Case Study Pharmacology

All physicians, patients, nursing staff, and data collector were blinded to the patient group assignment. For all patients full clinical examination and laboratory investigations as regards renal and hepatic functions as well as cardiovascular status were done.

Using a computer generated randomization schedule and serially numbered, opaque, sealed envelopes, patients were randomly allocated to one of three study groups; 32 patients in each group

Patients were randomly allocated to one of three study groups; 32 patients in each group:

Group 1 (C group) :(n=32) each patient received the combination of 3.5ml bupivacaine 0.5%, 3.5 ml lidocaine 2%, 0.5ml rocuronium bromide (5mg) plus 0.5ml Normal saline (0.9% NaCl)

Group 2 (D group) :(n=32) each

An infra‑temporal trans‑conjuctival injection of the study drug (4ml) using a 25‑gauge, 25‑mm needle was performed followed by gentle massage for 30 seconds to facilitate the spread of the local anesthetic mixture. A second trans‑conjuctival injection of the study drug (4ml) was performed medial to the lacrimal caruncle. Injection of the intended volume of the study drug was stopped when there was fullness of the orbit and/or drooping of the upper eyelid during injection. Gentle ocular massage was done , the eye pad was removed every 2 min to assess ocular movements and the orbicular muscle. Corneal anesthesia was also evaluated using a small cotton wool at the same time intervals. To assess ocular akinesia, patients were asked to look in four directions: Lateral, medial, superior, and inferior. Ocular movement in each direction was scored as 2 if it was normal, 1 if it was limited, and 0 if there was no directional movement (total score 0–8). The patient was then asked to forcefully close his/her eyes to assess the orbicularis muscle on a scale of 0–2 (0 = complete akinesia, 1 = partial movement, 2 = pronounced