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Irving W, Annear M, Whittaker C, Caruso K, Reynolds B, McCarthy P, Smith J. Effect of dexmedetomidine added to retrobulbar blockade with lignocaine and bupivacaine in dogs undergoing enucleation surgery. Vet Ophthalmol 2024; 27:148-157. [PMID: 37418492 DOI: 10.1111/vop.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To investigate the effect of the addition of dexmedetomidine (BLD) to retrobulbar blockade with combined lignocaine and bupivacaine on nociception. ANIMALS A total of 17 eyes from 15 dogs. METHODS Prospective, randomized, masked clinical comparison study. Dogs undergoing unilateral enucleation were randomly assigned into two groups; a retrobulbar administration of lignocaine and bupivacaine in a 1:2 volume ratio combined with either BLD or 0.9% saline (BLS). The total volume of the intraconal injection was calculated at 0.1 mL/cm cranial length. Intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2 ) arterial blood pressure (BP), and inspired isoflurane concentration (ISOinsp). Pain scores, heart rate and RR were recorded postoperatively. RESULTS Dogs receiving BLD (n = 8) had significantly lower intraoperative RR (p = 0.007), and significantly lower ISOinsp (p = 0.037) than dogs in the BLS group (n = 9). Postoperatively heart rate was significantly lower in the BLD group at 1 min (p = 0.025) and 1 h (p = 0.022). There were no other significant differences in intraoperative or postoperative parameters, or in postoperative pain scores (p = 0.354). Dogs receiving BLD had a higher rate of anesthetic events of bradycardia and hypertension (p = 0.027). Analgesic rescue was not needed in either group. CONCLUSIONS The addition of BLD to retrobulbar anesthesia did not result in a detectable difference in pain scores relative to blockade with lignocaine and bupivacaine alone. Dogs receiving retrobulbar BLD had a significantly lower intraoperative RR and isoflurane requirement and an increased incidence of intraoperative bradycardia and hypertension.
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Affiliation(s)
- William Irving
- Eye Clinic for Animals, Sydney, New South Wales, Australia
| | - Matthew Annear
- Eye Clinic for Animals, Sydney, New South Wales, Australia
| | | | - Kelly Caruso
- Eye Clinic for Animals, Sydney, New South Wales, Australia
| | | | - Paul McCarthy
- Eye Clinic for Animals, Sydney, New South Wales, Australia
| | - Jeff Smith
- Eye Clinic for Animals, Sydney, New South Wales, Australia
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Briley JD, Washington D, Westermeyer HD, Posner LP, Chiavaccini L. Comparison of a blind and an ultrasound-guided technique for Retrobulbar anesthesia in dogs undergoing unilateral subconjunctival enucleation. Vet Ophthalmol 2024; 27:79-85. [PMID: 37021439 DOI: 10.1111/vop.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
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.
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Affiliation(s)
- Jessica D Briley
- Department of Molecular Biomedical Sciences, Anesthesiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Hans D Westermeyer
- Department of Clinical Sciences, Comparative Ophthalmology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Lysa P Posner
- Department of Molecular Biomedical Sciences, Anesthesiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic and Population Medicine, Anesthesiology, College of Veterinary Medicine, University of Florida, Florida, Gainesville, USA
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Citarella G, Corona D, Parsons E, Giannikaki S, Rioja E. The Outcomes of an Opioid-Free Anaesthetic Plan in Fourteen Dogs Undergoing Enucleation Using an Ultrasound-Guided Supra-Temporal Retrobulbar Block: A Retrospective Case Series. Animals (Basel) 2023; 13:2059. [PMID: 37443857 DOI: 10.3390/ani13132059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The objective of this retrospective case series is to report the outcomes of an opioid-free anesthetic plan in dogs undergoing enucleation surgery. A total of 14 dogs were admitted for enucleation between March and December 2020. A multimodal approach to perioperative analgesia was used, with a focus on retrobulbar anesthesia. A combination of an ultrasound-guided retrobulbblock with a supratemporal approach in association with ketamine, dexmedetomidine and non-steroidal anti-inflammatory drugs was used in the reported cases. Intraoperative nociception was defined as an increase of 20% from the baseline in one or more of the following parameters: heart rate, respiratory rate or mean arterial pressure. An ultrasound-guided retrobulbar block in an opioid-free anesthesia regime was effective at managing the perioperative analgesia of 13 out of 14 dogs. In only one case, a bolus of fentanyl was administered to treat intraoperative nociception. Recovery was uneventful in all the dogs, and the postoperative pain scores remained below the intervention threshold at all time points. To the authors' knowledge, this is the first reported case series of opioid-free anesthesia for enucleation in dogs.
