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mepivacaine + hyaluronidase is a combination pharmacological intervention used for regional anesthesia in ophthalmic surgeries, such as cataract extraction. Mepivacaine is an amide-type local anesthetic that acts by binding to and blocking voltage-gated sodium channels on the neuronal membrane, which prevents the influx of sodium ions and the subsequent initiation and conduction of nerve impulses, resulting in regional anesthesia. Hyaluronidase is an enzyme that acts as a spreading factor by depolymerizing hyaluronic acid in the extracellular matrix of connective tissues. This action temporarily reduces the viscosity of the interstitial cement, thereby enhancing the diffusion and penetration of the co-administered mepivacaine throughout the orbital space. This combination is typically administered via peribulbar or retrobulbar injection to achieve rapid onset of both anesthesia and ocular akinesia. Sohag University has utilized this combination in clinical trials to investigate its effects on retinal microvasculature using optical coherence tomography angiography (OCTA).
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