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Improved peribulbar anaesthesia with alkalinization and hyaluronidase

  • Jeffrey E. Roberts
  • Bernard A. MacLeod
  • Raymond H. Hollands
Reports of Investigation

Abstract

A prospective double-blind randomized study was carried out to determine the effect ofpH and the addition of hyaluronidase to a mixture of lidocaine and bupivacaine on the efficacy of peribulbar anaesthesia. One hundred patients were assigned to one of five groups. All groups received a solution of two parts bupivacaine (0.75%) and one part lidocaine (2%) (with 1:100,000 adrenaline) as the base components of their anaesthesia. 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 mixture alkalinized with sodium bicarbonate to a pH of 5.1, the same as solution 2. Group 4 received the mixture with hyaluronidase alkalinized to pH of 6.7. Group 5 received the bupivacaine-lidocaine mixture alkalinized to a pH of 6.7. Efficacy of each block was graded according to the degree of residual movement 30 min following injection, as described by House et al1. The solution containing hyaluronidase and pH adjusted to 6.7 was found to be the most effective (P < 0.025). The presence of hyaluronidase without alkalinization did not improve the efficacy of the mixture; and similarly, alkalinization in the absence of hyaluronidase was ineffective. These results reflected the pH- and temperaturedependent thermodynamic properties of local anaesthetics, and the pH-dependent activity of hyaluronidase.

Key words

anaesthetic techniques: regional, peribulbar anaesthetics, local: lidocaine, bupivacaine enzymes: hyaluronidase 

Résumé

Une étude randomisée et à double insu est réalisée dans le but de déterminer l’effet du pH et de l’ajout d’hyaluronidase à un mélange de lidocaine et de bupivacaïne sur l’efficacité de l’anesthésie péribulbaire. Cent patients sont répartis en cinq groupes. Tous les groupes recoivent une solution de deux parties de bupivacaïne (0,75%) et d’une partie de lidocaïne (2%) adrénalinées à 1:100,000 comme agent de base. Le groupe 1 ne reçoit que le mélange bupivacaïne-lidocaïne à pH 3,9. Le groupe 2 reçoit la solution supplémentée d’hyaluronidase (10 u · ml−1) à pH 5,1. Le groupe 3 reçoit le mélange bupivacaïne-lidocaïne alcalinisé au bicarbonate de soude pour porter le pH à 5,1 comme la solution 2. Le groupe 4 reçoit le mélange supplémenté d’hyaluronidase alcalinisé au pH de 6,7. Le groupe 5 reçoit le mélange bupivacaïne-lidocaïne alcalinisé au pH 6,7. L’efficacité de chaque bloc est cotée selon le degré des mouvements résiduels 30 min après l’injection, selon la méthode de House et al1. La solution contenant de l’hyaluronidase avec un pH ajusté à 6,7 a été trouvée la plus efficace (P < 0,025). La présence d’hyaluronidase sans alcalinisation n’améliore pas l’efficacité du mélange et de la même façon, l’alcalinisation sans hyaluronidase n’améliore pas l’efficacité du mélange. L’alcalinisation en absence d’hyaluronidase n’est pas efficace. Ces résultats reflètent les propriétés thermodynamiques dépendantes du pH et de la températures des anesthésiques locaux, et l’activité de l’hyaluronidase elle-même dependante du pH.

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Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • Jeffrey E. Roberts
    • 1
  • Bernard A. MacLeod
    • 2
  • Raymond H. Hollands
    • 3
  1. 1.Department of Pharmacology and TherapeuticsUniversity of British ColumbiaVancouver
  2. 2.Department of AnaesthesiaUniversity of British ColumbiaVancouver
  3. 3.Department of OphthalmologyUniversity of British ColumbiaVancouver

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