A prospective, randomised controlled study was performed to investigate whether hyaluronidase improved the efficacy of peribulbar anaesthesia. Ninety-two patients undergoing peribulbar anaesthesia for intraocular surgery all received 10 ml of an anaesthetic solution consisting of a 50: 50 mixture of 2% lignocaine with 1 in 200 000 adrenaline and 0.5% bupivacaine. Patients were randomised to a hyaluronidase group which received 150 IU/ml hyaluronidase in this anaesthetic solution (a higher concentration than previous studies) or a control group which received no hyaluronidase. There were 44 patients in the hyaluronidase group and 48 patients in the control group. All anaesthetic injections were administered by an experienced ophthalmologist and no supplementary injections were required in any case. The mean time interval between administration of the block and commencement of surgery was 22 minutes. No statistically significant difference was found between the two groups for pre-operative akinesia (p = 0.16), intraoperative akinesia (p = 0.25), eyelid paralysis (p = 0.72), objective analgesia (p = 0.23) or subjective analgesia (p = 0.60). The majority of patients in both groups achieved excellent akinesia, eyelid paralysis and analgesia. The reasons for these findings in the light of previously conflicting reports on the value of hyaluronidase in peribulbar anaesthesia are discussed.
Davis DB II, Mandel MR . Efficacy and complication rates of 16 224 consecutive peribulbar blocks: a prospective multicentre study. J Cataract Refract Surg 1994;20:327–37.
Bloomberg LB . Administration of periocular anesthesia. J Cataract Surg 1986;12:677–9.
Crawford M, Kerr WJ . The effect of hyaluronidase on peribulbar block. Anaesthesia 1994;49:907–8.
Morsman CD, Holden R . The effects of adrenaline, hyaluronidase and age on peribulbar anaesthesia. Eye 1992;6:290–2.
Sarvela J, Nikki P . Hyaluronidase improves regional ophthalmic anesthesia with etidocaine. Can J Anaesth 1992;39:920–4.
House PH, Hollands RH, Schulzer M . Choice of anesthetic agents for peribulbar anesthesia. J Cataract Refract Surg 1991;17:80–3.
Roberts JE, MacLeod BA, Hollands RH . Improved peribulbar anesthesia with alkalinisation and hyaluronidase. Can J Anaesth 1993;40:835–8.
Zahl K, Jordan A, McGroarty J, Gotta AW . pH-adjusted bupivacaine and hyaluronidase for peribulbar block. Anesthesiology 1990;72:230–2.
Lewis P, Hamilton RC, Brant R, Loken RG, Maltby JR, Strunin L . Comparison of plain with pH-adjusted bupivacaine with hyaluronidase for peribulbar block. Can J Anaesth 1992;39:555–8.
Mather C, Hayden Smith J, Bloom PA . The efficacy of 0.75% bupivacaine with pH adjustment and hyaluronidase for peribulbar blockade: the incidence of prolonged ptosis. Eur J Ophthalmol 1994;4:13–8.
Wood G, Simpson T . The effect of hyaluronidase on the onset of retrobulbar anaesthesia. Can J Anaesth 1990;37:562.
Compendium of Pharmaceuticals and Specialties. Ottowa: Canadian Pharmaceutical Association, 1990:1193.
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Bowman, R., Newman, D., Richardson, E. et al. Is hyaluronidase helpful for peribulbar anaesthesia?. Eye 11, 385–388 (1997). https://doi.org/10.1038/eye.1997.81
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