Journal of Veterinary Science

The Korean Society of Veterinary Science (대한수의학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Leigh, Hannah (The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, The University of Edinburgh) ;
  • Gozalo-Marcilla, Miguel (The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, The University of Edinburgh) ;
  • Esteve, Vicente (Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities) ;
  • Bautista, Alvaro Jesus Gutierrez (Clinic for Small Animals, University of Veterinary Medicine) ;
  • Gimenez, Tamara Martin (Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities) ;
  • Viscasillas, Jaime (Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities)
  • Received : 2020.11.13
  • Accepted : 2021.01.26
  • Published : 2021.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

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 naive 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.

Keywords

References

  1. Johnston GM, Eastment JK, Wood J, Taylor PM. The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of Phases 1 and 2. Vet Anaesth Analg. 2002;29(4):159-170. https://doi.org/10.1046/j.1467-2995.2002.00106.x
  2. Valverde A. Balanced anesthesia and constant-rate infusions in horses. Vet Clin North Am Equine Pract. 2013;29(1):89-122. https://doi.org/10.1016/j.cveq.2012.11.004
  3. Schauvliege S, Cuypers C, Michielsen A, Gasthuys F, Gozalo-Marcilla M. How to score sedation and adjust the administration rate of sedatives in horses: a literature review and introduction of the Ghent Sedation Algorithm. Vet Anaesth Analg. 2019;46(1):4-13. https://doi.org/10.1016/j.vaa.2018.08.005
  4. Pollock PJ, Russell T, Hughes TK, Archer MR, Perkins JD. Transpalpebral eye enucleation in 40 standing horses. Vet Surg. 2008;37(3):306-309. https://doi.org/10.1111/j.1532-950X.2008.00382.x
  5. Levine JM, Levine GJ, Hoffman AG, Bratton G. Comparative anatomy of the horse, ox, and dog: the brain and associated vessels. Equine Compend Contin Educ Pract Vet. 2008;3:153-164.
  6. Stoppini R, Gilger BC. Equine ocular examination basic techniques. In: Gilger BC, editor. Equine Ophthalmology. 2nd ed. Saint Lous: W.B. Saunders. 2016, 28-29.
  7. Shilo-Benjamini Y, Pascoe PJ, Wisner ER, Kahane N, Kass PH, Maggs DJ. A comparison of retrobulbar and two peribulbar regional anesthetic techniques in dog cadavers. Vet Anaesth Analg. 2017;44(4):925-932. https://doi.org/10.1016/j.vaa.2017.02.009
  8. Viscasillas J, Everson R, Mapletoft EK, Dawson C. Ultrasound-guided posterior extraconal block in the dog: anatomical study in cadavers. Vet Anaesth Analg. 2019;46(2):246-250. https://doi.org/10.1016/j.vaa.2018.09.045
  9. Mahler S, Betti E, Guintard C. Evaluation of injectate distribution after ultrasound-guided peribulbar injections in canine cadavers. Vet Anaesth Analg. 2020;47(5):720-723. https://doi.org/10.1016/j.vaa.2020.04.013
  10. Ahn J, Jeong M, Lee E, Kim S, Park S, Park S, et al. Effects of peribulbar anesthesia (sub-Tenon injection of a local anesthetic) on akinesia of extraocular muscles, mydriasis, and intraoperative and postoperative analgesia in dogs undergoing phacoemulsification. Am J Vet Res. 2013;74(8):1126-1132. https://doi.org/10.2460/ajvr.74.8.1126
  11. Wagatsuma JT, Deschk M, Floriano BP, Ferreira JZ, Fioravanti H, Gasparello IF, et al. 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. https://doi.org/10.2460/ajvr.75.12.1040
  12. Shilo-Benjamini Y, Pascoe PJ, Maggs DJ, Pypendop BH, Johnson EG, Kass PH, et al. Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats. Am J Vet Res. 2014;75(12):1029-1039. https://doi.org/10.2460/ajvr.75.12.1029
  13. Ripart J, Lefrant JY, Prat-Pradal D, Vivien B, Eledjam JJde La Coussaye JE. Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections. Anesthesiology. 2001;94(1):56-62. https://doi.org/10.1097/00000542-200101000-00013
  14. Nouvellon E, Cuvillon P, Ripart J, Viel EJ. Anaesthesia for cataract surgery. Drugs Aging. 2010;27(1):21-38. https://doi.org/10.2165/11318590-000000000-00000
  15. Shilo-Benjamini Y. A review of ophthalmic local and regional anesthesia in dogs and cats. Vet Anaesth Analg. 2019;46(1):14-27. https://doi.org/10.1016/j.vaa.2018.10.004
  16. Campoy L, Read MR. Small Animal Regional Anesthesia and Analgesia. 1st ed. Ames: Wiley Blackwell; 2013.
  17. O'Neill HD, Garcia-Pereira FL, Mohankumar PS. Ultrasound-guided injection of the maxillary nerve in the horse. Equine Vet J. 2014;46(2):180-184. https://doi.org/10.1111/evj.12106
  18. Campoy L, Morris TB, Ducharme NG, Gleed RD, Martin-Flores M. Unilateral cervical plexus block for prosthetic laryngoplasty in the standing horse. Equine Vet J. 2018;50(6):727-732. https://doi.org/10.1111/evj.12956
  19. Kuls N, Trujanovic R, Otero PE, Larenza-Menzies MP. Ultrasound-guided transversus abdominis plane block in Shetland ponies: a description of a three-point injection technique and evaluation of potential analgesic effects. J Equine Vet Sci. 2020;90:102994. https://doi.org/10.1016/j.jevs.2020.102994
  20. Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev. 2015;(9):CD006459.
  21. 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. https://doi.org/10.1111/j.1467-2995.2012.00780.x
  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. https://doi.org/10.1016/j.vaa.2017.09.039
  23. Dyce KM, Sack WO, Wensing CJ. Textbook of Veterinary Anatomy. 3rd ed. Ames: W.B. Saunders; 2002.
  24. Hermans H, Veraa S, Wolschrijn CF, Van Loon JP. Local anaesthetic techniques for the equine head, towards guided techniques and new applications. Equine Vet Educ. 2019;31(8):432-440. https://doi.org/10.1111/eve.12757
  25. Ropo A, Nikki P, Ruusuvaara P, Kivisaari L. Comparison of retrobulbar and periocular injections of lignocaine by computerised tomography. Br J Ophthalmol. 1991;75(7):417-420. https://doi.org/10.1136/bjo.75.7.417
  26. Martin-Flores M. Neuromuscular blocking agents and monitoring in the equine patient. Vet Clin North Am Equine Pract. 2013;29(1):131-154. https://doi.org/10.1016/j.cveq.2012.11.010