Comparative Efficacy Of Sodium Bicarbonate And Hyaluronidase As Adjuvants In Peribulbar Block: A Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: FP21.03 | Type: Free paper | DOI: 10.82333/26xt-1m13
Authors: Dr Mustafa Alsaadi 1 , Dr Izzaldin Alremawi 2 , Dr Abdelaziz Abdelaal 3 , Dr Jumanah Qedair 4 , Dr Alemam Ahmed 5 , Dr Hashem Abu Serhan* 6
1Faculty of Medicine,Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences,Kufa,Iraq, 2Faculty of Medicine,Qatar University,Doha,Qatar, 3PGME Department,Harvard Medical School,Boston,United States, 4College of Medicine,King Saud bin Abdulaziz University for Health Sciences,Jeddah,Saudi Arabia, 5Faculty of Medicine,Zagazig University,Zagazig ,Egypt, 6Department of Ophthalmology,Hamad Medical Corporation,Doha,Qatar
Purpose
To evaluate the effectiveness and safety of sodium bicarbonate compared to hyaluronidase in peribulbar anesthesia.
Setting
A systematic review and meta-analysis.
Methods
The review was registered on PROSPERO (CRD420251053108). An electronic search was conducted to acquire all RCTs comparing sodium bicarbonate and hyaluronidase in peribulbar blocks. The primary outcome was successful block rate, while secondary outcomes included onset of anesthesia, onset of akinesia, need for supplemental injections, pain score during injection, and postoperative complications. Data were analyzed using STATA software (version 18). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
Results
Sodium bicarbonate showed no significant difference compared to hyaluronidase in terms of successful block rate (OR = 0.64; 95% CI: 0.14, 2.94). Similarly, no differences were noted in onset of akinesia (MD = 0.03; 95% CI: –1.87, 1.93), onset of anesthesia (MD = –0.42; 95% CI: –1.07, 0.24), and need for supplemental injections (OR = 0.79; 95% CI: 0.46, 1.36). No significant differences were observed in postoperative complications, including chemosis (OR = 1.18; 95% CI: 0.83, 1.68) and subconjunctival hemorrhage (OR = 0.82; 95% CI: 0.34, 1.97). However, sodium bicarbonate was associated with significantly lower pain (MD = -2.15; 95% CI: -2.55, -1.75) and a significantly higher risk of lid edema (OR = 7.50; 95% CI: 2.52, 22.34).
Conclusions
Sodium bicarbonate appears to be a safe and effective alternative to hyaluronidase as an additive in peribulbar anesthesia. It demonstrated similar efficacy, but offered significantly reduced injection pain, albeit with an increased risk of lid edema.