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Affiliation(s)
- Gerardo Citarella
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Daniele Corona
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | | | | | - Eva Rioja
- Optivet Referrals, Ltd., Havant, PO9 2NJ, UK
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Greco A, Costanza D, Senatore A, Bruzzese D, Micieli F, Chiavaccini L, Di Giancamillo M, Della Valle G, Vesce G, Brunetti A, Meomartino L. A computed tomography-based method for the assessment of canine retrobulbar cone volume for ophthalmic anaesthesia. Vet Anaesth Analg 2021; 48:759-766. [PMID: 34391668 DOI: 10.1016/j.vaa.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/01/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a comprehensive formula for calculating the volume of local anaesthetic solution used for retrobulbar anaesthesia in dogs with different skull morphologies. STUDY DESIGN Retrospective cohort imaging study. ANIMALS Skull computed tomography (CT) images of 188 dogs of different breeds collected between January 2009 and December 2017. METHODS Anatomical integrity of the orbit and adjacent structures, presenting complaint, clinical signs and CT findings were verified to exclude ocular abnormalities. The volume of the retrobulbar cone of 376 eyes was calculated using CT scans of the dogs' skulls. Additional data recorded included morphology of the skull, body weight, sex and size of the dogs, all of which were matched for possible association to the retrobulbar cone volume through univariable and multivariable linear regression models. Results of linear regression models were expressed as estimated beta coefficients with the corresponding 95% confidence intervals (95% CIs). RESULTS Using univariate analysis, the retrobulbar cone volume was positively associated with weight and male sex. In addition, brachycephalic and dolichocephalic dogs showed a larger retrobulbar cone volume than mesocephalic dogs, while sex was no longer significantly associated with the retrobulbar cone volume. In multivariate analysis, when considering all variables in the model, weight emerged as the strongest predictor (beta coefficient: 0.062 mL kg-1, 95% CI: 0.056-0.067 mL kg-1, p < 0.001). CONCLUSIONS and clinical relevance In the veterinary literature, there is no agreement on the precise volume of local anaesthetic solution that should be used to achieve intraconal retrobulbar anaesthesia in dogs. Here we suggest a formula to calculate the retrobulbar cone volume and, accordingly, the injection volume of local anaesthetic solution for effective retrobulbar anaesthesia.
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Affiliation(s)
- Adelaide Greco
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy; Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy.
