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Kim D, Shin D, Yun S, An G, Jung J, Son WG. Repeated bolus injections of bupivacaine for continuous bilateral transversus thoracis plane block undergoing median sternotomy in a dog: A case report. VET MED-CZECH 2024; 69:123-129. [PMID: 38751989 PMCID: PMC11093644 DOI: 10.17221/118/2023-vetmed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
An 8-year-old, 6.5 kg, neutered female Shih-Tzu dog was presented for surgical resection of a mediastinal mass. A median sternotomy and left cranial lung lobectomy were performed. Intraoperatively, with the patient under general anaesthesia, a bilateral transversus thoracis plane (TTP) block was performed by injecting 0.5% bupivacaine (0.2 ml/kg) per side using real-time ultrasound guidance. After surgery, indwelling catheters for repeated bolus injections of bupivacaine in TTP were placed as follows: the fifth sternebra was palpated in dorsal recumbency, and the transducer was placed in the longitudinal plane lateral to the sternal border. A 16 gauge over-the-needle catheter was inserted caudo-cranially using an in-plane technique and located in the TTP. An intermittent bolus of bupivacaine (0.1 ml/kg) per side was injected via the indwelling catheter every 8 h for 3 days, with a constant rate infusion of an intravenous fentanyl (1 μg/kg/h) and ketamine (0.12 mg/kg/h) combination. Post-operative pain was evaluated using the Glasgow composite measure pain scale and the score was 4-5/24 on the day of surgery and gradually decreased over time. Additional rescue analgesia was not required. Repeated boluses of bupivacaine for a continuous bilateral TTP block may be a useful adjuvant for perioperative pain management strategies, including median sternotomy, in dogs.
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Affiliation(s)
- Dalhae Kim
- Ilsan Animal Medical Center, Goyang, Republic of Korea
| | - Dongmin Shin
- Ilsan Animal Medical Center, Goyang, Republic of Korea
| | - Sookyung Yun
- Ilsan Animal Medical Center, Goyang, Republic of Korea
| | - Gayeon An
- Ilsan Animal Medical Center, Goyang, Republic of Korea
| | - Joohyun Jung
- Ilsan Animal Medical Center, Goyang, Republic of Korea
| | - Won-gyun Son
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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2
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Herrera-Linares ME, Rico-Pérez B, Yaffy D, Fernández-Parra R, Llanos C, Parra-Martínez C, Herrera-Gutiérrez ME, Sanchis-Mora S. Cadaveric study of the ultrasound-guided erector spinae plane block over the transverse process of the twelfth thoracic vertebra in dogs: Transversal vs longitudinal approach. Vet J 2024; 304:106094. [PMID: 38452849 DOI: 10.1016/j.tvjl.2024.106094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
This study describes a transversal (TV) ultrasound-guided erector spinae plane (ESP) block technique over the transverse process of T12. And evaluates the distribution of the dye and affected nerves branches compared to a longitudinal (LNG) approach over the transverse process of T12 in canine cadavers. Secondly, it also compares de anatomy and dimensions of the transverse processes of T12 with T9 and T5. For this double-masked, cadaveric experimental study, 12 adult Beagle cadavers were injected with 0.6 mL/kg of dye/contrast. Spread was evaluated by computed tomography (CT) and dissection. Mean bodyweight was 9.76 (±0.59) kg. The TV and LNG approaches stained a median (range) of four (2-6) and three (1-6) medial branches of the dorsal rami of the spinal nerves, three (2-6) and three (2-5) lateral branches, and one (0-3) and one (0-4) ventral branches, respectively. Dye was detected in the epidural space in 55.6% and 66.7% of cases for the TV and LNG approaches, respectively (P=0.63). And in the ventral paravertebral compartment in 22.2% and lymphatics in 88.8% in both approaches. There were no statistical differences for the spread. The dorsolateral edge of the transverse process (TP) was not visible with CT at T12. The mean (±SD) length of the TP was significantly shorter at T12 [3.34 (±0.22)] mm, compared to T9 [6.08 (±0.47)] mm and T5 [5.93 (±0.62)] mm (P <0.001). This study showed similar distribution whether using a TV or LNG approach and differences in the anatomy and length of the T12 TP.
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Affiliation(s)
- M E Herrera-Linares
- Doctoral School, Catholic University of Valencia San Vicente Mártir, San Agustín Square, 3, 46002, Spain; Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom.
