Comparison of Magnesium Sulfate Versus Hyaluronidase as Adjuvants in Peribulbar Anaesthesia for Cataract Surgery at National Eye Centre, Kaduna, North-West Nigeria: Being the text of the Council Lecture delivered during the 46th Annual Scientific Conference of the Ophthalmological Society of Nigeria on 1st September, 2022

Abdulrazak MomohJimoh; Emmanuel O. Babalola; Mahmoud B. Alhassan; Aminatu A. Abdulrahman; Murtala M. Umar; Lukman A. Raji; Ugochukwu A. Eze

Authors

Abdulrazak MomohJimoh Department of Ophthalmology, Federal Medical Centre, Keffi, Nigeria;
Emmanuel O. Babalola Department of Ophthalmology, Rachel Eye Centre, Abuja, Nigeria
Mahmoud B. Alhassan National Eye Centre, Kaduna, Nigeria
Aminatu A. Abdulrahman National Eye Centre, Kaduna, Nigeria
Murtala M. Umar National Eye Centre, Kaduna, Nigeria
Lukman A. Raji National Eye Centre, Kaduna, Nigeria
Ugochukwu A. Eze Department of Ophthalmology, Federal Medical Centre, Asaba, Nigeria

Keywords:

anaesthesia, peribulbar, hyaluronidase, Magnesium sulfate, Cataract

Abstract

Background: Akinesia and analgesia are important for successful ophthalmic surgery. The efficacy of local anaesthesia can be enhanced by the use of adjuvants such as Hyaluronidase and Magnesium sulfate. Magnesium sulfate is readily available and has a long shelf life, while Hyaluronidase which is more commonly used has some associated drawbacks such as the risk of anaphylaxis, short shelf-life and not being readily available in some parts of Nigeria.

Aim: To compare the effects of Magnesium sulfate versus Hyaluronidase as adjuvants in Peribulbar anaesthesia for cataract surgery.

Methods: A randomized, controlled, double-blinded experimental study involving 150 patients with age-related cataract surgery was carried out between October and December 2020. They were randomly allocated into three groups of fifty (50) subjects each. All the patients received a peribulbar local anaesthetic (LA) injection. Magnesium sulfate group had an additional 80mg of MgSO 4 in 0.5mls of normal saline (N/S). Hyaluronidase group had an additional 15.0 IU of hyaluronidase while the control group had an addition of 0.5mls of plain normal saline. Ocular akinesia score, duration of globe akinesia, and postoperative pain score were assessed.

Result: There was an earlier onset and longer duration of akinesia among the magnesium sulfate group compared to other groups (p <0.001). There was no significant difference in the postoperative pain scores across the groups (p > 0.850).

Conclusion: These findings suggest that there is better akinesia and prolonged duration of peribulbar block with adjuvant magnesium sulfate.

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References

Imarengiaye CO, Adamu SA, Isesele T, Tudjegbe SO. Anaesthesia for Ophthalmic Procedures in a Teaching Hospital. Niger J Ophthalmol. 2008;16(1):1-4.

Medhat M. M. and Abd-Elmonem E. Comparison of orbital muscle akinesia caused by rocuronium versus hyaluronidase mixed to the local

anesthetic in single injection peribulbar block for cataract surgery.Anaesth Essays Res. 2015 ; 9(3): 374-378

Seet E, Chia A, Maheshwar B, Macachor J, Mohan Kumar C. Effectiveness of single injection sub-Tenon’s block for Pars Plana Vitrectomy and associated procedures. New Front Ophthalmol. 2018;3(5): 1-4

Abdulrahman AA, Alhassan MB NA, AO. M. Comparison of One Site and Two Site Peribulbar Anaesthesia for Cataract Surgery in Nigerian Patients: A Randomised, Controlled Trial. Niger J Ophthalmol. 2017; 25(2):90-94.

