Improved peribulbar anaesthesia with alkalinization and hyaluronidase

Roberts, James W.; MacLeod, Bernard A.; Hollands, Raymond H.

doi:10.1007/bf03009254

Cited by 48 publications

(21 citation statements)

References 17 publications

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“…The trial showed pH adjustment of bupivacaine and hyaluronidase provided greater efficacy, less intra-operative pain, lower frequency of intra-operative supplementation and a decreased occurrence of postoperative pain in the first 24 h compared with the non-adjusted lignocaine/bupivacaine/hyaluronidase mix. Roberts et al 18 found similar results with a mix of 2% lignocaine and 0.75% bupivacaine in a 1:2 proportion with 10 IU ml −1 of hyaluronidase alkalinised to a pH of 6.7.…”

Section: Bicarbonate Buffering Of Local Anaesthesia and Hyaluronidasementioning

confidence: 72%

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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Section: Bicarbonate Buffering Of Local Anaesthesia and Hyaluronidasementioning

confidence: 72%

Adjuvants to local anaesthesia in ophthalmic surgery

Adams

2011

British Journal of Ophthalmology

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“…One hundred in-patients scheduled for cataract surgery under peribulbar anaesthesia were randomly allocated in a double-blind manner to receive either 0.75% bupivacaine (Marcain, Astra, Sweden) or 1% ropivacaine (Naropin, Astra, Sweden). Hyaluronidase (Wydase 150 IU.ml ¹1 , Wyeth Labs, Philadelphia, PA) was added to both solutions (7.5 IU.ml ¹1 ) in order to promote the spread of the anaesthetic and thus to decrease intraocular pressure [6][7][8]. No premedication was given, except in one case.…”

Section: Patientsmentioning

confidence: 99%

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

Huha¹,

Ala‐Kokko

Salomäki³

et al. 1999

Anaesthesia

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SummaryPeribulbar anaesthesia with 1% ropivacaine and 0.75% bupivacaine, both with hyaluronidase, was assessed in a prospective, randomised, double-blind study of 100 patients undergoing cataract surgery. Pharmacokinetic data were obtained from 22 subjects. Akinesia of the globe developed slightly more rapidly in the ropivacaine group, but this difference was only statistically significant at 2 min after injection of the local anaesthetic. Lid akinesia was significantly more complete in the ropivacaine group. There were no differences between the groups with respect to peri-operative analgesia or duration of akinesia. The dose-adjusted maximum concentration of ropivacaine was approximately twice that of bupivacaine with significantly higher values of the area under the concentration-time curves. No drug-related adverse effects were observed. We conclude that there are no clinically significant differences in the quality of the sensory and motor block between 1% ropivacaine and 0.75% bupivacaine when used for peribulbar anaesthesia.

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“…It has been shown to aid the spread of LA through tissue 4. It is postulated that it achieves this by a reversible depolymerising effect on hyaluronic acid 3.…”

Section: Discussionmentioning

confidence: 99%

Excellent postoperative analgesia with the addition of hyaluronidase to lignocaine for subcostal TAP block used in conjunction with systemic analgesia for laparoscopic cholecystectomy

Johnson¹,

O'Connor

2014

BMJ Case Reports

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Subcostal transversus abdominis plane (TAP) blocks provide good postoperative analgesia for laparoscopic cholecystectomies. We hypothesised that adding hyaluronidase may improve the efficacy of this technique by increasing spread of the local anaesthetic (LA). In this case, we performed a bilateral ultrasound-guided subcostal TAP block using lignocaine (40 mL 1%) with hyaluronidase (75 IU/mL) for postoperative analgesia following elective laparoscopic cholecystectomy. It was used in combination with intraoperative morphine, diclofenac and paracetamol. Regular paracetamol was administered postoperatively. We monitored serial serum lignocaine levels and recorded the patient's visual analogue scale (VAS) pain scores postoperatively. We found that the patient experienced excellent analgesia throughout the postoperative period and that the serum lignocaine levels did not exceed the therapeutic range.

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Improved peribulbar anaesthesia with alkalinization and hyaluronidase

Cited by 48 publications

References 17 publications

Adjuvants to local anaesthesia in ophthalmic surgery

Adjuvants to local anaesthesia in ophthalmic surgery

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

Excellent postoperative analgesia with the addition of hyaluronidase to lignocaine for subcostal TAP block used in conjunction with systemic analgesia for laparoscopic cholecystectomy

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