A comparison of retrobulbar and two peribulbar regional anesthetic techniques in dog cadavers

Yael Shilo-Benjamini, Peter J Pascoe, Erik R Wisner, Nili Kahane, Philip H Kass, David J Maggs

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective To compare injectate distribution and likelihood of regional anesthesia to the orbit following retrobulbar (RB) or peribulbar (PB) injections in dog cadavers. Study design Randomized, masked study. Animals Twenty-four dog cadavers (aged 5.5–17 years, 2.0–36.3 kg). Methods Orbits underwent one of three injection techniques with bupivacaine 0.5% and iohexol (1:1): ventrolateral RB injection (1–2 mL; 15 orbits), medial canthal PB injection (2–8 mL; PB-1; 16 orbits), or dorsomedial and ventrolateral PB injections (each 1–4 mL; PB-2; 16 orbits). The likelihood of successful regional anesthesia was estimated based on computed tomographic images scored for injectate volume of distribution at the base and within the extraocular muscle cone (EOMC), and injectate distribution around the optic nerve. Intraocular pressure (IOP) was measured before and after injections. Mixed-effects linear regression with post hoc Bonferroni contrast adjustments was performed. Significance was set at 0.05. Results A difference in injectate volume of distribution within or at the base of the EOMC was not detected among groups. The median optic nerve circumference of injectate distribution was significantly higher in the RB injected group than in the PB-2 group. Injectate distribution following RB, PB-1 and PB-2 injections was graded as likely to provide regional anesthesia within the EOMC in 40%, 19% and 31% of eyes, and at the EOMC base in 60%, 63% and 50% of eyes, respectively. The probability of likelihood to provide regional anesthesia was lower in dogs of higher body weights. The IOP was significantly higher than baseline following PB-1 (18 ± 14 mmHg) and in comparison with RB (2 ± 3 mmHg), but not different from PB-2 injection (10 ± 11 mmHg). Conclusions and clinical relevance None of the techniques reliably produced ‘successful’ injectate distribution based on this study's definitions; however, clinical assessment of anesthetic success is required.

Original languageEnglish (US)
Pages (from-to)925-932
Number of pages8
JournalVeterinary Anaesthesia and Analgesia
Volume44
Issue number4
DOIs
StatePublished - Jul 1 2017

Fingerprint

Cadaver
anesthetics
Anesthetics
Oculomotor Muscles
orbits
Dogs
injection
Orbit
Injections
Conduction Anesthesia
dogs
cones (retina)
anesthesia
muscles
Optic Nerve
optics
methodology
Intraocular Pressure
nerve tissue
eyes

Keywords

  • canine
  • peribulbar anesthesia
  • regional ocular anesthesia
  • retrobulbar anesthesia

ASJC Scopus subject areas

  • veterinary(all)

Cite this

A comparison of retrobulbar and two peribulbar regional anesthetic techniques in dog cadavers. / Shilo-Benjamini, Yael; Pascoe, Peter J; Wisner, Erik R; Kahane, Nili; Kass, Philip H; Maggs, David J.

In: Veterinary Anaesthesia and Analgesia, Vol. 44, No. 4, 01.07.2017, p. 925-932.

Research output: Contribution to journalArticle

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abstract = "Objective To compare injectate distribution and likelihood of regional anesthesia to the orbit following retrobulbar (RB) or peribulbar (PB) injections in dog cadavers. Study design Randomized, masked study. Animals Twenty-four dog cadavers (aged 5.5–17 years, 2.0–36.3 kg). Methods Orbits underwent one of three injection techniques with bupivacaine 0.5{\%} and iohexol (1:1): ventrolateral RB injection (1–2 mL; 15 orbits), medial canthal PB injection (2–8 mL; PB-1; 16 orbits), or dorsomedial and ventrolateral PB injections (each 1–4 mL; PB-2; 16 orbits). The likelihood of successful regional anesthesia was estimated based on computed tomographic images scored for injectate volume of distribution at the base and within the extraocular muscle cone (EOMC), and injectate distribution around the optic nerve. Intraocular pressure (IOP) was measured before and after injections. Mixed-effects linear regression with post hoc Bonferroni contrast adjustments was performed. Significance was set at 0.05. Results A difference in injectate volume of distribution within or at the base of the EOMC was not detected among groups. The median optic nerve circumference of injectate distribution was significantly higher in the RB injected group than in the PB-2 group. Injectate distribution following RB, PB-1 and PB-2 injections was graded as likely to provide regional anesthesia within the EOMC in 40{\%}, 19{\%} and 31{\%} of eyes, and at the EOMC base in 60{\%}, 63{\%} and 50{\%} of eyes, respectively. The probability of likelihood to provide regional anesthesia was lower in dogs of higher body weights. The IOP was significantly higher than baseline following PB-1 (18 ± 14 mmHg) and in comparison with RB (2 ± 3 mmHg), but not different from PB-2 injection (10 ± 11 mmHg). Conclusions and clinical relevance None of the techniques reliably produced ‘successful’ injectate distribution based on this study's definitions; however, clinical assessment of anesthetic success is required.",
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