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Williams et al: Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study
Veterinary Surgery 8, 2024

🔍 Key Findings

  • The addition of adrenaline (0.00198%) to bilateral maxillary nerve blocks significantly reduced intraoperative hemorrhage in dogs undergoing sharp staphylectomy (median reduction: 77.1%).
  • Normalized hemorrhage (g/kg) and total hemorrhage (g) were significantly lower in the adrenaline group (p = .021 and p = .013, respectively).
  • Surgeon-assessed hemorrhage scores were also significantly lower in the adrenaline group (median 2 vs. 3; p = .029), indicating improved surgical visibility.
  • No adverse effects (e.g. tachycardia, arrhythmia, or hypertension) were observed with adrenaline administration.
  • A standardized intraoral approach to the maxillary nerve block was used with 0.5 mL per side regardless of dog size.
  • Breed effect observed: English Bulldogs had higher normalized hemorrhage, possibly due to anatomical variation or underdosing relative to size.
  • Adrenaline may also prolong local anesthetic action and reduce blood aspiration risks, though this was not directly measured.
  • The study supports the routine inclusion of adrenaline in maxillary nerve blocks for staphylectomy in BOAS patients to improve surgical field and reduce bleeding.

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Williams et al: Evaluation of the addition of adrenaline in a bilateral maxillary nerve block to reduce hemorrhage in dogs undergoing sharp staphylectomy for brachycephalic obstructive airway syndrome. A prospective, randomized study
Veterinary Surgery 8, 2024

🔍 Key Findings

  • The addition of adrenaline (0.00198%) to bilateral maxillary nerve blocks significantly reduced intraoperative hemorrhage in dogs undergoing sharp staphylectomy (median reduction: 77.1%).
  • Normalized hemorrhage (g/kg) and total hemorrhage (g) were significantly lower in the adrenaline group (p = .021 and p = .013, respectively).
  • Surgeon-assessed hemorrhage scores were also significantly lower in the adrenaline group (median 2 vs. 3; p = .029), indicating improved surgical visibility.
  • No adverse effects (e.g. tachycardia, arrhythmia, or hypertension) were observed with adrenaline administration.
  • A standardized intraoral approach to the maxillary nerve block was used with 0.5 mL per side regardless of dog size.
  • Breed effect observed: English Bulldogs had higher normalized hemorrhage, possibly due to anatomical variation or underdosing relative to size.
  • Adrenaline may also prolong local anesthetic action and reduce blood aspiration risks, though this was not directly measured.
  • The study supports the routine inclusion of adrenaline in maxillary nerve blocks for staphylectomy in BOAS patients to improve surgical field and reduce bleeding.

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Multiple Choice Questions on this study

In Williams 2024 et al., on adrenaline use in maxillary nerve blocks, which breed showed significantly higher **normalized hemorrhage** despite adrenaline use?

A. Pug
B. French Bulldog
C. Boston Terrier
D. English Bulldog
E. Cavalier King Charles Spaniel

Answer: English Bulldog

Explanation: Even after adjusting for weight, English bulldogs bled more (p = .048).
In Williams 2024 et al., on adrenaline use in maxillary nerve blocks, which of the following best describes the difference in surgeon-assessed hemorrhage scores between groups?

A. Adrenaline group had a significantly higher score
B. No difference between groups
C. Adrenaline group had significantly lower scores
D. No dogs scored below 3 in either group
E. All dogs in no-adrenaline group had score 1

Answer: Adrenaline group had significantly lower scores

Explanation: Group A (adrenaline) had median score 2 vs. 3 in group NA; p = .029.
In Williams 2024 et al., on adrenaline use in maxillary nerve blocks, what adverse cardiovascular effects were observed due to adrenaline?

A. Tachycardia and hypertension
B. Tachypnea only
C. Bradycardia in English bulldogs
D. No significant adverse effects
E. Arrhythmia requiring rescue

Answer: No significant adverse effects

Explanation: No dogs developed tachycardia, arrhythmia, tachypnea, or hypertension.
In Williams 2024 et al., on adrenaline use in maxillary nerve blocks, what was the standard volume of local anesthetic injected per side during the block?

A. 0.25 mL per side
B. 0.5 mL per side
C. 1.0 mL per side
D. Volume adjusted to weight
E. 0.75 mL per side

Answer: 0.5 mL per side

Explanation: A fixed dose of 0.5 mL was used per side regardless of bodyweight.
In Williams 2024 et al., on adrenaline use in maxillary nerve blocks, what was the observed reduction in median intraoperative hemorrhage in the adrenaline group compared to the no-adrenaline group?

A. 25.0%
B. 42.3%
C. 59.9%
D. 77.1%
E. 89.5%

Answer: 77.1%

Explanation: Adrenaline reduced median hemorrhage from 7.95 g to 1.82 g, a 77.1% reduction.

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