Effect of Addition of Hyaluronidase to Bupivacaine During Axillary Brachial Plexus Block

Abstract

We have studied in 22 patients the effect of adding hyaluronidase to bupivacaine during axillary brachial plexus block (BPB) in a double-blind design. Patients received BPB using bupivacaine 2 mg kg-1 with adrenaline 1 in 200,000, either with or without hyaluronidase 3000 iu, in a volume of 0.5 ml per 2.54 cm of the patient's height. The use of hyaluronidase did not increase the speed of onset of anaesthesia or reduce the incidence of inadequate nerve block. Hyaluronidase produced a significant reduction in the duration of anaesthesia. Changes in grip strength and skin temperature were useful in assessing the onset and progress of BPB.

Brachial plexus anesthesia: Essentials of our current understanding☆

“…199 Hyaluronidase does not hasten block onset, reduce the incidence of failed block, or affect local anesthetic blood concentration, but it does shorten block duration. 140,200 To date, there have been no studies evaluating nonsteroidal anti-inflammatory drugs as adjuvants for brachial plexus block. 201 In summary, local anesthetic and adjuvant selec-tion, as well as dosing, clearly affect brachial plexus block characteristics.…”

Brachial plexus block with midazolam and bupivacaine improves analgesia

“…Various studies have investigated several adjuncts, including opioids, clonidine, neostigmine, hyaluronidase, and bicarbonate. [5][6][7][8][9] The results have been inconclusive, because of associated side effects or doubtful efficacy. Midazolam, a water-soluble benzodiazepine, is known to produce antinociception and to enhance the effect of local anesthetic when given epidurally or intrathecally.…”

Comparative Study Between Bupivacaine Alone and Bupivacaine With Fentanyl in Axillary Plexus Block for Upper Limb Surgeries

“…Of various local anaesthetics, Bupivacaine is used most frequently, as it has a long duration of action varying from 3 to 8 hours. Various drugs like Neostigmine, Opioids, Hyaluronidase, and Clonidine etc., [1][2][3][4] have been added to local anaesthetics in order to modify the block in terms of quick onset, good quality, prolonged duration and post-operative analgesia.…”