Background: In the current study, it was hypothesized that adding low dose atracurium to Local Anesthetic (LA) mixture would provide an early onset of akinesia and favorable surgical condition in percaruncular peribulbar anesthesia for high myopes undergoing phacoemulsification.Methods: 91 ASA-PS I-III high myopes scheduled for phacoemulsification were enrolled in this randomized controlled trial. The enrolled patients were randomly allocated to one of two groups. Group C (n=46) received 2.5ml of lidocaine 2%, 2.5ml of bupivacaine 0.5% with hyaluronidase 15IU/ml and 1ml normal saline, while patients in Group A (n=45) received the same mixture with 5mg atracurium. The onset of globe and eyelid akinesia and duration of akinesia were recorded. The need for supplementation, total LA volume and surgeons' satisfaction were recorded.Results: Eighty-two patients were analyzed with 41 patient in each group. The onset of globe akinesia was earlier in Group A than Group C [4 (2-9), 4 (4-15) min. respectively, p<0.001]. Furthermore, fewer patients in Group A required supplementation compared to Group C, 27% versus 62% respectively, p=0.002. The onset of eyelid akinesia, duration of akinesia and the total volume of LA were comparative between the 2 groups. Conclusion:Adding 5mg atracurium to LA solution reduced the time to onset of globe akinesia and the need for supplementation in the percaruncular block in myopic patients with no effect on duration of akinesia or quality of analgesia.