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Rocuronium versus cisatracurium as adjuvants to local anesthetic in peribulbar-induced akinesia

 Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
Ramy Mahrose,
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_99_17

Background and objectives Peribulbar anesthesia is widely used in cataract surgery, but the beginning of akinesia is much slower and slower compared with retrobulbar technique. The effect of using adjuvant to the peribulbar block for the development of improved conditions in the absence of any adverse effects and in fastening the onset of akinesia has been implicated. We investigate the effect of the use of rocuronium, cisatracurium, and hyaluronidase as adjuvants for the local anesthetic on peribulbar-induced akinesia in relation to the grade of akinesia. Patients and methods A total of 135 women were assigned for cataract surgery to three groups (45 patients in each group), who received local eye anesthesia of a mixture (8 ml) containing equal amounts of Marcaine 0.5% and lidocaine 2%, containing hyaluronidase 15 IU/ml plus 0.5 ml saline 0.9% (group C); a mixture (8 ml) containing equal parts of 0.5% Marcaine and 2% lidocaine plus 0.5 ml cisatracurium (1 mg) (group A); and a mixture (8 ml) containing equal parts of 0.5% Marcaine, 2% lidocaine plus 0.5 ml rocuronium (5 mg) (group R). Lid akinesia, globe akinesia, hemodynamics, and adverse effects were evaluated among groups. Results After 1 min of injection, the number of patients reaching total akinesia was 15 (33%) with rocuronium, nine (20%) with cisatracurium, and zero (0%) in the control group. After 3 min of injection, the total number of individuals achieving total immobility was 21 (46%) with rocuronium, 15 (33%) with cisatracurium, and six (13%) in the control group. After 5 min of injection, the number of patients reaching total akinesia was 33 (73%) with rocuronium, 27 (60%) with cisatracurium, and 21 (46%) with the control group. At the 10th minute after injection, the number of individuals reaching total akinesia was 39 (86%) with rocuronium, 33 (73%) with cisatracurium, and 30 (66%) with control. In groups of rocuronium and cisatracurium, the total akinesia is relatively more frequent than in the control group. The number of patients with complete akinesia was higher in the rocuronium group after 10 min than in the cisatracurium and control groups, but there was no statistically significant difference among the three groups regarding lid akinesia. We did not notice any adverse effects related to the peribulbar block or the drugs used during the study. Conclusion This study demonstrated that addition of low-dose cisatracurium and rocuronium to the anesthetic drug is recommended to improve the quality of akinesia especially when hyaluronidase is not added.

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