Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults

Abstract

Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults Patients or population: adults (aged ≥ 18 years) undergoing ophthalm ic surgery under local anaesthetic eye blocks. Setting: hospitals in the UK (4), Germ any (1), Brazil (1) and Iran (1). Intervention: local anaesthetic eye blocks containing hyaluronidase. Comparison: local anaesthetic eye blocks containing no hyaluronidase. * The risk in the intervention group (and its 95% conf idence interval) is based on the assum ed risk in the com parison group and the relative effect of the intervention (and its 95% CI). CI: conf idence interval; n.s: not statistically signif icant; RCT: random ized controlled trial; RR: risk ratio; SM D: standardized m ean dif f erence. GRADE Working Group grades of evidence High quality: we are very conf ident that the true ef f ect lies close to that of the estim ate of the ef f ect. M oderate quality: we are m oderately conf ident in the ef f ect estim ate: the true ef f ect is likely to be close to the estim ate of the ef f ect, but there is a possibility that it is substantially dif f erent. Low quality: our conf idence in the ef f ect estim ate is lim ited: the true ef f ect m ay be substantially dif f erent f rom the estim ate of the ef f ect. Very low quality: we have very little conf idence in the ef f ect estim ate: the true ef f ect is likely to be substantially dif f erent f rom the estim ate of ef f ect 1 Downgraded one level due to m arked heterogeneity with a calculated I 2 > 50%. 2 Downgraded one level f or im precision due to wide 95% conf idence intervals, ref lecting uncertainty in the direction of ef f ect estim ate. 3 Downgraded one level f or im precision and inconsistency in m easurem ent, lack of data and sm all sam ple size.

Fructosamine-3-Kinase as a Potential Treatment Option for Age-Related Macular Degeneration

“…The formulation of the solution was improved by adding thiosulfate (0.1 M) and hyaluronidase (5 U/mL). While thiosulfate was used to reduce calcified structures in drusen which have the potential to act as shields impairing adequate penetration of the enzyme [ 25 , 26 ], hyaluronidase (a well-known adjunct to local anesthetics in ophthalmic surgery) was chosen as an agent to reduce viscosity of the vitreous humor [ 27 , 28 , 29 ]. In the in vivo situation, saccadic eye movements induce a flow in the vitreous humor of the eye, which positively influences the dispersion of drugs injected into the vitreous chamber [ 30 ].…”

Efficacy of hyaluronidase combined with corticosteroids in treatment of oral submucous fibrosis: A meta‐analysis of randomized controlled clinical trials

“…25 Hyaluronidase has been applied to manage lymphoedema and keloids 26,27 and is used clinically as an adjuvant to increase the bioavailability of other medications. 28 Hyaluronidase is also used for local infiltration anaesthesia, 29 extravasation management, smoothing of wrinkles and folds and management of complications associated with hyaluronidase-based filler aesthetic injections. 25 Hyaluronidase can alternatively degrate collagen in patients with submucous fibrosis and decrease collagen formation.…”

Use of Hyaluronidase as an Adjunct to Local Anaesthetic Eye Blocks to Reduce Intraoperative Pain in Adults

“…Does the addition of hyaluronidase to local anesthetics for ophthalmic anesthesia in adults result in decreased perceived pain during the intraoperative phase? Additionally, this review sought to assess harm, patient and surgical satisfaction scores, and the economic impact associated with hyaluronidase use 1 …”