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BJA Advance Access originally published online on September 24, 2007
British Journal of Anaesthesia 2007 99(5):717-720; doi:10.1093/bja/aem272
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Hyaluronidase reduces local anaesthetic volumes for sub-Tenon's anaesthesia

H. E. Schulenburg1,*, C. Sri-Chandana2, G. Lyons2, M. O. Columb3 and H. A. McLure2

1 Department of Anaesthesia, D Floor, Jubilee Building, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK
2 Department of Anaesthesia, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
3 Acute Intensive Care Unit, University Hospital of South Manchester, NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK

* Corresponding author. E-mail: schulies_snh{at}hotmail.com

Background: Volumes of local anaesthetics for sub-Tenon's anaesthesia vary. Lower volumes produce less akinesia, whereas higher volumes increase chemosis and intra-ocular pressures. Hyaluronidase is often added to local anaesthetics to improve akinesia without increasing the volume of the injection, but this is controversial. This randomized, sequential allocation study examines the addition of hyaluronidase on the minimum local anaesthetic volume (MLAV) required for a sub-Tenon's block.

Methods: Sixty-two patients having sub-Tenon's blocks for cataract surgery were randomized into two groups. The control group (n=31) received 2% w/v lidocaine and the study group (n=31) received 2% w/v lidocaine with hyaluronidase 15 IU ml–1. Using parallel up–down sequential allocation from a 4 ml starting volume, the volumes in both groups were changed using a testing interval of 1 ml according to the quality of globe akinesia. The median effective local anaesthetic volume (MLAV) was calculated for both groups using probit regression.

Results: The groups were similar for age, sex, and ocular axial length. The MLAV in the hyaluronidase group was 2.6 ml [95% confidence interval (CI), 2.1–3.l] and 6.4 ml (95% CI, 5.1–8.1) in the control group (P<0.002).

Conclusions: Hyaluronidase permits a significant 2.4-fold (95% CI, 1.8–3.4) reduction in MLAV for sub-Tenon's anaesthesia.

Keywords: anaesthetic techniques, regional, sub-Tenon; drug delivery, volume; enzymes, hyaluronidase; eye, cataract


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