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Veterinary ophthalmology2022; 26(2); 135-144; doi: 10.1111/vop.13053

Safety and accuracy of blind vs. ultrasound-guided dorsal retrobulbar nerve blocks in horses-A cadaveric study.

Abstract: There is limited knowledge regarding the safety and accuracy of ultrasound-guided retrobulbar nerve blocks in horses. The aim of this study was to compare these parameters between blind and ultrasound-guided injection techniques for the dorsal retrobulbar nerve block in horses. Methods: Equine cadaver heads were used to inject the retrobulbar space with contrast medium (CM). Injections were performed either blindly based on anatomic landmarks (blind group, n = 44) or under ultrasonographic guidance (US-group, n = 44), equally divided between an experienced and unexperienced operator. Needle position and distribution of CM were assessed with computed tomography imaging and evaluated by a board-certified veterinary diagnostic imager blinded to the technique. Safety and accuracy of both techniques were compared. Results: Ocular penetration was observed in two cases (n = 2/44) in the blind group but not in the US group (n = 0/44). No intrathecal, intraneural, or intravascular injections were seen in either group. Safety was significantly improved in the US group (p = .026). There was no statistically significant difference between the groups regarding the accuracy of the injection. Excellent accuracy was achieved more often with the ultrasound-guided technique (n = 11/22) than with the blind technique (n = 7/22) when performed by the unexperienced operator, but this difference was not statistically significant. Conclusions: To prevent globe-threatening complications and improve the safety of the injection, we recommend using the ultrasound-guided injection technique for the dorsal retrobulbar nerve block.
© 2022 The Authors. Veterinary Ophthalmology published by Wiley Periodicals LLC on behalf of American College of Veterinary Ophthalmologists.
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Publication Date: 2022-12-19 PubMed ID: 36536509DOI: 10.1111/vop.13053Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article focuses on comparing the safety and precision of blind and ultrasound-guided techniques for injecting the dorsal retrobulbar nerve block in horses. The study showed a significant improvement in safety using an ultrasound-guided technique though there was no statistical difference in accuracy between the two methods.

Methodology

  • The researchers used equine cadaver heads to inject the retrobulbar space with a contrast medium (CM).
  • Two methods of injection were used: blind technique based on anatomic landmarks (blind group, n = 44) and ultrasonographic guidance (US-group, n = 44).
  • The injections were equally divided between an experienced and inexperienced operator.
  • Needle position and distribution of CM were then assessed using computed tomography (CT) imaging.
  • A board-certified veterinary diagnostic imager, unaware of which technique was used, evaluated the results.

Results

  • In the blind group, ocular penetration occurred in two cases, but it did not occur in the US group.
  • There were no cases of intrathecal, intraneural, or intravascular injections in either group.
  • The results significantly favoured the US technique in terms of safety (p = .026).
  • However, there was no significant difference between the blind and US methods regarding the injection’s accuracy.
  • Greater accuracy was more often achieved with the ultrasound-guided technique (11/22) compared to the blind technique (7/22) when executed by the inexperienced operator—though this difference was not statistically significant.

Conclusions

  • The researchers recommend using the ultrasound-guided injection technique for the dorsal retrobulbar nerve block to avoid serious complications for the animal’s eye and improve overall safety.

Cite This Article

APA
Thieme K, Mesquita L, Lieberth S, Dancker C, Doherr MG, Eule JC. (2022). Safety and accuracy of blind vs. ultrasound-guided dorsal retrobulbar nerve blocks in horses-A cadaveric study. Vet Ophthalmol, 26(2), 135-144. https://doi.org/10.1111/vop.13053

Publication

Veterinary ophthalmology
ISSN: 1463-5224
NlmUniqueID: 100887377
Country: England
Language: English
Volume: 26
Issue: 2
Pages: 135-144

Researcher Affiliations

Thieme, Katharina
  • Small Animal Clinic, Freie Universität Berlin, Berlin, Germany.
  • Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany.
Mesquita, Luis
  • Radiology Department, Willows Veterinary Centre and Referral Service, Solihull, UK.
Lieberth, Simona
  • Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany.
Dancker, Christian
  • Small Animal Clinic, Freie Universität Berlin, Berlin, Germany.
Doherr, Marcus Georg
  • Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany.
Eule, Johanna Corinna
  • Small Animal Clinic, Freie Universität Berlin, Berlin, Germany.

