Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A comparative study was carried out to evaluate peribulbar anaesthesia (group A) vs subconjunctival anaesthesia (group B). The results proved peribulbar anaesthesia to be more effective than subconjunctival anaesthesia as regards orbicularis akinesia (p < 0.05) and ocular akinesia (p < 0.05). There was no significant difference in the sensory anaesthesia, analgesia and intraocular pressure changes in the two groups (p > 0.05). Block assessment was ideal in 80% of patients in group A in comparison to 51% in group B (p < 0.05), and unsatisfactory in 14% in group A and 30% in group B (p < 0.05). Further, no significant complications were observed with peribulbar anaesthesia. Therefore, we conclude that peribulbar anaesthesia should be preferred over subconjunctival anaesthesia for conventional extracapsular cataract extraction with or without intraocular lens implantation.
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PMID:Evaluation of subconjunctival anaesthesia vs peribulbar anaesthesia in cataract surgery. 774 84

Two methods of periocular anaesthesia (PI and PII) were compared with the traditional retrobulbar block in a prospective study of 450 patients undergoing elective cataract extraction and intraocular lens implantation. A solution of local anaesthetic containing equal amounts of 2% lignocaine and 0.5% bupivacaine was used in all the groups. Hyaluronidase (75 IU/10 ml of local anaesthetic solution) was added. Three groups of patients were studied, with 150 patients in each group. The retrobulbar injection (group R) was performed with 4 ml of the anaesthetic solution through the lower eyelid inferotemporally and a further 6 ml was injected for seventh cranial nerve block. In the first periocular technique (group PI) the local anaesthetic was injected inferotemporally (5 ml) through the lower lid and superonasally (5 ml) through the upper lid. In the second periocular technique (PII) the injections were performed inferotemporally (5 ml) and into the medial compartment (2 ml) of the orbit at the medial canthus. Satisfactory anaesthesia could be achieved with all of these methods. Additional block because of insufficient akinesia of the muscles was required in 12% (18/150) in group R, in 19% (28/150) in group PI, and in 11% (16/150) in PII. The medial compartment technique (PII) was associated with the highest percentage of total akinesia of the muscles and lowest reblock rate. All three methods produced sufficient analgesia during surgery and there were no differences in the requirements for additional analgesic drugs during surgery. It is concluded that the medial compartment technique represents a good alternative to retrobulbar block.
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PMID:Regional anaesthesia for cataract surgery: comparison of three techniques. 811 Jun 68

One-hundred and thirty-nine consecutive cases of retrobulbar blocks were evaluated concerning clinical effect on motility and pain. The patients were randomly selected to one of four different mixtures of anaesthetics. A mixture containing lidocaine w/adrenaline, bupivacaine w/adrenaline and hyaluronidase was shown to be significantly more effective than any of the other tested mixtures concerning analgesia and significantly better than mixtures without hyaluronidase concerning motility/akinesia.
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PMID:Retrobulbar anaesthesia. A clinical evaluation of four different anaesthetic mixtures. 815 54

Seven groups of thirty patients undergoing cataract extraction under local anesthesia were each given different combinations of local anesthesia. These varied from a maximum approach using supra-orbital, infra-orbital and facial blocks with Hyalase, orbital compression and pre-operative Acetazolamide down to a minimum group receiving purely an infra-orbital and supra-orbital block with a Lignocaine/Bupivacaine mixture. There was no significant difference in local analgesia or in the complication rates between the seven groups. The benefits of Acetazolamide and orbital compression remain doubtful. The use of Hyalase and of a facial block resulted in fewer complications and in better akinesia.
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PMID:Local anesthesia in cataract surgery--a comparison of different methods. 825 78

Two concentrations of etidocaine (1 and 1.5%) and of pH-adjusted bupivacaine (0.5 and 0.75%, pH 6.8), all fortified with hyaluronidase, were compared as local anesthetics in regional ophthalmic surgery for cataract extraction. The series comprised 160 patients assigned randomly to four groups (n = 40). Each patient received one of the four anesthetics in a double blind manner. The technique used was an inferolateral intraconal injection (3 mL) followed by a medial extraconal injection (3 mL). Supplemental injections were given at 10 and 20 min, if needed. At 10 min, globe akinesia was satisfactory in both etidocaine groups and in the 0.75% bupivacaine group (78-80% of patients), but in only 37% of the 0.5% bupivacaine group. In lid akinesia, the 0.75% bupivacaine group gained the highest scores, but there was no significant difference between the groups. Perioperative analgesia was better in both bupivacaine groups, in which only 3 and 5 patients felt pain compared to 7 and 12 in the etidocaine groups (P < 0.05). Of these local anesthetics, pH-adjusted 0.75% bupivacaine is recommended for regional ophthalmic anesthesia.
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PMID:Comparison of regional ophthalmic anesthesia produced by pH-adjusted 0.75% and 0.5% bupivacaine and 1% and 1.5% etidocaine, all with hyaluronidase. 831 20

