Globe penetration in a cat following maxillary nerve block for dental surgery

Perry, Rachel; Moore, Denise; Scurrell, Emma

doi:10.1177/1098612x14560101

Cited by 32 publications

(22 citation statements)

References 32 publications

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“…This finding may have resulted from inadequate technique and deposition of methylene blue dye in close proximity to the eye globe or migration of dye from the place of injection. Other macroscopically observed events reported in previous studies, such as intraneural or intravascular injection and damage to the peribulbar tissue, were not evidenced in the present study (GROSS et al, 2000;PERRY et al, 2015). However, such complications might be difficult to observe in a cadaver study if histopathology or MRI was not performed.…”

Section: Veterinarian Sbz Iocontrasting

confidence: 58%

“…There are several local anesthetic techniques described in dogs and cats with the aim of providing analgesia for specific regions of the head, including the oral cavity (FUTEMA et al, 2002;BARDELL et al, 2010;VISCASILLAS et al, 2013). Maxillary nerve is a branch of the trigeminal, which provides sensory information to the skin of the upper lips and nostrils, as well as the soft and hard palate, upper teeth, gingiva and maxilla (DELLMANN & MCCLURE, 2008;PERRY et al, 2015). Therefore, maxillary nerve blockade provides anesthesia for selected procedures such as rhinoscopy, maxillectomy and upper teeth extractions (CREMER et al, 2013).…”

Section: Clinic and Sugerymentioning

confidence: 99%

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Subzygomatic and infraorbital approaches for maxillary nerve blockade in cats’ cadaver

et al. 2018

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This study compared the accuracy of dye placement on the maxillary nerve by using the percutaneous subzigomatic (SBZ) and infraorbitary (IO) approaches in cats’ cadavers. A second aim was to compare the accuracy of dye placement on the maxillary nerve between different untrained anesthetists. This was a prospective, randomized, blinded study, performed in 40 heads obtained from feline cadavers. Three veterinarians (A, B and C) with no previous experience with the IO approach performed the experiments. The SBZ approach was randomly performed on one side of the head and the IO approach was performed in the contralateral side of the same head. For each approach, 0.2ml of 1% methylene blue dye was injected. Scores for length of nerve staining were as follows: 0 (failure), no staining; 1 (moderate), <6mm of nerve stained; and 2 (ideal), ≥6mm of nerve stained. Median scores (interquartile range) for the SBZ and IO approaches were 2.0 (0.3-2.0) and 1.0 (0.0-2.0), respectively. Scores for length of nerve staining were higher with the SBZ approach than the IO approach (P=0.016). Considering the scores for both the SBZ and IO approaches, there was a significant difference among the three veterinarians (P=0.002). Results of this study do not support the IO approach to perform a maxillary nerve block in cats. A greater accuracy of methylene blue dye placement was observed with the SBZ approach. A variable accuracy may exist between different veterinarians when performing a maxillary nerve block employing the SBZ and IO techniques in cats.

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Section: Veterinarian Sbz Iocontrasting

confidence: 58%

Section: Clinic and Sugerymentioning

confidence: 99%

Subzygomatic and infraorbital approaches for maxillary nerve blockade in cats’ cadaver

et al. 2018

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“…Furthermore, a cadaver study in dogs showed the infraorbital approach for the maxillary nerve block, using an intravenous catheter, to be more suitable and safer compared with the percutaneous approach 15. Also, ocular side effects have been reported after maxillary nerve block performed by the transcutaneous approach in dogs and cats 32 33. In the present report, the maxillary nerve block through the infraorbital canal seemed an easy and suitable regional anaesthesia technique for intraoperative pain management in lactating wallabies undergoing maxillary surgery, without any clinical side effects.…”

Section: Discussionmentioning

confidence: 54%

Maxillary nerve block as part of a multimodal anaesthesia in a lactating red‐necked wallaby (Macropus rufogriseus) undergoing partial maxillectomy

Rodrigo-Mocholí

Vlaminck

Gasthuys

et al. 2018

Vet Record Case Reports

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A partial maxillectomy was performed in a four-year-old, 12-kg lactating female red-necked wallaby or Bennett’s wallaby (Macropus rufogriseus) with a diagnosis of oral necrobacillosis or ‘lumpy jaw disease’. After intramuscular administration of dexmedetomidine and ketamine, anaesthesia was maintained with isoflurane in a mixture of oxygen and medical air. A maxillary nerve block was performed through the infraorbital canal with bupivacaine 0.5 per cent (0.2 ml/kg) to provide perioperative analgesia. Inhalant anaesthesia requirements gradually decreased during maintenance of anaesthesia. Oral tramadol was administered for postoperative pain management. During the following days, no behavioural or other signs of pain or discomfort were recorded. Physiological parameters stayed within reference values.

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“…Inadvertent ocular penetration with needles used to administer local anesthetic has been documented or suspected in a number of cats and dogs. [9][10][11] All previously reported cases have been linked with dentistry-associated caudal maxillary blocks, in which the anesthetic delivery device is inserted percutaneously or intraorally at the junction of the maxilla and zygomatic arch, caudal to the last maxillary molar.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic ocular trauma associated with infraorbital block performed for rhinoscopy in a cat: case report and preliminary imaging findings

Pumphrey

Reader

Rosenstein

et al. 2021

Journal of Feline Medicine and Surgery Open Reports

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Objectives This paper describes a case of endophthalmitis in a feline patient caused by globe penetration during an infraorbital block performed to provide analgesia during rhinoscopy, and presents additional imaging and dissection data demonstrating risk of iatrogenic ocular trauma during infraorbital blocks in cats when the infraorbital canal is entered. Methods Case records and accompanying histopathologic reports were reviewed for the feline patient. Separately, two feline cadavers were imaged using CT following placement of 5/8" 25 G needles or 1" 22 G over the needle catheters in the infraorbital canal. Infraorbital blocks with injection of trypan blue dye followed by dissection were performed in two further feline cadavers to assess the potential for globe penetration and to provide preliminary information regarding the potential efficacy of infraorbital blocks for analgesia during rhinoscopy. Results Clinical and histopathologic findings support inadvertent globe penetration during infraorbital block as the cause for endophthalmitis in the feline patient described. CT imaging and dye injection studies further demonstrate the risks involved with this local anesthetic technique in cats. Conclusions and relevance Further study is needed to assess the safety and efficacy of infraorbital blocks performed for rhinoscopy in cats. Catheters may be safer anesthetic delivery devices than needles. Extreme caution should be used when entering the infraorbital canal in cats.

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Globe penetration in a cat following maxillary nerve block for dental surgery

Abstract: Complications arising from veterinary dental regional anaesthesia appear to be rare; however, it may be that they are under-reported. This case report highlights the risks involved and reviews the safest and most efficacious regional anaesthesia technique for the feline maxilla.

Cited by 32 publications

References 32 publications

Subzygomatic and infraorbital approaches for maxillary nerve blockade in cats’ cadaver

Subzygomatic and infraorbital approaches for maxillary nerve blockade in cats’ cadaver

Maxillary nerve block as part of a multimodal anaesthesia in a lactating red‐necked wallaby (Macropus rufogriseus) undergoing partial maxillectomy

Iatrogenic ocular trauma associated with infraorbital block performed for rhinoscopy in a cat: case report and preliminary imaging findings

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