Abstract
Objective
The aim of this preliminary proof-of-concept study was to evaluate and compare the
success and complication rate of infiltration of the maxillary nerve of cadaver heads
using previously described surface landmarks, standard ultrasound and a novel needle
guidance positioning ultrasound system (SonixGPS).
Study design
Prospective, anatomical, method-comparison study.
Animals
Thirty-eight equine cadaver heads.
Methods
Twenty-six veterinary students performed the three methods consecutively on cadaver
heads using an 18 gauge, 8.9 cm spinal needle and 0.5 mL iodinated contrast medium.
Computed tomography was used to quantify success (deposition of contrast in contact
with the maxillary nerve) and complication rate (contrast identified within surrounding
vasculature or periorbital structures) associated with each method.
Results
Perineural injection of the maxillary nerve was attempted 76 times, with an overall
success rate of 65.8% (50/76) and complication rate of 53.9% (41/76). Success rates
were 50% (13/26) with surface landmark, 65.4% (17/26) with standard ultrasound guidance
and 83.3% (20/24) with SonixGPS guidance approaches (Fisher's exact test, p=0.046). No significant difference in complication rate was found between the three
methods.
Conclusions
Ultrasound-guided maxillary nerve blocks were significantly more successful than surface
landmark approaches when performed by inexperienced operators, and the highest success
rate was achieved with guidance positioning system (GPS) needle guidance.
Clinical relevance
Local anaesthesia of the equine maxillary nerve in the fossa pterygopalatina is frequently
used for diagnostic and surgical procedures in the standing sedated horse. Due to
vague superficial landmarks with various approaches and the need for experience via
ultrasound guidance, this block remains challenging. GPS guidance may improve reliability
of maxillary and other nerve blocks, and allow a smaller volume of local anaesthetic
solution to be used, thereby improving specificity and reducing the potential for
side effects.
Keywords
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References
- Regional anaesthesia of the equine head and body.in: Proceedings of the ACVS Equine and Small Animal Symposium. 2011: 580-584
- A cadaver study comparing two approaches to perform a maxillary nerve block in the horse.Equine Vet J. 2010; 42: 721-725
- Assessment of a real time ultrasound guided spinal technique using SonixGPS in human cadavers.Can J Anaesth. 2012; 59: 1156-1157
- Peripheral nerve damage and regional anaesthesia.Br J Anaesth. 1992; 69: 429-430
- Confidential enquiry of perioperative equine fatalities (CEPEF-1): preliminary results.Equine Vet J. 1995; 27: 193-200
- Ultrasound guided thoracic paravertebral block using the SonixGPS system in human cadavers.Can J Anaesth. 2013; 60: 331-332
- A retrospective study of mortality associated with general anaesthesia in horses: elective procedures.Vet Rec. 1998; 142: 275-276
- Headshaking in horses: possible aetiopathogenesis suggested by the results of diagnostic tests and several treatment regimes used in 20 cases.Equine Vet J. 2000; 32: 208-216
- Complications of local anaesthesia for ophthalmic surgery.Br J Anaesth. 1995; 75: 93-96
- Ultrasound-guided injection of the maxillary nerve in the horse.Equine Vet J. 2014; 46: 180-184
- Comparison of the retrobulbar and Peterson nerve block techniques via magnetic resonance imaging in bovine cadavers.J Am Vet Med Assoc. 2003; 223: 852-855
- Surgery of the paranasal sinuses performed with the horse standing.Clin Tech Equine Pract. 2005; 4: 188-194
- Local anaesthesia for dental and maxillofacial surgery in equines.in: European Veterinary Conference Voorjaarsdagen; 2013. 2013
- Characterizing novice behaviour associated with learning ultrasound-guided peripheral regional anesthesia.Reg Anesth Pain Med. 2007; 32: 107-115
- Simulation of local anaesthetic nerve block of the infraorbital nerve within the pterygopalatine fossa: anatomical landmarks defined by computed tomography.Res Vet Sci. 2008; 85: 399-406
- SonixGPS needle tracking system for out-of-plane brachial plexus block in human cadavers.Acta Anaesthesiol Scan. 2013; 57: 398-399
- SonixGPS—the role of operator experience.Anaesthesia. 2014; 69: 1060-1061
- Ultrasound-guided needle handling using a guidance positioning system in a phantom.Anaesthesia. 2014; 69: 24-31
- Local analgesic techniques for the equine head.Equine Vet Educ. 2007; 19: 495-503
- An ultrasound needle insertion guide in a porcine phantom model.Anaesthesia. 2013; 68: 826-829
- Validation of the accuracy of needle placement as used in diagnostic local analgesia of the maxillary nerve for investigation of trigeminally mediated headshaking in horses.Vet Rec. 2015; 176: 148
- Factors influencing the outcome of equine anaesthesia: a review of 1,314 cases.Equine Vet J. 1993; 25: 147-151
Article info
Publication history
Published online: June 16, 2017
Accepted:
September 15,
2016
Received:
June 15,
2016
Identification
Copyright
© 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
