Effects of adrenaline and hyaluronidase on plasma concentrations of lignocaine and bupivacaine after peribulbar anaesthesia

Abstract

We have measured peak plasma concentrations of lignocaine and bupivacaine after dual injection peribulbar block and investigated the influence of adrenaline and hyaluronidase. Twenty-four patients were allocated randomly to one of four groups: (I) local anaesthetic alone (lignocaine 10 mg ml-1-bupivacaine 3.75 mg ml-1); (II) local anaesthetic with adrenaline (5 micrograms ml-1); (III) local anaesthetic with hyaluronidase (75 iu ml-1); or (IV) local anaesthetic with adrenaline and hyaluronidase. Venous plasma concentrations of lignocaine and bupivacaine were measured in 24 patients using gas liquid chromatography before and at 5, 10, 15, 20, 25, 30, 45, 60, 90, 120, 180, 300 and 540 min after completion of the peribulbar injections. Main outcome measures were analysed using two-way analysis of variance. All patients, with one exception, received 10 ml of the local anaesthetic mixture. Overall peak plasma concentrations varied from 230 to 1910 micrograms ml-1 for lignocaine and from 160 to 1090 micrograms ml-1 for bupivacaine. Adrenaline significantly reduced peak plasma concentrations of lignocaine to 57% (P = 0.001) and bupivacaine to 61% (P = 0.004) compared with the nonadrenaline groups. Hyaluronidase had no significant effect on peak plasma concentrations of lignocaine and bupivacaine, which were 90% (P = 0.34) and 100% (P = 0.84) of the non-hyaluronidase groups. The area under the plasma concentration-time curves to 300 min (AUC300) behaved similarly. There was a reduction in AUC300 for lignocaine (P = 0.005) and bupivacaine (P = 0.011) in the adrenaline groups compared with the non-adrenaline groups, in contrast with no significant effects of hyaluronidase on AUC300 for lignocaine (P = 0.14) or bupivacaine (P = 0.53) compared with the non-hyaluronidase groups.

Clinical efficacy and pharmacokinetics of 1% ropivacaine and 0.75% bupivacaine in peribulbar anaesthesia for cataract surgery

“…The maximum tolerated total venous plasma concentrations of ropivacaine and bupivacaine have been reported to be 2.2 vs. 2.0 mg.ml ¹1 respectively, following intravenous administration in healthy volunteers [4]. In our study, the maximum concentrations of bupivacaine were well below this value and in agreement with those published earlier [19,20]. At 120 min, the mean concentrations of both ropivacaine and bupivacaine were below reported toxic values.…”

Comparison of 0.75% levobupivacaine with 0.75% racemic bupivacaine for peribulbar anaesthesia

“…A wide interindividual variation in plasma concentrations has been demonstrated after peribulbar anaesthesia with bupivacaine and lignocaine. Barr et al recorded near toxic levels in two of 12 subjects receiving the mixture without adrenaline, and Gao and Budd noted a similar level in one of 25 patients, although none of these patients experienced toxic symptoms or signs [12,13].…”

Efeitos cardiovasculares da mepivacaína com epinefrina seguida de hialuronidase: ensaio duplo-cego controlado em cirurgias bilaterais de terceiros molares inferiores

“…O lado em que foi realizada a primeira cirurgia foi escolhido de modo aleatório, como também a solução que seria utilizada primeiro (hialuronidase ou placebo). Na cirurgia realizada do outro lado, era necessária a utilização da outra No protocolo utilizado em oftalmologia, quando a hialuronidase foi injetada junto ao AL, não foram observadas alterações cardiovasculares significativas (BARR et al,1995;GAO;BUDD, 1996;NATHAN et al, 1996;SOARES et al, 2002). Ainda, Nathan et al (1996) …”

“…Em cirurgias oftalmológicas, vários estudos vêm sendo realizados com o objetivo de melhorar a eficácia dos bloqueios anestésicos tanto retrobulbar (KALLIO; PALOHEIMO; MAUNUKSELA, 2000; SARVELA; NIKKI, 1992) como peribulbar (BARR et al, 1995;GAO;BUDD, 1996;HAMADA et al, 2005;KALLIO;PALOHEIMO;MAUNUKSELA, 2000;NICOLL et al, 1986;SOARES et al, 2002).…”

“…Barr et al (1995) estudaram as diferenças entre a concentração plasmática máxima (C max ) de quatro grupos distintos após a anestesia peribulbar. No grupo 1 utilizou-se uma mistura anestésica de lidocaína 10mg/mL e bupivacaína 3,75 mg/mL de bupivacaína.…”