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Development of a retrobulbar injection technique for ocular surgery and analgesia in dogs

Peter J. AccolaVeterinary Emergency Service, 1612 N High Point Rd, Ste 100, Middleton, WI 53562

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Ellison BentleyDepartment of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706-1102

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Lesley J. SmithDepartment of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706-1102

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Lisa J. ForrestDepartment of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706-1102

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Cheryl A. BaumelDepartment of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706-1102

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Christopher J. MurphyDepartment of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706-1102

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Abstract

Objective—To develop and compare 3 techniques for retrobulbar injection of local anesthetic agents for ocular surgery and analgesia in dogs.

Design—Prospective study.

Animals—17 dogs (including 9 cadavers).

Procedures—Inferior-temporal palpebral (ITP), perimandibular, and combined superior-inferior peribulbar injection techniques were compared by assessing the distribution of latex after injection into the orbits of 5 canine cadavers; magnetic resonance imaging (MRI) evaluation of the distribution of contrast agent after injection in the retrobulbar space of 4 canine cadavers; and assessment of the efficacy and MRI evaluation of the anatomic distribution of injections of a lidocainecontrast agent mixture in 4 anesthetized, nonrecovery dogs. By use of the preferred technique (ITP), the ocular effects of lidocaine anesthesia were evaluated in 4 dogs; during a 2-week period after treatment, dogs underwent ophthalmic examination, Schirmer tear testing (STT), intraocular pressure (IOP) measurement, and Cochet–Bonnet esthesiometry.

Results—Of the 3 techniques, the ITP technique was the preferred method for retrobulbar administration of anesthetic agent in dogs because it was efficacious (pupil dilation and central rotation of the globe achieved in all eyes), easiest to perform, and provided thorough coverage of the intraconal retrobulbar space without complication. During the 2-week follow-up period, the ITP injection did not significantly affect STT, IOP, or Cochet-Bonnet esthesiometry values in dogs.

Conclusions and Clinical Relevance—In dogs, retrobulbar administration of anesthetic agents via the ITP technique is a potential alternative to systemic administration of neuromuscular blocking agents for ophthalmic surgery and provides the additional benefit of local ocular analgesia.

Abstract

Objective—To develop and compare 3 techniques for retrobulbar injection of local anesthetic agents for ocular surgery and analgesia in dogs.

Design—Prospective study.

Animals—17 dogs (including 9 cadavers).

Procedures—Inferior-temporal palpebral (ITP), perimandibular, and combined superior-inferior peribulbar injection techniques were compared by assessing the distribution of latex after injection into the orbits of 5 canine cadavers; magnetic resonance imaging (MRI) evaluation of the distribution of contrast agent after injection in the retrobulbar space of 4 canine cadavers; and assessment of the efficacy and MRI evaluation of the anatomic distribution of injections of a lidocainecontrast agent mixture in 4 anesthetized, nonrecovery dogs. By use of the preferred technique (ITP), the ocular effects of lidocaine anesthesia were evaluated in 4 dogs; during a 2-week period after treatment, dogs underwent ophthalmic examination, Schirmer tear testing (STT), intraocular pressure (IOP) measurement, and Cochet–Bonnet esthesiometry.

Results—Of the 3 techniques, the ITP technique was the preferred method for retrobulbar administration of anesthetic agent in dogs because it was efficacious (pupil dilation and central rotation of the globe achieved in all eyes), easiest to perform, and provided thorough coverage of the intraconal retrobulbar space without complication. During the 2-week follow-up period, the ITP injection did not significantly affect STT, IOP, or Cochet-Bonnet esthesiometry values in dogs.

Conclusions and Clinical Relevance—In dogs, retrobulbar administration of anesthetic agents via the ITP technique is a potential alternative to systemic administration of neuromuscular blocking agents for ophthalmic surgery and provides the additional benefit of local ocular analgesia.

Contributor Notes

The authors thank Drs. Richard Dubielzig and Laura Goodman for image acquisition.

Address correspondence to Dr. Bentley.