The use of hyaluronidase in nasal infiltration: prospective randomized controlled pilot study

Abstract

A double-blind randomized prospective case-control pilot study was performed to assess tissue distortion caused by the infiltration of local anaesthetic to the dorsum of the nose and to see if this was altered by the addition of hyaluronidase. Forty patients undergoing nasal manipulation for fractured nasal bones were randomized to receive either 4 ml of two per cent lignocaine and adrenaline 1:200000 or 4 ml of two per cent lignocaine and adrenaline 1:200000 with 1500 IU hyaluronidase, which was infiltrated subcutaneously over the nasal dorsum. One surgeon using a standardized technique performed the nasal infiltration. Other outcome measures were ease of manipulation, adequacy of the reduction, patient satisfaction with cosmesis and patient analgesia requirements. There were trends for decreased tissue distortion and improved ease of manipulation in the hyaluronidase group. Larger trials are required to confirm these results.

Differential gene expression profiles in the venom gland/sac of Orancistrocerus drewseni (Hymenoptera: Eumenidae)

“…Therefore, it is often used in coinjection or conjunction with other drugs in order to improve the dispersion and delivery of medications (Clement et al, 2003;McMahon et al, 2001). Degradation of hyaluronic acid by hyaluronidase is also involved in bacterial pathogenesis, fertilization, and cancer progression (Botzki et al, 2004;Chao et al, 2007;Menzel and Farr, 1998;Shuster et al, 2002).…”

Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances

“…Here, the dependency of the effect on concentration [32,33], temperature [34], and pH value has been investigated [35], and sodium bicarbonate as adjuvant has been tested [36,37]. In addition, co-application of HAase in infiltration anaesthesia in dentistry [38,39,40], plastic surgery [22,41], proctologic surgery [42], nail reduction surgery [43], chronic pain syndromes [44], and traumatological procedures [45,46,47,48,49] has been described so far. Also useful in clinical practice is the acceleration of resorption in extravasation by HAase.…”

Clinical Trial for Safety Evaluation of Hyaluronidase as Diffusion Enhancing Adjuvant for Infiltration Analgesia of Skin with Lidocaine

“…The time of macroscopic wound closure in the test area (photographic proof of complete epithelization) and the degree of hemovascular perfusion (laser-Doppler flow) at baseline and on Days 0, 4,7,8,9,10,11,12,13, and 14 were determined as secondary target parameters.…”

“…The medical use of HA‐degrading enzymes, especially HAases, has been successfully practiced for many years in ophthalmology . Because of the enzymatic loosening of the ECM after intracutaneous application, the efficacy of HAase is being discussed in the therapy of scars and keloids and for sculpture modeling; enzymatic fasciotomy; posttraumatic application in fractures of the bridge of the nose; and as an adjuvant to local anesthetics, botulinum toxin, and other actives substances to promote diffusion …”

“…2 The medical use of HA-degrading enzymes, especially HAases, has been successfully practiced for many years in ophthalmology. 3 Because of the enzymatic loosening of the ECM after intracutaneous application, the efficacy of HAase is being discussed in the therapy of scars and keloids 4,5 and for sculpture modeling; 6,7 enzymatic fasciotomy; posttraumatic application in fractures of the bridge of the nose; 8 and as an adjuvant to local anesthetics, [9][10][11] botulinum toxin, and other actives substances to promote diffusion. 12,13 *Department of Dermatology and Venereology; † Institute of Applied Dermatopharmacy; ‡ Department of Paediatric Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; § Riemser Arzneimittel AG, Greifswald, Germany…”