Sub-Tenon's Block: The Effect of Hyaluronidase on Speed of Onset and Block Quality

Guise, Philip A; Laurent, S.

doi:10.1177/0310057x9902700209

Cited by 33 publications

(19 citation statements)

References 5 publications

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“…There was no improvement in sensory blockade with the addition of hyaluronidase but in both groups the quality of the block was excellent. This supports the findings of a recent study by Guise and Laurent8 who showed significantly better akinesia after 9 minutes in the “with hyaluronidase” group compared with the control group. When they compared the quality of block at 13 minutes, however, they found no significant difference between the two groups.…”

Section: Discussionsupporting

confidence: 91%

Sub-Tenon's local anaesthesia: the effect of hyaluronidase

Rowley

Hale²,

Finlay³

2000

British Journal of Ophthalmology

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Aims-A prospective, randomised, double blind study was used to investigate the eVect of hyaluronidase on the quality of block achieved with sub-Tenon's local anaesthesia. Methods-150 patients scheduled for elective cataract surgery were randomly allocated to either sub-Tenon's block with 3 ml lignocaine 2%/adrenaline 1:200 000 alone or with the addition of 30 IU/ml of hyaluronidase. The blocks were assessed for degree of akinesia and reduction of eyelid movement, and also post-injection and postoperative pain scores. Results-Akinesia and reduction of eyelid movement measured 10 minutes after injection were significantly better in the group with hyaluronidase added to the anaesthetic solution. Postoperative pain scores were not significantly diVerent between the two groups but the postinjection pain score was greater (marginally significant) in the group with hyaluronidase added. Conclusion-The addition of hyaluronidase significantly improves the quality of the motor blockade achieved with subTenon's local anaesthesia, but has no eVect on the sensory blockade. (Br J Ophthalmol 2000;84:435-436) The single quadrant technique for sub-Tenon's local anaesthesia was popularised by Stevens 1 in 1992 as a safe and eVective method for ophthalmic anaesthesia, avoiding the risks of sharp needle techniques. Delivery of the local anaesthetic solution to the posterior sub-Tenon's space is followed by diVusion of the solution through Tenon's capsule and into the retrobulbar compartment where the anaesthetic exerts its eVect.

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Section: Discussionsupporting

confidence: 91%

Sub-Tenon's local anaesthesia: the effect of hyaluronidase

Rowley

Hale²,

Finlay³

2000

British Journal of Ophthalmology

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“…Guise and Laurent20 performed an RCT using 30 IU ml −1 in a 5 ml sub-Tenon injection. Akinesia scores were improved at the time intervals 3–9 min after instillation of the block.…”

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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“…However, as an adjuvant in retrobulbar and peribulbar anesthesia, 6,9,42 it enhances the onset of the block. It also improves the onset and quality of the block in the sub-Tenon procedure by promoting diffusion to the periorbital and retroorbital tissue 19,[43][44][45] and alleviating the need for a facial nerve block, which can be painful. 31,45 Hyaluronidase 6 helps to prevent a decrease in retinal circulation, an increase in intraocular pressure (IOP) and also reduce the risk for muscle toxicity from local anesthetic agents.…”

Section: Anesthetic Agentsmentioning

confidence: 99%

Local anesthesia for cataract surgery

Malik¹,

Fletcher²,

Chong³

et al. 2010

Journal of Cataract and Refractive Surgery

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Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.

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Sub-Tenon's Block: The Effect of Hyaluronidase on Speed of Onset and Block Quality

Cited by 33 publications

References 5 publications

Sub-Tenon's local anaesthesia: the effect of hyaluronidase

Sub-Tenon's local anaesthesia: the effect of hyaluronidase

Adjuvants to local anaesthesia in ophthalmic surgery

Local anesthesia for cataract surgery

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