Is hyaluronidase helpful for peribulbar anaesthesia?

Bowman, Richard; Newman, D K; Richardson, E C; Callear, A B; Flanagan, Declan

doi:10.1038/eye.1997.81

Cited by 40 publications

(37 citation statements)

References 11 publications

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“…In contrast to the above studies Bowman et al 13 performed a randomised controlled trial (RCT) using 150 IU ml −1 of hyaluronidase in peribulbar blocks and found no difference in akinesia or subjective and objective analgesia. The anaesthetic mix in this trial was 10 ml of 1:1 2% lignocaine and 0.5% bupivacaine.…”

Section: Hyaluronidasementioning

confidence: 99%

Adjuvants to local anaesthesia in ophthalmic surgery

Adams

2011

British Journal of Ophthalmology

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This article reviews the use of adjuvants to local anaesthesia for ophthalmic regional anaesthesia. Hyaluronidase, bicarbonate, epinephrine, muscle relaxants, opiates and clonidine have all been described singly and in combination for use as an adjuvant to ophthalmic regional anaesthesia. The article focuses on the efficacy of the adjuvants with regard to improving akinesia, analgesia, speed of onset and reducing block failure. A description of the pharmacological action of each adjuvant is given followed by a review of randomised control trials, dosage and notable papers on the subject. There is no effective consensus between anaesthetists or surgeons on the use of adjuvants to local anaesthesia and it so is the purpose of this review to draw attention to the wealth of current data and allow an informed decision on the choices available.

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Section: Hyaluronidasementioning

confidence: 99%

Adjuvants to local anaesthesia in ophthalmic surgery

Adams

2011

British Journal of Ophthalmology

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“…A beneficial effect has been recorded with doses of 3.75-300 IU/ml, whereas others have been unable to demonstrate a difference with doses of 0.75-150 IU/ml. [3][4][5][6][7] Some of this discrepancy may relate to differences in the technique, differences in the type and volume of injected local anaesthetic, and problems with the assessment of akinesia.…”

Section: Introductionmentioning

confidence: 99%

The effect of hyaluronidase on ultrasound-measured dispersal of local anaesthetic following sub-Tenon injection

Khandwala

Ahmed

Goel

et al. 2007

Eye

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Purpose To determine by B-scan ultrasonography if the addition of hyaluronidase affects the dispersal of anaesthetic fluid after sub-Tenon's injection. Design Single-centre prospective randomised double-blind study. Materials and methods We performed a trial in 19 patients who were randomised to receive 5 ml of lidocaine 2% alone, or with hyaluronidase 15 IU/ml. A pre-anaesthetic B-scan ultrasound was performed followed by a standard infero-nasal sub-Tenon's injection. Further B-scan ultrasound studies were performed at 1, 3, and 5 min recording depth of local anaesthetic fluid. Data was analysed with Fisher's exact test and Student's t-test where appropriate. Results were considered significant when Po0.05. Results The maximum depth of local anaesthetic was significantly less in the hyaluronidase group than the control group at 3 and 5 min (0.79 vs 1.65 mm, P-value 0.01 and 0.43 vs 1.52 mm, P-value 0.002 respectively). There were no statistically significant differences in the akinesia, pain and surgical satisfaction scores between the two groups. Conclusions The addition of hyaluronidase significantly augments the dispersal of local anaesthetic fluid, as measured by B-scan ultrasonography.

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“…Conflicting results have been reported on the advantage of HA addition to local anaesthetics. Although there are some reports of HA as an adjunctive in RA for ophthalmic surgery improving the efficacy and speed of nerve blocks [14][15][16][17][18][19][20], other authors do not report any beneficial effect of adjunctive HA [21][22][23]. Interestingly, Schulenburg et al [24] concluded that HA reduces the volumes needed for local anaesthesia.…”

Section: Discussionmentioning

confidence: 92%

“…In addition, careful review of the literature revealed that HA has added value in terms of efficacy and speed of the anaesthesia and avoids a significant increase in intraocular pressure when small volumes (5-8 ml) are used [14][15][16][17][18][19][20]. No beneficial effect of HA has been observed to date when larger volumes are used (8-10 ml) [21][22][23]. Of note, these larger volumes induced a marked rise in intra-ocular pressure, which is unfavourable for the optic nerve, particularly in glaucoma patients.…”

Section: Discussionmentioning

confidence: 94%