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Orbicular muscle akinesia in regional ophthalmic anaesthesia with pH-adjusted bupivacaine: effects of hyaluronidase and epinephrine

  • J. Sarvela
  • P. Nikki
  • M. Paloheimo
Reports of Investigation

Abstract

The success rate and duration of lid akinesia after adding hyaluronidase and / or epinephrine to pH-adjusted bupivacaine was examined in a double-blind fashion in patients undergoing cataract surgery under local anaesthesia. A two-injection-site technique was used. For globe akinesia all patients (n = 120) received an inferolateral intraconal injection (3 ml) of pH-adjusted bupivacaine 0.75% and hyaluronidase. Lid akinesia was obtained with a medial extraconal injection (3.5 ml) of alkalinized bupivacaine with or without an adjunct. The patients were randomized to four groups as follows: a medial injection of plain bupivacaine (n = 31), with added hyaluronidase (n = 30), with added epinephrine (n = 29) or with both epinephrine and hyaluronidase (n = 30). The final solutions had a p H of 6.7. Lid akinesia was supplemented with periosteal injections if needed. The degree of akinesia from clinical assessment was graded from 0–2 and also measured with electromyography at ten minute intervals for 30 min after surgery, and three hours after the block. The least satisfactory result (P < 0.01) and shortest duration of the lid block (P < 0.05) was obtained with plain pH-adjusted bupivacaine. No differences in the success rate or duration of the block among the other groups were seen. The duration of the block was longer in the epinephrine groups than in the two other groups (P < 0.01) and longer in the epinephrine and hyaluronidase group than in the group receiving only hyaluronidase (P < 0.05). We conclude that the best initial results and longest duration of blocks were shown in the groups receiving epinephrine or epinephrine and hyaluronidase.

Key words

Anaesthetic Techniques: regional, peribulbar, retrobulbar Anaesthetics, Local: bupivacaine Surgery: ophthalmic 

Résumé

Cette étude à double insu évalue le taux de succès et la durée de l’akinésie de la paupière après l’ajout d’hyaluronidase et/ ou d’épinéphrine à la bupivacaine à pH ajusté chez des patients soumis à une chirurgie de la cataracte sous anesthésie locale. Une technique à deux sites d’injections est préconisée. Pour l’anesthésie du globe oculaire, tous les patients (n = 120) reçoivent une injection inférolatérale dans le cône musculaire (3 ml) d’une solution à pH ajusté de bupivacaine 0,75% et d’hyaluronidase. L’akinésie palpébrale est obtenue par une injection médiane hors du cône (3,5 ml) de bupivacaine alcalinisée avec ou sans ajout. Les patients sont randomisés de la façon suivante en quatre groupes: injection médiane de bupivacaïne simple (n = 31), avec hyaluronidase (n = 30), avec ajout d’épinéphrine (n = 29) ou épinéphrine associée à l’hyaluronidase (n = 30). Le pH final de chaque solution est ajusté à 6,7. L’akinésie palpébrale est supplémentée par des injections pèriostées au besoin. Le degré d’akinésie est coté de 0–2 et mesuré à l’électromyographie à des intervalles de dix minutes pour 30 minutes, après la chirurgie et trois heures après le bloc. Le résultat le moins satisfaisant (P < 0,01) et la durée la plus courte du bloc palpébral (P < 0,05) survient avec la bupivacaine simple à pH ajusté. Pour le taux de succès ou la durée du bloc, on ne trouve pas de différences entre les autres groupes. La durée du bloc est plus longue dans le groupe épinéphrine que dans les deux autres groupes (P < 0,01) et plus longue dans le groupe épinéphrine-hyaluronidase que dans le groupe ne recevant que de l’hyaluronidase (P < 0,05). Nous concluons que les meilleurs résultats initiaux et les plus longues durées d’action se retrouvent dans les groupes recevant de l’épinéphrine ou de l’épinéphrine associée à l’hyaluronidase.

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Copyright information

© Canadian Anaesthesiologists 1993

Authors and Affiliations

  • J. Sarvela
    • 1
  • P. Nikki
    • 1
  • M. Paloheimo
    • 1
  1. 1.Eye Hospital, Anaesthesiology ClinicHelsinki University Central HospitalHelsinkiFinland

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