IMPROVED PERIBULBAR ANESTHESIA WITH ALKALINIZATION AND HYALURONIDASE

Citation
Je. Roberts et al., IMPROVED PERIBULBAR ANESTHESIA WITH ALKALINIZATION AND HYALURONIDASE, Canadian journal of anaesthesia, 40(9), 1993, pp. 835-838
Citations number
21
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0832-610X
Volume
40
Issue
9
Year of publication
1993
Pages
835 - 838
Database
ISI
SICI code
0832-610X(1993)40:9<835:IPAWAA>2.0.ZU;2-M
Abstract
A prospective double-blind randomized study was carried out to determi ne the effect of pH and the addition of hyaluronidase to a mixture of lidocaine and bupivacaine on the efficacy of peribulbar anaesthesia On e hundred patients were assigned to one of five groups. All groups rec eived a solution of two parts bupivacaine (0.75%) and one part lidocai ne (2%) (with 1:100,000 adrenaline) as the base components of their an aesthesia. Group 1 received only the bupivacaine-lidocaine mixture, pH 3.9 Group 2 received a solution supplemented with hyaluronidase (ten units - ml-1). pH of 5.1. Group 3 received the bupivacaine-lidocaine m ixture alkalinized with sodium bicarbonate to a pH of 5.1, the same as solution 2. Group 4 received the mixture with hyaluronidase alkaliniz ed to pH of 6.7. Group 5 received the bupivacaine-lidocaine mixture al kalinized to a pH of 6.7. Efficacy of each block was graded according to the degree of residual movement 30 min following injection, as desc ribed by House et al. 1 The solution containing hyaluronidase and pH a djusted to 6.7 was found to be the most effective (P < 0. 025). The pr esence of hyaluronidase without alkalinization did not improve the eff icacy of the mixture, and similarly, alkalinization in the absence of hyaluronidase was ineffective. These results reflected the pH- and tem perature-dependent thermodynamic properties of local anaesthetics, and the pH-dependent activity of hyaluronidase.