Orbital regional anesthesia is the only circumstance where hyaluronidase is routinely added to local anesthetics to accelerate the onset of the block. The aim of this study was to compare the pharmacokinetics of lidocaine and bupivacaine with or without hyaluronidase for peribulbar blockade. Twenty-one patients scheduled for cataract surgery with lens implantation were included in this prospective randomized study. Peribulbar blocks were achieved with plain bupivacaine 0.5% (5.5 mL), lidocaine 2% (5.5 mL), and hyaluronidase (100 IU = 2 mL) (n = 10) ir sterile water (2 mL) (n = 11). Plasma bupivacaine and lidocaine concentrations were measured by high-performance liquid chromatography at regular intervals from the end of the local anesthetic injection until the 360th minute. Maximum plasma concentration (Cmax) and time to reach Cmax (Tmax) were obtained for all the patients except one who needed a supplementary injection and was excluded from the study. The time to onset and duration of the analgesia and akinesia were monitored at the times of sampling. Motor blockade was incomplete in two patients in each group without affecting surgery. The Tmax and absorption half-life (t1/2a) of lidocaine and bupivacaine were not different within each group (P > 0.05). The Tmax of lidocaine was shorter in the presence of hyaluronidase (17.1 +/- 2.6 min vs 32.7 +/- 6.0 min) as well as the Tmax of bupivacaine (16.8 +/- 3.0 min vs 26.5 +/- 4.4 min). The Cmax of lidocaine and bupivacaine were not modified by the addition of hyaluronidase. The clearance, terminal half-life, and volume of distribution were not different between groups. The absorption of lidocaine and bupivacaine from the peribulbar space are hastened by the addition of hyaluronidase. The Tmax of lidocaine is not different from that of bupivacaine within each group suggesting that the absorption of local anesthetics is minimally influenced by the liposolubility of the drugs. Moreover, hyaluronidase influences the absorption kinetics of both lidocaine and bupivacaine in the same manner.
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PMID:The role of hyaluronidase on lidocaine and bupivacaine pharmacokinetics after peribulbar blockade. 861 Aug 68

We studied the effect of the addition of hyaluronidase to a mixture of lignocaine 2% and bupivacaine 0.75% for peribulbar anaesthesia in 60 patients presenting for elective intra-ocular surgery. Using a randomised, double-blind design, patients were allocated to one of three groups: no hyaluronidase (group A) (n = 20); hyaluronidase 50 iu.ml-1 (group B) (n = 20); hyaluronidase 150 iu.ml-1 (group C) (n = 20). The speed of onset of the block, the presence of akinesia, analgesia and the need for supplementary injections were assessed. The addition of 150 iu.ml-1 of hyaluronidase resulted in a mean (SEM) time to akinesia of 9.2 (0.9) min compared to 10.9 (0.9) min in the control group and 10.7 (1.1) min in those receiving the lower dose. Fewer patients in group C required a further injection (20%) than those in groups A (40%) or B (45%). None of the findings were statistically significant. Hyaluronidase was not associated with any complications.
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PMID:An evaluation of two concentrations of hyaluronidase for supplementation of peribulbar anaesthesia. 869 95

A prospective, randomised controlled study was performed to investigate whether hyaluronidase improved the efficacy of peribulbar anaesthesia. Ninety-two patients undergoing peribulbar anaesthesia for intraocular surgery all received 10 ml of an anaesthetic solution consisting of a 50:50 mixture of 2% lignocaine with 1 in 200,000 adrenaline and 0.5% bupivacaine. Patients were randomised to a hyaluronidase group which received 150 IU/ml hyaluronidase in this anaesthetic solution (a higher concentration than previous studies) or a control group which received no hyaluronidase. There were 44 patients in the hyaluronidase group and 48 patients in the control group. All anaesthetic injections were administered by an experienced ophthalmologist and no supplementary injections were required in any case. The mean time interval between administration of the block and commencement of surgery was 22 minutes. No statistically significant difference was found between the two groups for pre-operative akinesia (p = 0.16), intraoperative akinesia (p = 0.25), eyelid paralysis (p = 0.72), objective analgesia (p = 0.23) or subjective analgesia (p = 0.60). The majority of patients in both groups achieved excellent akinesia, eyelid paralysis and analgesia. The reasons for these findings in the light of previously conflicting reports on the value of hyaluronidase in peribulbar anaesthesia are discussed.
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PMID:Is hyaluronidase helpful for peribulbar anaesthesia? 937 82

Medial canthus single injection periocular anesthesia is an alternative technique to classical regional anesthesia techniques for cataract surgery. The occurrence of a chemosis at the end of this injection has made us question ourselves about the real site of injection. The purpose of this anatomic study was to identify this site with precision, and to describe the spreading of the injected solution. Various volumes of colored liquid latex were injected when using this technique on 10 human orbits. They were deeply frozen and sectioned in thin slices. The site of injection is clearly the episceral (sub-Tenon) space. This is a gliding space through which pass the ciliary nerves supplying the globe sensitivity. This could explain the high quality of the analgesia of the globe. With the larger volumes injected, spreading of the latex was detected in the orbicularis palpebra. This probably explains the good akinesia of the lids obtained without any facial block. Spreading of the latex to the rectus muscles sheaths should explain the good akinesia of the globe, but was only partially proved in this study. We conclude that the medial canthus single injection periocular anesthesia is an episcleral (sub-Tenon) injection which may explain good anesthesia.
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PMID:Medial canthus episcleral (sub-Tenon) anesthesia imaging. 980 Sep 18

Peribulbar anaesthesia with 1% ropivacaine and 0.75% bupivacaine, both with hyaluronidase, was assessed in a prospective, randomised, double-blind study of 100 patients undergoing cataract surgery. Pharmacokinetic data were obtained from 22 subjects. Akinesia of the globe developed slightly more rapidly in the ropivacaine group, but this difference was only statistically significant at 2 min after injection of the local anaesthetic. Lid akinesia was significantly more complete in the ropivacaine group. There were no differences between the groups with respect to peri-operative analgesia or duration of akinesia. The dose-adjusted maximum concentration of ropivacaine was approximately twice that of bupivacaine with significantly higher values of the area under the concentration-time curves. No drug-related adverse effects were observed. We conclude that there are no clinically significant differences in the quality of the sensory and motor block between 1% ropivacaine and 0.75% bupivacaine when used for peribulbar anaesthesia.
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PMID:Clinical efficacy and pharmacokinetics of 1% ropivacaine and 0.75% bupivacaine in peribulbar anaesthesia for cataract surgery. 1021 8


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