterinary medical teaching hospital, National Chung Hsing University were included in this study. The subjects were divided into two groups: saline group (n = 6) and nalbuphine group (n = 6). 0.1 ml saline or nalbuphine
solution was instilled in randomly selected eye. Baseline values of all assessments were measured in surgical eyes before and after phacoemulsification. Postoperatively, corneal touch threshold (CTT), the extent of blepharospasm, corneal edema, conjunctival hyperemia and flare, frequency of eyelid blink and pupil diameter for each eye were recorded before and at 15, 30 and 60 minutes following nalbuphine or saline administration. The significant differences in CTT were noted between values before and after nalbuphine treatment on day 1 to 2 after surgery. There was no significant difference in scores for blepharospasm between two groups before treatment on day 1 (p = 0.1), whereas a significant difference was noted on day 2, postoperatively (p = 0.001). The
significant differences in eye blink frequency between two groups were noted before and after treatment on day 2. According to the results, a significant reduction in blepharospasm and eye blink frequency was observed in the nalbuphine group on postoperative day 2. The present results of the study indicate that prepared 0.8% nalbuphine solution can decrease the corneal sensitivity at 15, 30 and 60 minutes after topical administration and it may has little effect on ocular pain relief after phacoemulsification.

Abstract: English version ············································· i
Abstract: Chinese version ············································· iii
List of figures ······················································ vi
List of tables ······················································· vii
1. Introduction······················································ 1
2. Literature review ·················································· 3
2.1. Neural basis of sensation in corneas································ 3
2.1.1. Corneal sensory nerve fibers and their functional characteristics······ 3
2.1.2. Measurement of corneal sensitivity····························· 5
2.1.3. Activities of corneal sensory fibers in injured and inflamed corneas ··· 5
2.1.4. Action of drugs on corneal sensory fibers························ 6
2.2. Topical ophthalmic anesthetics and analgesics························ 7
2.2.1. Topical anesthetics·········································· 7
2.2.2. Topical non-steroidal anti-inflammatory drugs (NSAIDs) ··········· 8
2.2.3. Topical opioids············································· 9
2.3. Phacoemulsification ············································ 11
2.3.1. Procedures of surgery involved cornea ·························· 11
2.3.2. Intraoperative and postoperative pain ··························· 12
2.3.3. Postoperative changes in corneal sensitivity······················ 14
3. Materials and methods·············································· 16
3.1. Animals and materials··········································· 16

3.2. Methods ····················································· 17
3.2.1. Pre-surgical and post-surgical evaluation ························ 17
3.2.2. Protocol of phacoemulsification ······························· 20
3.2.2.1. Pre-surgical treatment···································· 20
3.2.2.2. Surgical procedures······································ 20
3.2.2.3. Post-surgical treatment··································· 22
3.2.3. Study procedures··········································· 22
3.2.3.1. Preparation of 0.8% nalbuphine solution ····················· 22
3.2.3.2. Study design··········································· 24
3.3. Statistical analysis·············································· 24
4. Results·························································· 25
4.1. Baseline characteristics·········································· 25
4.2. Changes in cornea, conjunctiva and anterior chamber·················· 26
4.3. Corneal sensitivity ············································· 28
4.4. Blepharospasm ················································ 29
4.5. Eye blink frequency ············································ 33
4.6. Pupil size····················································· 34
4.7. Schirmer tear test ·············································· 36
5. Discussions ······················································ 38
References························································· 45

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