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Adjuvants to local anaesthesia in ophthalmic surgery
  1. Lee Adams
  1. Moorfields Eye Hospital, London, UK
  1. Correspondence to Dr Lee Adams, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; dr_adams{at}


This article reviews the use of adjuvants to local anaesthesia for ophthalmic regional anaesthesia. Hyaluronidase, bicarbonate, epinephrine, muscle relaxants, opiates and clonidine have all been described singly and in combination for use as an adjuvant to ophthalmic regional anaesthesia. The article focuses on the efficacy of the adjuvants with regard to improving akinesia, analgesia, speed of onset and reducing block failure. A description of the pharmacological action of each adjuvant is given followed by a review of randomised control trials, dosage and notable papers on the subject. There is no effective consensus between anaesthetists or surgeons on the use of adjuvants to local anaesthesia and it so is the purpose of this review to draw attention to the wealth of current data and allow an informed decision on the choices available.

  • Ophthalmic
  • local anaesthesia
  • hyaluronidase
  • bicarbonate
  • adrenaline
  • pharmacology

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  • The author is an Anaesthetic Specialist Registrar at Moorfields Eye Hospital, London.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.