SAFTEY AND EFFICACY OF SODIUM BICARBONATE VERSUS HYALURONIDASE IN PERIBULBAR ANAESTHESIA FOR CATARACT SURGERY

Abstract

BACKGROUND: The goals of safe and effective anaesthesia for intra ocular surgery are to obtain good analgesia and anaesthesia without complications. The most ideal pre-requisite for an eye surgeon is to achieve good surface anaesthesia, akinesia and hypotony for a favorable visual outcome. There are various studies on the efficacy of lidocaine, bupivacaine and hyaluronidase in peribulbar anaesthesia and a few studies on sodium bicarbonate as an effective alternative agent. Recently some studies have doubted the efficacy of hyaluronidase in improving the quality of anaesthesia. Added to this is the cost factor, limited shelf life and re usage in the same sitting along with the risk of anaphylaxis due to its enzyme nature. Hence this study was conducted with the objectives. To determine and compare globe akinesia, quality of analgesia, onset and duration of anaesthesia and complications between Hyaluronidase and Sodium bicarbonate groups. MATERIAL AND METHODS: A Prospective Comparative study was conducted in the department of Ophthalmology, R. L. Jalappa Hospital and Research Centre at Kolar from August 2022 to December 2023. 182 subjects were randomly divided in to two groups. Group A received hyaluronidase and Group B received Sodium bicarbonate. Institutional Ethical clearance was obtained prior to the start of the study. Informed consent was obtained from all the patients recruited prior to the start of the study. STATISTICAL ANALYSIS: Data was analyzed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. Chi-square test and Independent t test was used as test of significance for qualitative data and quantitative variables respectively. p value of <0.05 was considered as statistically significant. xxv RESULTS: Mean age of subjects in Group A was 67.86 ± 10.457 years and in Group B was 64.19 ± 9.396 years. In Both groups majority of subjects were females. Majority were females in both groups. Time of Onset of Anaesthesia in Group A was 0-5 mins in 48.4%, 6-10 mins in 13.2% and in 11-15 mins in 38.5%, in Group B was 0-5 mins in 65.9%, 6-10 mins in 6.6% and in 11-15 mins in 27.5%. In Group A, 59.3% had No pain, 34.1% had mild pain and 6.6% had moderate pain. In Group B, 75.8% had no pain, 22% had mild pain and 2.2% had moderate pain. In Group A, 51.6% had Grade 1 Akinesia, 36.3% had Grade 2 Akinesia, 12.1% had Grade 3 Akinesia. In Group B, 70.3% had Grade 1 Akinesia, 24.2% had Grade 2 Akinesia, 5.5% had Grade 3 Akinesia. There was significant difference in Time of onset, pain score and akinesia between two groups. CONCLUSION: From the study it was concluded that sodium bicarbonate is an effective alternative to hyaluronidase in peribulbar anaesthesia with a faster onset of anaesthetic action, longer duration of anaesthesia and Good akinesia.