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Hyaluronidase improves regional ophthalmic anaesthesia with etidocaine

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The effect of adding hyaluronidase to regional ophthalmic anaesthesia with etidocaine 1.5% was examined. Two studies were performed in a double-blind fashion. In Study #1, 70 patients were given peribulbar anaesthesia with etidocaine either with or without hyaluronidase (7.5 IU · ml−1) using a standard intraorbital injection and separate lid injections. The block was supplemented as needed. Lower intraorbital volumes (6.4 ± 2.2 ml vs 8.2 ± 2.3 ml, P < 0.01) and improved scores for globe akinesia (P < 0.01), lid akinesia (P < 0.01) and analgesia (P < 0.05) were recorded in the hyaluronidase group than in the plain etidocaine group. In Study #2, 80 patients were randomized to receive etidocaine and hyaluronidase either at a concentration of 7.5 IU · ml−1 or 15 IU · m−1 using a two-injection-site technique. No differences were noted in the volumes of local anaesthetics required or in the success rates between the two groups. It was concluded that the addition of hyaluronidase to etidocaine decreases the volume needed and improves the quality of block compared with plain etidocaine. Doubling the dose of hyaluronidase does not improve the effectiviness of block.


Cette étude évalue les effets de l’addition d’hyaluronidase à l’anesthésie régionale opthtalmique à l’étidocaïne 1.5%. Deux études à double insu sont réalisées. Dans l’étude I, soixante-dix patients reçoivent une anesthésie péribulbaire d’étidocaïne avec ou sans hyaluronidase 7,5 UI · ml−1 par injections intraorbitales standard et palpébrale séparées. Le block est supplémenté au besoin. Les volumes intraorbitaux injectés sont moindres (6,4 ± 2,2 ml comparativement à 8,2 ± 2,3, P < 0,01); on note une amélioration pour l’akinésie globulaire (P < 0,01), Vakinésie palpébrale (P < 0,01) et l’analgésie (P < 0,01) dans le groupe hyaluronidase. Dans l’étude II, quatre-vingts patients sont distribués de façon aléatoire pour recevoir l’étidocaine avec hyaluronidase à des concentrations de 7,5 UI · ml−1 ou 15 UI · ml−1 par une technique à deux sites d’injections. On n’a pas constaté de différence pour les volumes d’anesthésique requis ou le taux de succès entre les deux groupes. L’hyaluronidase permet de diminuer le volume et améliore la qualité du block comparativement à l’étidocaïne pure. Doubler la dose d’hyaluronidase naméliore en Hen l’efficacité du block.


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Correspondence to J. Sarvela.

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Sarvela, J., Nikki, P. Hyaluronidase improves regional ophthalmic anaesthesia with etidocaine. Can J Anaesth 39, 920–924 (1992).

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Key words

  • anaesthetic techniques: regional, peribulbar
  • anaesthetics, local: etidocaine
  • hyaluronidase
  • surgery: ophthalmic