Alhassan MB, Kyari F, Ejere HO. Peribulbar versus retrobulbar anaesthesia for cataract surgery. Cochrane Database Syst Rev. 2015; (7):CD004083

Abdalali SA, Mohamed GF, Abdalmagid AS, Desoki SAH. Clinical comparative study between Magnesium sulphate versus Rocuronium versus Dexmedetomidine as adjuvants for local anesthetic in peribulbar block for eye surgeries. Egypt. J. Hosp. Med. 2018;73(8):7204-7210

Shin HJ, Do SH. Magnesium Sulfate/ : A Versatile Anesthetic Adjuvant. J Anest and Inten Care Med. 2017;4(5): 555646

Kathuria B, Luthra N, Gupta A, Grewal A, Sood D. Comparative Efficacy of Two Different Dosages of Intrathecal Magnesium Sulphate Supplementation in Subarachnoid Block. Journal of Clinical and Diagnostic Research. 2014;8(6):1-5.

Rhee WJ, Lee SY, Lee JH, Choi SR, Lee SC, Lee JH, Lee SI. The effect of high concentration of magnesium with ropivacaine, gentamicin, rocuronium, and their combination on neuromuscular blockade. Korean J Anesthesiol. 2015 Feb;68(1):50-61

Nazareth N, Gonsalves S, Vivekand U, Rodrigues FEA. Sodium bicarbonate versus hyaloronidase in peribulbar anaesthesia. Indian Journal of Clinical and Experimental Ophthalmolog. 2018;4(4):487-491 .

Rajalakshmi AR, Kumar MA. Hyaluronidase hypersensitivity/ : A rare complication of peribulbar block. Indian Journal of Ophthalmology. 2016;64(2):160-162.

Ibrahim T. Sample size determination. Research Methodology and Dissertation Writing for Health and Allied Professionals. 1st ed. Abuja: Cress Global Link Limited; 2009: 70-75.

Davis DB, Mandel MR. Posterior peribulbar anaesthesia: An alternative to retrobulbar anaesthesia. J Cataract Refract Surg 1986;12:182-184

Mogahed MM, Anwar AG, Abo-elazm WN. The Effect of Adding Two Different Doses of Magnesium Sulphate as Adjuvant to Ropivacaine in Peribulbar Block for Cataract Surgery. Journal of Anesthesia & Clinical 2017;8(5):725

Sinha R, Sharma A, Ray B, Chandiran R, Chandralekha C, Sinha R. Effect of addition of magnesium to local anesthetics for peribulbar block: A prospective randomized double-blind study. Saudi J Anaesth. 2016;10(1):64-67 .

El-Raouf MABD, Hefzy OM, Bawdy AA, El- aziz MHABD, Sherif NA. Evaluation of the Effect of Using Magnesium Sulphate as an Adjuvant to Regional Anesthesia for Ophthalmic Surgery Using Peribulbar Block. Med. J. Cairo Univ. 2016;84(3):283-288.

Abu Elyazed MM, Mostafa SF. Fentanyl versus magnesium sulphate as adjuvant to peribulbar anesthesia in cataract surgery. Egypt J Anaesth. 2017;33(2):159- 163.

Hamawy TY, Bestarous JN. Rocuronium versus magnesium as an adjuvant to local anesthetics in peribulbar block. Ain-Shams J Anesthesiol 2013;6:317-321.

Schulenburg HE, Lyons G, Columb MO, Mclure HA. Hyaluronidase reduces local anaesthetic volumes for sub-Tenon ’ s anaesthesia. British Journal of Anaesthesia 2007; 99(5):717-720.

Remy M, Pinter F, Nentwich MM, Kampik A, Scho C. Efficacy and safety of hyaluronidase 75 IU as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery. J Cataract Refract Surg. 2008:10-13.

Mohamed AZE, Genidy MM. Magnesium sulphate versus dexmedetomidine as an adjuvant to local anesthetic mixture in peribulbar anesthesia Magnesium sulphate versus dexmedetomidine as an adjuvant. Egypt J Anaesth. 2017; 33(4): 375-380.

El-Hamid AM, Ahmed M. Evaluation of the Effect of Magnesium Sulphate Vs . Clonidine As Adjunct To Local Anesthetic During Peribulbar Block. Ain Shams J Anesthesiol. 2011;4(1)21-26.