In-plane ultrasound-guided peribulbar block in the dog: an anatomical cadaver study

Abstract

Objective: To describe a novel in-plane ultrasound (U/S)-guided temporal approach to peribulbar block in dogs.

Study design: Prospective experimental cadaver study.

Animals: A group of 10 Beagle cadavers.

Methods: After describing the U/S anatomy, peribulbar injection was performed bilaterally in 10 thawed Beagle cadavers by two randomly assigned operators. A 5-8 MHz microconvex U/S probe was positioned caudal to the orbital ligament in the longitudinal plane. Using an in-plane technique, methylene blue dye was injected in five dogs (10 eyes total), while methylene blue dye and iohexol contrast mixture (50:50) were injected in the remaining five dogs. Injection volume was 0.2 mL cm^-1 of cranial length. A computed tomography (CT) scan was performed on dogs injected with dye and contrast to identify spread of contrast. Dissection to visualize dye spread in the orbit was performed in all dogs. Injection success was defined as spread of contrast into the peribulbar space. The pattern of distribution of contrast-dye was also assessed. Comparisons between operator and bilateral injections were assessed using a Student t test (p < 0.05). All other data are reported as number (n/N) and percentage (%).

Results: Peribulbar spread was noted in 19/20 injections (95%) on dissection. CT imaging (five dogs) illustrated peribulbar contrast spread in 9/10 injections (90%), with mixed peribulbar/retrobulbar spread for the remaining injection. Contrast was present at the rostral alar foramen in 4/10 (40%) injections, orbital fissure in 5/10 (50%), oval foramen in 1/10 (10%), maxillary nerve in 3/10 (30%) and intracranial in 5/10 (50%). Coverage of the maxillary nerve was noted on 3/20 (15%) injections on dissection. No further dye spread was noted.

Conclusions and clinical relevance: This technique demonstrated peribulbar spread of injectate in 100% of injections for the 10 canine cadavers studied. Further studies are required to evaluate this technique clinically.

Keywords: locoregional; peribulbar; ultrasound.