Abstract
We review evidence regarding the use of 0.9% benzyl alcohol in 0.9% sodium chloride solution for periocular injections (‘preserved saline’) including botulinum toxin A injections and local anaesthesia. A literature search was undertaken using search terms ‘bacteriostatic saline’, ‘benzyl-alcohol saline’, ‘benzyl alcohol sodium chloride’ and ‘preserved saline’. Bibliographies identified further sources. There have been 62 studies published on the subject of preserved-saline since 1928. Significantly lower injection-associated pain levels for periocular/facial botulinum toxin injections reconstituted with preserved-saline rather than preservative-free saline are reported by 5 studies. Significantly lower injection-associated pain with preserved-saline diluted lidocaine and epinephrine solution for eyelid anaesthesia compared with unmodified or buffered lidocaine with epinephrine, and adequate anaesthesia, was reported by one study. Thirty-one studies have explored preserved-saline for anaesthetic and seven for bacteriostatic properties, with very low infection rates after periocular botulinum toxin injections, and reduced rates of infection in indwelling catheters when preserved saline is used to flush. A meta-analysis concluded that lidocaine-containing solutions are more effective at reducing pain from insertion of intravenous catheters. Patient-perceived pain related to periorbital injections of local anaesthesia is reduced when the anaesthetic is diluted with benzyl alcohol-preserved saline compared with other dilution or buffering options. Pain is similarly reduced for periocular botulinum toxin injections reconstituted with preserved saline compared with unpreserved saline. Benzyl-alcohol preserved-saline is inexpensive but costlier than unpreserved-saline, with minimal reported complications, particularly with periocular administration, and offers the opportunity to improve the patient experience.
摘要
我们回顾了眼周注射使用0.9%氯化钠溶液含0.9%苯甲醇(“防腐生理盐水”)的研究证据, 包括A型肉毒杆菌注射和局部麻醉。使用“抑菌生理盐水”、“苯乙醇生理盐水”、“苯甲醇氯化钠”和“防腐生理盐水”等关键词进行文献检索。参考目录进一步确定来源。自1928年以来, 已有62项关于防腐生理盐水的研究发表。有5项研究报道称, 眼周/面部肉毒杆菌毒素注射用的防腐生理盐水与不防腐的生理盐水相比, 前者能显著降低注射相关的疼痛水平。一项研究报告称, 在眼睑麻醉中使用盐水稀释后的利多卡因和肾上腺素, 与未稀释的该溶液相比, 注射相关的疼痛水平明显降低, 且麻醉充分。31项研究探索了防腐生理盐水用于麻醉的特点, 7项研究探索了其抑菌特性, 并发现使用该生理盐水后, 眼周注射肉毒杆菌毒素的感染率非常低, 使用该盐水冲洗留置导管的感染率也降低。一项荟萃分析得出结论, 含利多卡因的溶液在减少静脉导管插入时的疼痛方面更有效。与其他稀释或缓冲溶液的方法相比, 用含苯甲醇防腐的生理盐水稀释麻醉剂时, 可降低眶周局部麻醉相关的疼痛水平。与无防腐的生理盐水相比, 眼周注射肉毒杆菌毒素的疼痛也同样减轻。含苯甲醇防腐的生理盐水价格低廉, 但仍比无防腐的生理盐水价格高, 前者并发症报道最少, 尤其是在眼周给药中, 这为改善患者体验提供了机会。
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Hunt, S.V., Malhotra, R. Bacteriostatic preserved saline for pain-free periocular injections: review. Eye 36, 1546–1552 (2022). https://doi.org/10.1038/s41433-021-01925-z
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DOI: https://doi.org/10.1038/s41433-021-01925-z
