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Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Yael Shilo-Benjamini DVM1, Peter J. Pascoe BVSc2, David J. Maggs BVSc3, Bruno H. Pypendop DrMedVet, DrVetSci4, Eric G. Johnson DVM5, Philip H. Kass DVM, MPVM, PhD6, and Erik R. Wisner DVM7
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  • 1 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 2 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 3 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 4 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 5 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 6 Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 7 Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Abstract

Objective—To compare effectiveness and complications associated with peribulbar and retrobulbar anesthesia with bupivacaine in cats.

Animals—6 healthy adult cats.

Procedures—Cats were sedated with dexmedetomidine and received a peribulbar injection of 0.5% bupivacaine (1.5 mL), iopamidol (0.5 mL), and saline (0.9% NaCl) solution (1 mL) or retrobulbar injection of 0.5% bupivacaine (0.75 mL) and iopamidol (0.25 mL) in a crossover study with ≥ 2 weeks between treatments. The contralateral eye was the control. Injectate distribution was evaluated with CT. After atipamezole administration, periocular and corneal sensations, intraocular pressure (IOP), and ocular reflexes and appearance were evaluated for 24 hours.

Results—All peribulbar and 3 of 6 retrobulbar injections resulted in CT evidence of intraconal injectate. Corneal sensation and periocular skin sensation were absent or significantly reduced relative to that for control eyes for 3 hours after peribulbar injection. Mean ± SD IOP immediately after injection was significantly higher for eyes with peribulbar injections (33 ± 12 mm Hg) than for control eyes or eyes with retrobulbar injections (both 14 ± 4 mm Hg) but 10 minutes later decreased to 18 ± 3 mm Hg. Exophthalmos, chemosis, and ptosis were evident in most injected eyes, and irritation was evident in 3 of 6 peribulbar-injected and 1 of 6 retrobulbar-injected eyes. All conditions resolved within 14 hours.

Conclusions and Clinical Relevance—Peribulbar injection resulted in intraconal deposition of bupivicaine in a higher percentage of cats than did retrobulbar injection and induced notable anesthesia relative to that for the control eye; however, IOP increased temporarily.

Contributor Notes

Dr. Shilo-Benjamini's present address is Anesthesia Department, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot 7610001, Israel.

Presented in abstract form at the Annual Meeting of the American College of Veterinary Anesthesia and Analgesia, 19th International Veterinary Emergency and Critical Care Symposium, San Diego, September 2013.

The authors thank Georgina Newbold, Rich Larson, Jason Peters, and Jennifer Harrison for technical assistance.

Address correspondence to Dr Shilo-Benjamini (shilo.yael@gmail.com).