الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Through our stages study we tried to develop a simple effective periocular technique as regards the approach and the local and the local anesthesetic mixture used.
In the first and second stages of this study we fixed an approach and performing the block through two point transconjunctival injection and our aim is to optimize the standard local anesthesetic mixture as regards the spread through the orbital contents and the onset of action. With that optimized local anesthesetic mixture the third stage aimed to reduce times of injections if the efficacy of the block is not compromised.
First stage: evaluation of role of hyaluronidase in peribulbar block.
Second stage: evaluation of pH adjustment of local anesthesetic mixture with or without hyaluronidase.
Third stage: Do we really need two point injection sites with our chosen local anesthesetic mixture? Evaluation of one point approach.
Which site could be sufficient infrotemporal or medial site?
Conclusions:
In the first stage our results demonstrates the great role of hyaluronidase enzyme in peribulbar block as by its addition to the local anesthetic mixture in concentration of 15 U/ml it promotes diffusion and spread the local anesthetic mixture to the aimed place so it hastens the onset of action and efficiency of the local anesthetic mixture as regards extra ocular muscle movement scores resulting in increase incidence of the initial successful blocks and decrease incidence of supplementary injection and also it help in solving the minor complications ”or prevents its occurrence from the start” which may resulted from the transconjunctival approach of peribulbar block such as conjunctival edema and the increase in intra ocular tension which results from injecting large volume of local anesthetic mixture.
In the second stage, pH adjustment of local anesthetic mixture to nearly 6.5 resulted in a significant increase in the efficiency of local anesthetic mixture in terms of shortening the onset of action due to increase the incidence of non ionized form entering the nerve sheath as we got an increase in the initial success rate of the block after just five minutes.
In the third stage, the single infrotemporal or single medial injection approach are efficient. But it seems that the single medial site injection preserve more easily the goal of attainment the ideal operative conditions because the following advantages: rapid onset of anesthesia akinesia of the globe and eyelids, suitable intra ocular tension, completely painless block, no minor complications recorded, maximum patients satisfaction and maximum surgeon assessment scores so it has the maximum overall quality scores.