The Effect of Addition of Rocuronium to Local Anesthetic in Peribulbar Block for Cataract Surgery

Introduction: There are a limited number of studies that compared Rocuronium as additive to local anesthetic mixture in cataract surgery using peribulbar technique; but none of these studies evaluated the duration of block. Purpose: To evaluate the effects of adding Rocuronium (5mg) to local anesthetic mixture on akinesia of globe and eyelid regarding onset and duration in cataract surgery using peribulbar technique. Methods: This study was carried out as a single blind randomized clinical trial. Sixty patients were randomly assigned to one of study groups; the first group (control group) received local anesthetic 3.5ml 2% Lidocaine+3.5ml 0.5% plain Bupivacaine +0.5ml saline 0.9%, the second group (Rocuronium group) received local anesthetic 3.5ml 2% lidocaine+3.5ml 0.5% plain Bupivacaine+0.5ml Rocuronium (5mg). Results: Regarding the onset of lid movement measured at 3 minutes in Rocuronium group only 2 patients (6.67%) of the group showed complete lid akinesia and 16 patients (53.33%) showed flickering, representing statistically significant difference between Rocuronium and control groups. Rocuronium group demonstrated significantly better lid akinesia scores than control group at 5 and 10 minutes post injection. There was statistically significant difference in onset of globe movement at 1 minute with Rocuronium group versus control group, as 8 patients in Rocuronium group (26.67%) show partial akinesia. At 3 minutes, 5 patients of Rocuronium group (16.67%) showed complete akinesia which statistically significant difference and 20 patients of Rocuronium group (66.67%) versus 5 patients of control group (16.67%) had partial akinesia. Also Rocuronium group demonstrated significantly better globe akinesia scores than control group at 5 and 10 minutes post injection. Four patients in Rocuronium group (13.33%) and versus 12 patients (40%) required a supplementary injection 10 min after block because of inadequate motor block (akinesia score 4) and the difference was statistically relevant (p=0.03). Duration of globe akinesia was (122.5±9.72) in Rocuronium group versus control group (91.5±9.11) showed highly statistical significant difference (p=0.001). No difference in pain scores noted intraoperative or postoperative follow-up for two hours. No systemic or ocular adverse effects were recorded in any group. Conclusion: The addition of low dose rocuronium 5mg to local anesthetic solution shortens the onset time, prolongs the duration of akinesia and reduces the need for supplementary injections without known complications.