Rocuronium versus dexmedetomidine as an adjuvant to local anesthetics in peribulbar block: A double blind randomized placebo controlled study

Abstract

a b s t r a c tObjective: To compare the use of rocuronium with that of dexmedetomidine as an adjuvant to the local anesthetic mixture in peribulbar anesthesia for cataract surgery. Design: A double blind, prospective, randomized controlled study. Methods: Ninety patients with cataract in the age group 18-80 years of American Society of Anesthesiologists (ASA) physical status I-III scheduled for elective cataract surgery under regional anesthesia were randomly divided into three groups; Group C (control) received peribulbar anesthesia using a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 1 ml normal saline. Group R received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 0.06 mg/kg rocuronium (maximum 5 mg) in 1 ml saline.Group D received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and dexmedetomidine 50 lg (1 ml). Patients were assessed for onset and duration of corneal anesthesia and globe akinesia, postoperative pain using visual analog score (VAS), intraocular pressure (IOP), and sedation level using modified Ramsay sedation score (RSS). Patient and surgeon satisfaction score were also assessed. Results: Corneal anesthesia was achieved more rapidly in groups D and R than group C (P < 0.01). Akinesia was achieved more rapidly in the group R than both group D and group C. Akinesia was achieved more rapidly in group D than the control group. Intraocular Pressure was significantly lower in group D compared to both the control group and group R. Ramsay sedation score was significantly higher in group D compared to both the control group and D. Patient and surgeon satisfaction was significantly higher in group R and D compared to the control group. Conclusion: Adding 5 mg rocuronium to local anesthetic mixture provides more rapid onset of corneal and globe akinesia than 50 lg dexmedetomidine. Adding dexmedetomidine decreases IOP and provides sedation.

Dexamethasone compared to dexmedetomidine as an adjuvant to local anesthetic mixture in peribulbar block for vitreoretinal surgery. A prospective randomized study

“…It may also facilitate drainage of aqueous humor by reducing the sympathetic mediated vasomotor tone of the drainage system of the eye. [ 17 18 ] Our results were similar to those obtained by Channabasappa et al . [ 19 ] who reported that a combination of bupivacaine and lidocaine with dexmedetomidine in peribulbar anesthesia helped to decrease the IOP significantly.…”

“…Dexmedetomidine is a highly specific centrally acting α2-agonist; it is widely used nowadays with local anesthetic mixture in peripheral nerve blocks, subarachnoid anesthesia,[ 30 ] and ophthalmic anesthesia. [ 17 ] Alpha 2-agonists acts peripherally by reducing the discharge of norepinephrine and by inhibition of nerve fiber action potential while their central analgesic effect is produced at the level of the dorsal root neuron in pain pathway as well as at the locus coeruleus by preventing the release of substance P and by activation of α2-receptors, respectively. [ 18 ]…”

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

“…On the other hand, the addition of 50 mg magnesium sulphate to local anesthesia in older (40-80 years-old) patients who underwent cataract surgery did not show any benefit regarding the onset of block or akinesia score [23]. AbdAlali et al [19] reported better analgesic and anesthetic effects of rocuronium as an additive to local anesthetic drugs in the peribulbar block than magnesium sulphate.…”

Dexmedetomidine vs. Magnesium Sulphate as an Adjuvant to Rocuronium Bromide, and Local Anaesthetic Mixture in Peribulbar Anaesthesia for Viteroretinal Surgery

“…Using dexmedetomidine, and magnesium sulphate as adjuvants to peribulbar anesthesia has been investigated in several studies [18][19][20], comparing their effects versus rocuronium in peribulbar anesthesia [19,21] has been studied as well. To our knowledge little was done to investigate the local effects of dexmedetomidine or magnesium on the muscle relaxant potentiated block.…”