Rocuronium Versus Atracurium as Adjuvants to Local Anesthetic in Peribulbar Induced Akinesia

Abstract

SUMMARY AND CONCLUSION R egional anesthesia with the help of retrobulbar or peribulbar blocks or topical anesthesia is being used in cataract surgeries. The key role of anesthesia is akinesia-establishment that helps the surgeon during the operations. The retrobulbar technique is more effective and rapid than the peribulbar methods in establishing the akinesia. However it potentially carries hazardous side effects. Many adjuvant agents were added to local anesthetic in peribulbar block including low dose of atracurium, rocuronium, and hyaluronidase. In this study we compare the effect of using atracurium, rocuronium and hyaluronidase, as adjuvant agents to the local anesthetic substance on peribulbar-induced akinesia in cataract surgeries. 45 Patients were randomly allocated into three groups:  Control group: received a mixture (8 ml) containing equal parts of marcaine 0.5%, lidocaine 2% containing hyaluronidase 15IU/ ml plus 0.5 ml saline 0.9%.  Atracurium group: received a mixture (8 ml) containing equal parts of marcaine 0.5%, lidocaine 2% plus 0.5 ml atracurium 5 mg.  Rocuronium group: received a mixture (8 ml) containing equal parts of marcaine 0.5%, lidocaine 2% plus 0.5 ml rocuronium 5mg. The score of akinesia was evaluated in the 1st, 3rd, 5th, 10th minutes after administration of the medications. 10 minute after drug administration, 13 (86%) reached the total akinesia with rocuronium, 11(73%) with atracurium and 10 (66%) with the control (P>0.05). Addition of low-dose atracourium and rocuronium to the anesthetic drug is recommended in order to enhance the quality of akinesia especially when hyaluronidase is not added.