Evaluation of injectate distribution after ultrasound-guided peribulbar injections in canine cadavers

Comparison between Ultrasonographic-Guided Temporal and Coronoid Approaches for Trigeminal Nerve Block in Dogs: A Cadaveric Study

The trigeminal nerve is responsible for innervating the periorbita. Ultrasound-guided trigeminal block is employed in humans for trigeminal neuralgia or periorbital surgery. There are no studies evaluating this block in dogs. This study aims to evaluate and compare two approaches (coronoid and temporal) of the trigeminal nerve block. We hypothesised superior staining with the coronoid approach. Thirteen dog heads were used. After a preliminary anatomical study, two ultrasound-guided injections per head (right and left, coronoid and temporal approach, randomly assigned), with an injectate volume of 0.15 mL cm-1 of cranial length, were performed (iodinated contrast and tissue dye mixture). The ultrasound probe was placed over the temporal region, visualising the pterygopalatine fossa. For the temporal approach, the needle was advanced from the medial aspect of the temporal region in a dorsoventral direction. For the coronoid approach, it was advanced ventral to the zygomatic arch in a lateromedial direction. CT scans and dissections were conducted to assess and compare the position of the needle, the spread of the injectate, and nerve staining. No significant differences were found. Both approaches demonstrated the effective interfascial distribution of the injectate, with some minimal intracranial spread. Although the coronoid approach did not yield superior staining as hypothesised, it presents a viable alternative to the temporal approach. Studies in live animals are warranted to evaluate clinical efficacy and safety.

Comparison of a blind and an ultrasound-guided technique for Retrobulbar anesthesia in dogs undergoing unilateral subconjunctival enucleation

OBJECTIVE

This study compared the quality of retrobulbar anesthesia using a blind inferior-temporal palpebral approach (ITP) with an ultrasound-guided supratemporal (ST) technique in dogs undergoing unilateral enucleation.

ANIMAL STUDIED

Twenty-one client-owned dogs were undergoing enucleation.

PROCEDURES

Dogs were randomly assigned to receive ITP (n = 10) or ST (n = 11) with 0.5% ropivacaine at 0.1 mL/cm of neurocranial length. The anesthetist was blinded to the technique. Intraoperative data included cardiopulmonary variables, inhalant anesthetics requirement, and requirement for rescue analgesia (intravenous fentanyl 2.5 mcg/kg). Postoperative data included pain scores, sedation scores, and need for intravenous hydromorphone (0.05 mg/kg). Treatments were compared using Wilcoxon's rank sum test or Fisher's exact test as appropriate. Comparison of variables over time were tested using a mixed effect linear model on rank. Significance was set at p = 0.05.

RESULTS

Intraoperative cardiopulmonary variables and inhalant requirements were not different between groups. Dogs receiving ITP required median (interquartile range, IQR) 1.25 (0, 2.5) mcg/kg intraoperative fentanyl while those receiving ST required none (p < 0.01). Intraoperative fentanyl was required in 5/10 and 0/11 of dogs in the ITP and ST groups, respectively (p = 0.01). Postoperative analgesia requirements were not significantly different between groups; 2/10 and 1/10 dogs in the ITP and ST groups, respectively. Sedation score negatively affected pain score (p < 0.01).

CONCLUSIONS

The ultrasound-guided ST technique was more effective at decreasing intraoperative opioid requirements than the blind ITP approach in dogs undergoing unilateral enucleation.

Description of a novel ultrasound guided peribulbar block in horses: a cadaveric study

BACKGROUND

Standing surgery in horses combining intravenous sedatives, analgesics and local anaesthesia is becoming more popular. Ultrasound guided (USG) peribulbar nerve block (PB) has been described in dogs and humans for facial and ocular surgery, reducing the risk of complications versus retrobulbar nerve block (RB).

OBJECTIVE

To describe a technique for USG PB in horse cadavers.

METHODS

Landmarks and PB technique were described in two equine cadaver heads (Phase 1), with computed tomography (CT) imaging confirming contrast location and spread. In Phase 2, ten equine cadaver heads were randomised to two operators naïve to the USG PB, with moderate experience with ultrasonography and conventional "blind" RB. Both techniques were demonstrated once. Subsequently, operators performed five USG PB and five RB each, unassisted. Contrast location and spread were evaluated by CT. Injection site success was defined for USG PB as extraconal contrast, and for RB intraconal contrast.

RESULTS

Success was 10/10 for USG PB and 0/10 for RB (p < 0.001). Of the RB injections, eight resulted in extraconal contrast and two in the masseter muscle (p = 0.47).

CONCLUSIONS

The USG PB had a high injection site success rate compared with the RB technique; however, we cannot comment on clinical effect. The USG technique was easily learnt, and no potential complications were seen. The USG PB nerve block could have a wide application for use in horses for ocular surgeries (enucleations, eyelid, corneal, cataract surgeries, and ocular analgesia) due to reduced risk of iatrogenic damage. Further clinical studies are needed.

Cadaveric Evaluation of Injectate Distribution for Two Maxillary Nerve Block Techniques in Cats

Regional nerve blocks have been shown to decrease general anesthetic drug requirements and improve pain management in patients undergoing surgery. Regional nerve blocks are used routinely in patients undergoing oral surgery, such as dental extractions. There is little published information regarding the efficacy of feline maxillary and infraorbital nerve blocks. The goal of the study was to compare injectate distributions of the infraorbital foramen and percutaneous maxillary nerve block techniques in feline cadavers using a combined dye and radiopaque contrast media solution to simulate an injection. There was no significant difference in length of stained nerve between the two different techniques. It was not necessary to advance the needle into the infraorbital canal to achieve effective staining of the maxillary nerve. There was no significant difference in injectate distribution between two different injectate volumes, 0.2 and 0.4 ml, indicating that the smaller volume injected at the infraorbital foramen resulted in adequate nerve staining.