| | - Dario Costanza
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy
| | - Andrea Senatore
- Centro Intedipartimentale di Ricerca sui Biomateriali, Università degli Studi di Napoli 'Federico II', Naples, Italy
| | - Dario Bruzzese
- Dipartimento di Sanità Pubblica, Università di Napoli 'Federico II', Naples, Italy
| | - Fabiana Micieli
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Ludovica Chiavaccini
- Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Della Valle
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Giancarlo Vesce
- Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli 'Federico II', Naples, Italy
| | - Leonardo Meomartino
- Centro Interdipartimentale di Radiologia Veterinaria, Università di Napoli 'Federico II', Naples, Italy; Dipartimento di Medicina Veterinaria e Produzioni animali, Università di Napoli 'Federico II', Naples, Italy
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Scott EM, Vallone LV, Olson NL, Han G, Loria Lepiz MA, Simon BT. Analgesic effects of a retrobulbar block with 0.75% ropivacaine in dogs undergoing enucleation. Vet Anaesth Analg 2021; 48:749-758. [PMID: 34144876 DOI: 10.1016/j.vaa.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the analgesic effects of a retrobulbar block with ropivacaine in dogs undergoing enucleation. STUDY DESIGN Prospective, randomized, masked placebo-controlled trial. ANIMALS A total of 23 client-owned dogs. METHODS Dogs were randomized to be administered a preoperative inferior-temporal palpebral retrobulbar injection of either ropivacaine 0.75% (1 mL 10 kg-1; group RG) or equivalent volume of 0.9% saline (control; group CG). Intraoperative variables recorded to detect a response to noxious stimuli included heart rate (HR) and mean arterial pressure (MAP). Three observers assessed and recorded pain using a numerical rating pain scale and visual analog scale (VAS) before anesthesia (baseline) and postoperatively at 0, 0.5, 1, 2, 3, 4, 5, 6 and 24 hours after extubation. Rescue analgesia was administered if intraoperative HR or MAP increased by ≥ 20% from the previously recorded surgical time point, average postoperative pain scores totaled ≥ 9/20, scored ≥ 3/4 in any one category with VAS ≥ 35/100, or if VAS was ≥ 35/100 with a palpation score > 0/4. RESULTS Intraoperatively, there was no significant difference in HR or MAP between groups. Rescue analgesia was administered intraoperatively to four and one dogs and postoperatively to five and seven dogs in groups CG and RG, respectively, with no significant difference between groups. VAS scores were significantly lower in ropivacaine dogs at extubation (p = 0.02), but not at other postoperative time points. Adverse events were not observed in either group. CONCLUSIONS AND CLINICAL RELEVANCE Preoperative retrobulbar 0.75% ropivacaine injection (1 mL 10 kg-1) provided analgesia in dogs following enucleation at extubation; however, intraoperative and postoperative pain control did not differ from a placebo injection with saline. Lack of differences between groups may have been influenced by sample size limitations.
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Affiliation(s)
- Erin M Scott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - Lucien V Vallone
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Natalie L Olson
- Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Gang Han
- Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Mauricio A Loria Lepiz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Bradley T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
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Vézina-Audette R. Anesthesia Case of the Month. J Am Vet Med Assoc 2020; 256:176-178. [PMID: 31910081 DOI: 10.2460/javma.256.2.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bartholomew KJ, Smith LJ, Bentley E, Lasarev MR. Retrospective analysis of complications associated with retrobulbar bupivacaine in dogs undergoing enucleation surgery. Vet Anaesth Analg 2020; 47:588-594. [PMID: 32653165 DOI: 10.1016/j.vaa.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate complications associated with, and without, bupivacaine retrobulbar local anesthesia in dogs undergoing unilateral enucleation surgery. STUDY DESIGN Retrospective, observational study. ANIMALS A total of 167 dogs underwent unilateral enucleation surgery via a transpalpebral approach. METHODS Records from 167 dogs that underwent unilateral enucleation surgery that did (RB) or did not (NB) include retrobulbar bupivacaine anesthesia were reviewed, including anesthetic record, daily physical examination records, surgery report, patient discharge report and patient notes within 14 days of the surgery. Specific complications and severity were compared between RB and NB using the Wilcoxon rank-sum test. A 'complication burden' (0-5) comprising five prespecified complications was assigned and tested using rank-sum procedures. Statistical significance was set to 0.05. RESULTS Group RB included 97 dogs and group NB 70 dogs. Dogs in NB had a 17.0 percentage points (points) greater risk for a postoperative recovery complication (38.6% versus 21.6%; 95% confidence interval: 3.0-30.6 points; p = 0.017). There was inconclusive evidence that dogs in group RB had a lower risk of requiring perioperative anticholinergic administration (12.4% versus 22.9%; 10.5 points; p = 0.073). Other complications were similar between groups RB and NB with risks that differed by <10 points. The risk of hemorrhage was similar between groups RB (22.7%) and NB (20.0%) with no significant difference in the level of severity (p = 0.664). CONCLUSIONS AND CLINICAL RELEVANCE In this retrospective study, the use of retrobulbar bupivacaine for enucleation surgery in dogs was not associated with an increased risk of major or minor complications.
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Affiliation(s)
- Kyle J Bartholomew
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Lesley J Smith
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, USA.
| | - Ellison Bentley
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin - Madison, Madison, WI, USA
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