[Impact of hyaluronidase on anesthetic distribution in retrobulbar region following sub-Tenon anesthesia]. 2008

Maja Surbatović, and Mirjana Kendrisić, and Miodrag Jevtić, and Nikola Filipović, and Nada Popović, and Zoran Slavković
Vojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd, Srbija.

OBJECTIVE Sub-Tenon's block is nowadays commonly used in ophthalmic surgery because of its safety and efficacy. The aim of this study was to investigate the distribution of the anaesthetic solution with different amounts of hyaluronidase in the retrobulbar space, following an injection into the Sub-Tenon's space. METHODS In this experimental study, 40 pig cadaver heads were used (80 eyeballs). The material was divided into four groups (of 20 eyeballs each). Each group was administered 4.5 ml of a mixture of 2% lignocaine, 0.5% bupivacaine, and 0.5 ml of Indian ink, with different amounts of hyaluronidase--15 IU/ml, 75 IU/ml, 150 IU/ml, except the control one. Samples of retrobulbar tissue were analysed using the standard histopathological procedure. After that, they were also analysed using the Adobe Photoshop program (Windows, USA). The retrobulbar space was divided into eight zones by four perpendicular lines, which crossed in the centre of the optic nerve. The presence of ink in fat and muscle tissues and in the sheath of the optic nerve was observed. RESULTS The presence of the local anaesthetic solution was significantly higher in inferonasal and superonasal quadrants of the fat and muscle tissues (p < 0.01). The distribution in optic nerve sheath is similar in each quadrant. Distribution of local anesthetic in each zone of the muscle tissue (I-VIII) was strongly influenced by the amount of hyaluronidase added. In the fat tissue, the distribution of local anesthetic under the influence of hyaluronidase was significantly higher (p < 0.05) in the areas which were distant from the place of injection (I-IV). The distribution in the optic nerve sheath is significantly higher (p < 0.01) in the group with 150 IU/ml of hyaluronidase. CONCLUSIONS Following a sub-Tenon block local anaesthetic was present in the retrobulbar space in a high percentage of the cases. The presence of local anaesthetic solution in retrobulbar space depends on the amount of hyaluronidase previously added to the local anaesthetic.

UI MeSH Term Description Entries
D008012 Lidocaine A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of PROCAINE but its duration of action is shorter than that of BUPIVACAINE or PRILOCAINE. Lignocaine,2-(Diethylamino)-N-(2,6-Dimethylphenyl)Acetamide,2-2EtN-2MePhAcN,Dalcaine,Lidocaine Carbonate,Lidocaine Carbonate (2:1),Lidocaine Hydrocarbonate,Lidocaine Hydrochloride,Lidocaine Monoacetate,Lidocaine Monohydrochloride,Lidocaine Monohydrochloride, Monohydrate,Lidocaine Sulfate (1:1),Octocaine,Xylesthesin,Xylocaine,Xylocitin,Xyloneural
D009801 Oculomotor Muscles The muscles that move the eye. Included in this group are the medial rectus, lateral rectus, superior rectus, inferior rectus, inferior oblique, superior oblique, musculus orbitalis, and levator palpebrae superioris. Extraocular Muscles,Extraocular Rectus Muscles,Inferior Oblique Extraocular Muscle,Inferior Oblique Muscles,Levator Palpebrae Superioris,Musculus Orbitalis,Oblique Extraocular Muscles,Oblique Muscle, Inferior,Oblique Muscle, Superior,Oblique Muscles, Extraocular,Rectus Muscles, Extraocular,Superior Oblique Extraocular Muscle,Superior Oblique Muscle,Extraocular Muscle,Extraocular Muscle, Oblique,Extraocular Muscles, Oblique,Extraocular Oblique Muscle,Extraocular Oblique Muscles,Extraocular Rectus Muscle,Inferior Oblique Muscle,Muscle, Oculomotor,Muscles, Oculomotor,Oblique Extraocular Muscle,Oblique Muscle, Extraocular,Oblique Muscles, Inferior,Oblique Muscles, Superior,Oculomotor Muscle,Rectus Muscle, Extraocular,Superior Oblique Muscles
D009900 Optic Nerve The 2nd cranial nerve which conveys visual information from the RETINA to the brain. The nerve carries the axons of the RETINAL GANGLION CELLS which sort at the OPTIC CHIASM and continue via the OPTIC TRACTS to the brain. The largest projection is to the lateral geniculate nuclei; other targets include the SUPERIOR COLLICULI and the SUPRACHIASMATIC NUCLEI. Though known as the second cranial nerve, it is considered part of the CENTRAL NERVOUS SYSTEM. Cranial Nerve II,Second Cranial Nerve,Nervus Opticus,Cranial Nerve, Second,Cranial Nerves, Second,Nerve, Optic,Nerve, Second Cranial,Nerves, Optic,Nerves, Second Cranial,Optic Nerves,Second Cranial Nerves
D009915 Orbit Bony cavity that holds the eyeball and its associated tissues and appendages. Eye Socket,Eye Sockets,Orbits,Socket, Eye,Sockets, Eye
D002045 Bupivacaine A widely used local anesthetic agent. 1-Butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide,Bupivacain Janapharm,Bupivacain-RPR,Bupivacaina Braun,Bupivacaine Anhydrous,Bupivacaine Carbonate,Bupivacaine Hydrochloride,Bupivacaine Monohydrochloride, Monohydrate,Buvacaina,Carbostesin,Dolanaest,Marcain,Marcaine,Sensorcaine,Svedocain Sin Vasoconstr,Bupivacain RPR
D006821 Hyaluronoglucosaminidase An enzyme that catalyzes the random hydrolysis of 1,4-linkages between N-acetyl-beta-D-glucosamine and D-glucuronate residues in hyaluronate. (From Enzyme Nomenclature, 1992) There has been use as ANTINEOPLASTIC AGENTS to limit NEOPLASM METASTASIS. Hyaluronidase,Duran-Reynals Permeability Factor,GL Enzyme,Hyaglosidase,Hyaluronate Hydrolase,Wydase,Duran Reynals Permeability Factor,Factor, Duran-Reynals Permeability,Hydrolase, Hyaluronate,Permeability Factor, Duran-Reynals
D000273 Adipose Tissue Specialized connective tissue composed of fat cells (ADIPOCYTES). It is the site of stored FATS, usually in the form of TRIGLYCERIDES. In mammals, there are two types of adipose tissue, the WHITE FAT and the BROWN FAT. Their relative distributions vary in different species with most adipose tissue being white. Fatty Tissue,Body Fat,Fat Pad,Fat Pads,Pad, Fat,Pads, Fat,Tissue, Adipose,Tissue, Fatty
D000779 Anesthetics, Local Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate. Anesthetics, Conduction-Blocking,Conduction-Blocking Anesthetics,Local Anesthetic,Anesthetics, Topical,Anesthetic, Local,Anesthetics, Conduction Blocking,Conduction Blocking Anesthetics,Local Anesthetics,Topical Anesthetics
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D013508 Ophthalmologic Surgical Procedures Surgery performed on the eye or any of its parts. Ophthalmologic Surgical Procedure,Ophthalmological Surgical Procedures,Procedure, Ophthalmologic Surgical,Procedures, Ophthalmologic Surgical,Surgical Procedure, Ophthalmologic,Surgical Procedures, Ophthalmologic,Ophthalmological Surgical Procedure,Procedure, Ophthalmological Surgical,Procedures, Ophthalmological Surgical,Surgical Procedure, Ophthalmological,Surgical Procedures, Ophthalmological

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