title: Hyaluronidase as an adjuvant in bupivacaine-lidocaine mixture for retrobulbar/peribulbar block.
abstract: Hyaluronidase 7.5 IU/mL added to the local anesthetic improves peribulbar block, but smaller concentrations have not been shown to be effective. In this prospective, double-blinded study, 714 consecutive ocular surgery patients were randomized into three groups: no hyaluronidase (n = 241), hyaluronidase 3.75 IU/mL (n = 244), and hyaluronidase 7.5 IU/mL (n = 229). Retrobulbar/peribulbar block was performed with two injections of a 1:1 mixture of bupivacaine 0.75% and lidocaine 2%, 6-8 mL. Patient data were collected on demographics, initial volume of local anesthetic, need for supplementary block, and akinesia of the anesthetized eye. When hyaluronidase was used (3.75 or 7.5 IU/mL), the initial block was sufficient and the anesthetized eye was akinetic significantly more often than in the group without hyaluronidase. The hyaluronidase groups (3.75 and 7.5 IU/mL) did not differ significantly in any respect. We conclude that the addition of hyaluronidase 3.75 or 7.5 IU/mL improved the success of the initial retrobulbar/peribulbar block and akinesia and reduced the need for supplementary block.
  
  
  CONCLUSIONS
  We conclude that the addition of hyaluronidase 3.75 or 7.5 IU/mL improved the success of the initial retrobulbar/peribulbar block and akinesia and reduced the need for supplementary block.
authors.affiliation: Department of Anesthesia, Helsinki University Central Hospital, Eye Hospital, Helsinki, Finland. helena.kallio@hus.fi
authors.forename: H
authors.initials: H
authors.lastname: Kallio
authors.forename: M
authors.initials: M
authors.lastname: Paloheimo
authors.forename: E L
authors.initials: EL
authors.lastname: Maunuksela
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage*; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009801:Oculomotor Muscles / Q000187:drug effects; D009900:Optic Nerve; D018918:Phacoemulsification; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine