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

Abstract

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.

Review of the Mechanism of Action and Clinical Efficacy of Recombinant Human Hyaluronidase Coadministration with Current Prandial Insulin Formulations

“…Additional clinical studies also have reported the overall safety and tolerability of rHuPH20 coadministration with other agents. [40][41][42] It should be noted that there is no long-term, repeat dose exposure to rHuPH20 data available; an ongoing 3-month × 3-month crossover study comparing regular insulin-PH20 to insulin lispro in 48 type 1 diabetic subjects did not uncover any safety or tolerability signals at the time of an interim safety analysis among the 22 subjects receiving regular insulin-PH20 (data not shown); longer term data in larger numbers of subjects will be needed to better address this question.…”

“…10,23,[38][39][40][41][42] The clinical safety and tolerability of hyaluronidase, which was first reported by Burket and Gyorgy in 1949, 38 have been established further with over 6 decades of use. 10,23,[39][40][41][42] Clinical history demonstrates the increased dispersion and faster absorption of a broad range of drugs and fluids administered with hyaluronidase products.…”

“…10,23,[38][39][40][41][42] The clinical safety and tolerability of hyaluronidase, which was first reported by Burket and Gyorgy in 1949, 38 have been established further with over 6 decades of use. 10,23,[39][40][41][42] Clinical history demonstrates the increased dispersion and faster absorption of a broad range of drugs and fluids administered with hyaluronidase products. 10,23,[38][39][40][41][42][43][44] With rHuPH20, for example, Thomas and colleagues 45,46 have demonstrated an accelerated PK profile of SC morphine coadministered with rHuPH20 compared with SC morphine alone, with earlier and greater peak exposure and comparable total bioavailability.…”

“…10,23,[39][40][41][42] Clinical history demonstrates the increased dispersion and faster absorption of a broad range of drugs and fluids administered with hyaluronidase products. 10,23,[38][39][40][41][42][43][44] With rHuPH20, for example, Thomas and colleagues 45,46 have demonstrated an accelerated PK profile of SC morphine coadministered with rHuPH20 compared with SC morphine alone, with earlier and greater peak exposure and comparable total bioavailability. Similarly, administration of rHuPH20 significantly enhanced gravity-driven SC infusion flow rates of fluid and electrolytes compared with placebo, leading the authors to suggest the possibility of using hyaluronidaseenabled SC infusions as replacements for pump-driven intravenous fluid therapy.…”

Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists

“…Following sub-Tenon injection, local anaesthetic solution has been demonstrated to accumulate in the sub-Tenon space, behind the globe, which is traversed by short and long ciliary nerves (Khandwala et al 2008).…”