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Sub-Tenon's anesthesia and orbicularis oculi function

S Rauz1, S Subramaniam

  • 1Department of Ophthalmology, Charing Cross Hospital, London, United Kingdom.

Ophthalmic Surgery and Lasers
|September 26, 1997
PubMed
Summary
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A 7 ml volume of local anesthetic with hyaluronidase in the sub-Tenon

Area of Science:

  • Ophthalmology
  • Anesthesiology

Background:

  • Achieving complete eyelid akinesia is crucial for ophthalmic surgery.
  • Sub-Tenon's local anesthesia is commonly used, but its efficacy can vary.
  • Hyaluronidase is added to improve anesthetic spread.

Purpose of the Study:

  • To determine the optimal volume of sub-Tenon's local anesthetic with hyaluronidase for complete eyelid akinesia.
  • To compare the efficacy of 5 ml versus 7 ml of anesthetic solution.

Main Methods:

  • Eighty-five patients were randomized to receive either 5 ml or 7 ml of local anesthetic in the sub-Tenon's space.
  • The anesthetic solution contained lidocaine, bupivacaine hydrochloride, and hyaluronidase.
  • Orbicularis oculi function was assessed at 5 and 10 minutes post-injection.

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Main Results:

  • Complete eyelid akinesia was achieved in 93.3% of patients receiving 7 ml versus 7.5% receiving 5 ml (P < .005).
  • A significantly higher rate of anesthetic top-up was required in the 5-ml group.
  • On-table anesthesia top-ups were needed more frequently in the 5-ml group.

Conclusions:

  • The addition of hyaluronidase enhances anesthetic diffusion for effective orbicularis oculi akinesia.
  • Infiltrating 7 ml of the anesthetic solution significantly increases the success rate of eyelid akinesia.
  • 7 ml of sub-Tenon's anesthetic with hyaluronidase is recommended for optimal eyelid akinesia.