{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:09:41Z","timestamp":1760242181339,"version":"build-2065373602"},"reference-count":16,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,4,18]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Ophthalmic eye blocks, such as retrobulbar, peribulbar and sub-Tenon\u2019s, are traditionally conducted \u201cblind\u201d. Complications are rare but potentially devastating. Life-threatening complications include brain stem anesthesia and local anesthetic toxicity, whereas sight-threatening complications include globe perforation, optic nerve damage and ocular muscle damage. Ultrasound permits a view of orbital structures and can be used to guide needle placement. The ultrasound appearances of unintended local anesthetic injection into vital orbital structures have not been documented. This study aimed to record the ultrasound appearances of unintended injection locations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The spherical shape of the eyeballs of three soft-fix Thiel embalmed human cadavers were restored using glycerol. Iatrogenic injury in peribulbar block was then simulated through injection of printers\u2019 ink mixed with Thiel embalming fluid. Ultrasound was used to guide the needles and the tips were redirected to lie within the globe, lateral rectus and optic nerve. Ultrasound images were recorded during injection. The orbital cavities were then dissected via a superior approach to record the location and extent of injectate spread.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Real-time globe rupture, ocular muscle injection and optic nerve injection were visible using ultrasound. Characteristic appearances were identified in each case. Dissection confirmed needle and injection placement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The ultrasound appearance of block complications is important to document and should be an integral part of regional anesthesia training. This study is the first to provide such images for ophthalmic nerve blocks. It offers ophthalmic anesthetists and ophthalmologists the potential to diagnose severe complications rapidly and accurately with a potential impact on patient safety.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-101433","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T06:55:24Z","timestamp":1594882524000},"page":"740-743","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Ultrasound detection of iatrogenic injury during peribulbar eye block: a cadaveric study"],"prefix":"10.1136","volume":"45","author":[{"given":"Amy","family":"Sadler","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Ninewells Hospital, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graeme","family":"McLeod","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Ninewells Hospital, Dundee, UK"},{"name":"School of Medicine, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6061-7502","authenticated-orcid":false,"given":"Paul G","family":"McHardy","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracey","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,7,15]]},"reference":[{"key":"2025101110361437000_45.9.740.1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200407000-00023"},{"key":"2025101110361437000_45.9.740.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2006.106005"},{"key":"2025101110361437000_45.9.740.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(91)32262-0"},{"key":"2025101110361437000_45.9.740.4","doi-asserted-by":"publisher","DOI":"10.1159\/000090570"},{"key":"2025101110361437000_45.9.740.5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/00000542-200101000-00013","article-title":"Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections","volume":"94","author":"Ripart","year":"2001","journal-title":"Anesthesiology"},{"key":"2025101110361437000_45.9.740.6","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e31825541e8"},{"key":"2025101110361437000_45.9.740.7","article-title":"Peribulbar versus retrobulbar anaesthesia for cataract surgery","author":"Alhassan","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101110361437000_45.9.740.8","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200304000-00025"},{"key":"2025101110361437000_45.9.740.9","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/87.4.631"},{"key":"2025101110361437000_45.9.740.10","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen293"},{"key":"2025101110361437000_45.9.740.11","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000340"},{"key":"2025101110361437000_45.9.740.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0886-3350(99)80011-X"},{"key":"2025101110361437000_45.9.740.13","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1111\/anae.12976","article-title":"A randomised controlled trial of periconal eye blockade with or without ultrasound guidance","volume":"70","author":"Najman","year":"2015","journal-title":"Anaesthesia"},{"key":"2025101110361437000_45.9.740.14","doi-asserted-by":"publisher","DOI":"10.1002\/ca.22222"},{"key":"2025101110361437000_45.9.740.15","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2011.69"},{"key":"2025101110361437000_45.9.740.16","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev548"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2020-101433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:36:23Z","timestamp":1760204183000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2020-101433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,15]]},"references-count":16,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,8,20]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/rapm-2020-101433"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2020-101433","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"type":"print","value":"1098-7339"},{"type":"electronic","value":"1532-8651"}],"subject":[],"published":{"date-parts":[[2020,7,15]]}}}