MeSH Terms

  • Animals
  • Horses
  • Ultrasonography, Interventional / veterinary
  • Ultrasonography, Interventional / methods
  • Nerve Block / veterinary
  • Nerve Block / methods
  • Ultrasonography / veterinary
  • Orbit / diagnostic imaging
  • Cadaver
  • Horse Diseases

Grant Funding

  • European College of Veterinary Ophthalmologists

References

This article includes 40 references
  1. Grubb T, Lobprise H. Local and regional anaesthesia in dogs and cats: overview of concepts and drugs (part 1). Vet Med Sci 2020;6(2):209-217.
  2. Romano M, Portela DA, Breghi G, Otero PE. Stress-related biomarkers in dogs administered regional anaesthesia or fentanyl for analgesia during stifle surgery. Vet Anaesth Analg 2016;43(1):44-54.
  3. Shilo-Benjamini Y. A review of ophthalmic local and regional anesthesia in dogs and cats. Vet Anaesth Analg 2019;46(1):14-27.
  4. Labelle AL, Clark-Price SC. Anesthesia for ophthalmic procedures in the standing horse. Vet Clin North Am Equine Pract 2013;29(1):179-191.
  5. Oel C, Gerhards H, Gehlen H. Effect of retrobulbar nerve block on heart rate variability during enucleation in horses under general anesthesia. Vet Ophthalmol 2014;17(3):170-174.
  6. Yang VY, Eaton JS, Harmelink K. Retrobulbar lidocaine injection via the supraorbital fossa is safe in adult horses but produces regionally variable periocular anaesthesia. Equine Vet J 2022;54:807-819.
  7. Robertson SA. Standing sedation and pain management for ophthalmic patients. Vet Clin North Am Equine Pract 2004;20(2):485-497.
  8. Oliver JA, Bradbrook CA. Suspected brainstem anesthesia following retrobulbar block in a cat. Vet Ophthalmol 2013;16(3):225-228.
  9. Grimm K, Lamont L, Tranquilli W, Greene S, Robertson S. Lumb and Jones Veterinary Anesthesia and Analgesia. .
  10. Gayer S, Palte HD. Ultrasound-guided ophthalmic regional anesthesia. Curr Opin Anaesthesiol 2016;29(6):655-661.
  11. Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev 2015;2015(9):CD006459.
  12. Walker KJ, McGrattan K, Aas-Eng K, Smith AF. Ultrasound guidance for peripheral nerve blockade. Cochrane Database Syst Rev 2009;(4):CD006459.
  13. Wagatsuma JT, Deschk M, Floriano BP. Comparison of anesthetic efficacy and adverse effects associated with peribulbar injection of ropivacaine performed with and without ultrasound guidance in dogs. Am J Vet Res 2014;75(12):1040-1048.
  14. Morath U, Luyet C, Spadavecchia C, Stoffel MH, Hatch GM. Ultrasound-guided retrobulbar nerve block in horses: a cadaveric study. Vet Anaesth Analg 2013;40(2):205-211.
  15. Leigh H, Gozalo-Marcilla M, Esteve V, Bautista ÁJG, Gimenez TM, Viscasillas J. Description of a novel ultrasound guided peribulbar block in horses: a cadaveric study. J Vet Sci 2021;22(2):e22.
  16. Hermans H, Lloyd-Edwards RA, Ferrão-van Sommeren AJH. Comparing blind and ultrasound-guided retrobulbar nerve blocks in equine cadavers: the training effect. Animals 2022;12(2):154.
  17. Najman IE, Ferreira JZ, Abimussi CJ. Ultrasound-assisted periconal ocular blockade in rabbits. Vet Anaesth Analg 2015;42(4):433-441.
  18. Stoppini R, Gilger BC. Equine ocular examination basic techniques. In: Gilger BC, ed. Equine Ophthalmology. 3rd ed. John Wiley & Sons; 2016:1-39.
  19. Shilo-Benjamini Y, Pascoe PJ, Maggs DJ, Kass PH, Wisner ER. Retrobulbar and peribulbar regional techniques in cats: a preliminary study in cadavers. Vet Anaesth Analg 2013;40(6):623-631.
  20. Wadood AC, Dhillon B, Singh J. Inadvertent ocular perforation and intravitreal injection of an anesthetic agent during retrobulbar injection. J Cataract Refract Surg 2002;28(3):562-565.
  21. Briley J, Chiavaccini L, Washington D, Westermeyer H, Posner L. Comparison of a blind and an ultrasound-guided technique for retrobulbar anesthesia in dogs undergoing unilateral subconjunctival enucleation. Vet Anaesth Analg 2021;48(6):S984-S985.
