Egyptian Journal of Anaesthesia (Apr 2016)

Adding low dose rocuronium to local anesthetic mixture: Effect on quality of peribulbar blockade for vitreoretinal surgery

  • Mohamed T. Ghanem,
  • Mohamed A. Tawfeek

DOI
https://doi.org/10.1016/j.egja.2015.09.015
Journal volume & issue
Vol. 32, no. 2
pp. 201 – 205

Abstract

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Background: The purpose of this study was to assess the effect of adding low dose rocuronium to local anesthetic solution on the quality of peribulbar blockade for vitreoretinal (VR) surgery. Methods: 80 consecutive adult patients scheduled for VR surgery were enrolled in this double-blind randomized clinical trial. Patients were categorized randomly into 2 equal groups: group C (control group) received local anesthetic mixture (4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and hyaluronidase “30 U/ml”) plus 0.5 ml normal saline, and group S (study group) received the same local anesthetic mixture plus 5 mg (0.5 ml) rocuronium. Globe and lid akinesia were assessed 15 min after injection, and supplemental peribulbar blockade was done in case of inadequate analgesia and or akinesia. Intraoperatively, supplementary sub-Tenon infiltration was performed in case of inadequate analgesia and/or akinesia. Measurement data included rate of supplementation, analgesic efficacy, time to first sub-Tenon infiltration, and total anesthetic volume. Major complications, and patient’s and surgeon’s satisfaction were also recorded. Results: The adequacy of peribulbar blockade 15 min after injection was comparable in both groups. Rate of supplementary sub-Tenon infiltration was lower in the rocuronium group which is statistically significant (15 injections versus 53 injections in the control group). Time to first sub-Tenon infiltration was significantly prolonged in the rocuronium group (90.4 + 11.8 versus 60.2 + 9.2 in the control group). The total anesthetic volume injected was significantly lower in the rocuronium group (13.2 + 0.6 versus 20.6 + 0.8 in the control group). There were no major systemic or local complications in both groups. Patient’s and surgeon’s satisfaction was significantly higher in the rocuronium group. Conclusion: Adding low dose rocuronium to local anesthetics prolongs duration of peribulbar anesthesia and offers an optimal surgical condition without serious adverse effects for patients undergoing VR surgery.

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