Comparative Evaluation of Sodium Bicarbonate and Hyaluronidase as Adjuncts to Lignocaine in Peribulbar Block During Cataract Surgery

Background Peribulbar anaesthesia is widely used in cataract surgery to provide reliable analgesia, akinesia, and a low rate of complications. Hyaluronidase is conventionally added to local anaesthetic solutions to enhance diffusion and improve block quality. More recently, sodium bicarbonate has been suggested as an alternative adjunct, as its alkalinising effect increases the proportion of non-ionised lignocaine, potentially accelerating onset and improving efficacy. This study aimed to compare the effectiveness of sodium bicarbonate and hyaluronidase as adjuncts to lignocaine in peribulbar block during cataract surgery, with particular focus on pain perception, onset of anaesthesia, and onset of akinesia. Materials and methods A randomised interventional study was conducted on 80 patients undergoing cataract surgery, divided equally into two groups of 40. Group A received a mixture of lignocaine, bupivacaine, and hyaluronidase, while Group B received lignocaine, bupivacaine, and sodium bicarbonate. Pain intensity was assessed using the Visual Analogue Scale (VAS), and the onset of anaesthesia and akinesia were recorded at one-minute intervals for up to 10 minutes. Data were analysed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Results Patients in Group B reported significantly lower pain scores (p < 0.05) and a faster onset of anaesthesia compared to Group A. In contrast, the onset of akinesia was significantly slower in Group B. Complication rates were comparable between the two groups, with no statistically significant differences observed. Conclusion The findings suggest that sodium bicarbonate is a useful adjunct to lignocaine in peribulbar anaesthesia, offering faster onset and reduced pain perception, though its effect on akinesia requires further evaluation.