  22. Badawy AM, Eshra EA. Development of an ultrasound-guided technique for retrobulbar nerve block in dromedary camels: a cadaveric study. Vet Anaesth Analg 2018;45(2):175-182.
  23. Hagag U, El Nahas A. Ultrasound-guided retrobulbar nerve block in donkey cadavers. Vet Anaesth Analg 2022;49(2):197-202.
  24. Johnson JP, Vinardell T, David F. Ultrasound-guided injections of the equine head and neck: review and expert opinion. J Equine Sci 2021;32(4):103-115.
  25. Tóth J, Hollerrieder J. Experiences with the local retrobulbar anesthesia in ophthalmologic surgery of the standing horse. Pferdeheilkunde 2013;29(1):21-26.
  26. Gottsauner-Wolf F, Grabowski JJ, Chao EYS, An K-N. Effects of freeze/thaw conditioning on the tensile properties and failure mode of bone-muscle-bone units: a biomechanical and histological study in dogs. J Orthop Res 1995;13(1):90-95.
  27. Jalal N, Zidi M. Effect of cryopreservation at −80°C on visco-hyperelastic properties of skeletal muscle tissue. J Mech Behav Biomed Mater 2018;77:572-577.
  28. Maiden NR, Byard RW. Unpredictable tensile strength biomechanics may limit thawed cadaver use for simulant research. Aust J Forensic Sci 2016;48(1):54-58.
  29. Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog 2012;59(2):90-103.
  30. Meyer GA, Lin HC, Hanson RR, Hayes TL. Effects of intravenous lidocaine overdose on cardiac electrical activity and blood pressure in the horse. Equine Vet J 2001;33(5):434-437.
  31. Löscher W, Richter A. Lehrbuch der Pharmakologie und Toxikologie für die Veterinärmedizin. .
  32. Gilger BC, Davidson MG. How to prepare for ocular surgery in the standing horse. Presented at: Annual Convention of the AAEP; Orlando. 2002.
  33. Eberspächer-Schweda E. Sedierung und Lokalanästhesie bei Eingriffen am Kopf des Pferdes. Pferdespiegel 2017;20(2):50-59.
  34. Klaumann PR, Moreno JCD, Montiani-Ferreira F. A morphometric study of the canine skull and periorbita and its implications for regional ocular anesthesia. Vet Ophthalmol 2018;21(1):19-26.
  35. Greco A, Costanza D, Senatore A. A computed tomography-based method for the assessment of canine retrobulbar cone volume for ophthalmic anaesthesia. Vet Anaesth Analg 2021;48(5):759-766.
  36. Parviainen A, Trim C. Complications associated with anaesthesia for ocular surgery: a retrospective study 1989-1996. Equine Vet J 2000;32(6):555-559.
  37. Ploog CL, Swinger RL, Spade J, Quandt KM, Mitchell MA. Use of lidocaine-bupivacaine-infused absorbable gelatin hemostatic sponges versus lidocaine-bupivacaine retrobulbar injections for postoperative analgesia following eye enucleation in dogs. J Am Vet Med Assoc 2014;244(1):57-62.
  38. Chow DW, Wong MY, Westermeyer HD. Comparison of two bupivacaine delivery methods to control postoperative pain after enucleation in dogs. Vet Ophthalmol 2015;18(5):422-428.
  39. Zibura AE, Posner LP, Ru H, Westermeyer HD. A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation. Vet Ophthalmol 2020;23(2):225-233.
  40. Myrna KE, Bentley E, Smith LJ. Effectiveness of injection of local anesthetic into the retrobulbar space for postoperative analgesia following eye enucleation in dogs. J Am Vet Med Assoc 2010;237(2):174-177.

Citations

This article has been cited 2 times.
  1. Lardone E, Crasta M, Ostan PC, Gherlinzoni P, Landi A, Franci P. Blind supratemporal retrobulbar block in cats: a feasibility cadaveric study and its efficacy in a group of subjects undergoing corneal or intraocular surgery. Front Vet Sci 2024;11:1478732.
    doi: 10.3389/fvets.2024.1478732pubmed: 39649681google scholar: lookup
  2. El-Sherif MW, Nazih MA. A novel extraoral ultrasound-guided approach for mandibular nerve block in Rahmani sheep. BMC Vet Res 2024 Feb 24;20(1):74.
    doi: 10.1186/s12917-024-03924-0pubmed: 38402395google scholar: lookup
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