| | - B Rico-Pérez
- Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - D Yaffy
- Department of Pathobiology and Population Sciences. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - R Fernández-Parra
- Department of Small Animal Medicine and Surgery, Faculty of Veterinary Medicine and experimental Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, C/ de Quevedo, 2, 46001, Spain
| | - C Llanos
- Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - C Parra-Martínez
- Department of Clinical Science and Services. The Royal Veterinary College, Hawkshead Ln, Hatfield AL9 7TA, United Kingdom
| | - M E Herrera-Gutiérrez
- Department of Intensive Care Medicine. Regional University Hospital of Málaga, Av., 84, Málaga 29010, Spain
| | - S Sanchis-Mora
- Department of Small Animal Medicine and Surgery, Faculty of Veterinary Medicine and experimental Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, C/ de Quevedo, 2, 46001, Spain
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Patouchas O, Kulendra N, Medina-Serra R. Ipsilateral thoracic limb block and Horner's syndrome associated with bupivacaine in a dog undergoing thoracotomy. Vet Anaesth Analg 2024:S1467-2987(24)00040-0. [PMID: 38772849 DOI: 10.1016/j.vaa.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/09/2024] [Accepted: 03/19/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Odyssefs Patouchas
- North Downs Specialist Referrals, Bletchingley, UK; Eastcott Referrals, Swindon, UK
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Pentsou J, Vagias M, Davies T, Hoey S, Huuskonen V. Thoracolumbar Retrolaminar Block: Anatomical and Radiological Study of Injectate Pattern Distribution in Canine Cadavers. Animals (Basel) 2023; 13:3008. [PMID: 37835614 PMCID: PMC10571983 DOI: 10.3390/ani13193008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The retrolaminar block is a regional anaesthetic technique, first developed in humans, in which the local anaesthetic is deposited directly onto the dorsal aspect of the thoracic or lumbar vertebral lamina. This study aims to evaluate the distribution of landmark-guided thoracolumbar retrolaminar injections in greyhound cadavers. Thirteen injections of contrast-dye solution were performed in eight cadavers at the level of the twelfth thoracic vertebra (T12), with either 20 mL (n = 8, high volume, HV) or 10 mL (n = 5, low volume, LV) per site. The spread of the injectate was evaluated through computed tomography and transverse anatomical dissection. The groups were compared using the Mann-Whitney U test. The median (range) of the extent of the spread was 4 (2-5) and 3 (2-4) intervertebral foramina in the LV and HV groups, respectively. The median (range) of the spread along the retrolaminar space was 3 (2-3) retrolaminar segments in the LV and 3 (2-4) in the HV group. Epidural and retroperitoneal spread was identified in seven cadavers. Following landmark-guided retrolaminar injections, the injectate spread both in the retrolaminar and paravertebral spaces, without any obvious association between the volume of injectate and the extent of the spread. Further studies are warranted to determine the clinical efficacy of the technique.
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Affiliation(s)
- Julia Pentsou
- Department of Veterinary Anaesthesia and Analgesia, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Michail Vagias
- Department of Small Animal Surgery, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK;
| | - Thomas Davies
- Bristol Vet Specialists, Unit 10, More Plus Central Park, Madison Way, Severn Beach, Bristol BS35 4ER, UK;
| | - Séamus Hoey
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04 W6F6 Dublin, Ireland; (S.H.); (V.H.)
| | - Vilhelmiina Huuskonen
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04 W6F6 Dublin, Ireland; (S.H.); (V.H.)
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Degani M, Dupont J, Giansetto T, Claeys S, Sandersen C. Ultrasound‐guided parasternal block in a cat undergoing median sternotomy for pulmonary lobectomy. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Massimiliano Degani
- Clinical Department for Companion Animals Faculty of Veterinary Medicine University of Liege Liege Belgium
| | - Julien Dupont
- Clinical Department for Companion Animals Faculty of Veterinary Medicine University of Liege Liege Belgium
| | - Thomas Giansetto
- Clinical Department for Companion Animals Faculty of Veterinary Medicine University of Liege Liege Belgium
| | - Stéphanie Claeys
- Clinical Department for Companion Animals Faculty of Veterinary Medicine University of Liege Liege Belgium
| | - Charlotte Sandersen
- Clinical Department for Companion Animals Faculty of Veterinary Medicine University of Liege Liege Belgium
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Henze IS, Meira C, Baron Toaldo M, Nolff MC, Steblaj B. Anaesthetic management of three Maine Coon cats undergoing hybrid intervention for treatment of cor triatriatum sinister. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Inken Sabine Henze
- Section of Anaesthesiology Department of Clinical Diagnostics and Services Vetsuisse Faculty of the University of Zurich Winterthurerstrasse Zurich Switzerland
| | - Carolina Meira
- Section of Anaesthesiology Department of Clinical Diagnostics and Services Vetsuisse Faculty of the University of Zurich Winterthurerstrasse Zurich Switzerland
| | - Marco Baron Toaldo
- Section of Cardiology Clinic for Small Animal Internal Medicine Vetsuisse Faculty of the University of Zurich Winterthurerstrasse Zurich Switzerland
| | - Mirja Christine Nolff
- Clinic for Small Animal Surgery Vetsuisse Faculty of the University of Zurich Winterthurerstrasse Zurich Switzerland
| | - Barbara Steblaj
- Section of Anaesthesiology Department of Clinical Diagnostics and Services Vetsuisse Faculty of the University of Zurich Winterthurerstrasse Zurich Switzerland
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A Two-Point Ultrasound-Guided Injection Technique for the Transversus Thoracis Plane Block: A Canine Cadaveric Study. Animals (Basel) 2022; 12:ani12172165. [PMID: 36077885 PMCID: PMC9454867 DOI: 10.3390/ani12172165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The transversus thoracis plane block is a locoregional technique recently described in canine cadavers to desensitize the intercostal nerves running through this plane. In canine cadavers, a transverse approach through a single injection point at the fifth intercostal space has been described, although consistent staining of the intercostal nerves was not completely achieved. The objective of this study was twofold: (1) to evaluate if the transverse approach is feasible at the third and sixth intercostal spaces and (2) to compare, by anatomical dissection, the spread of a dye solution and the staining of the intercostal nerves when a low volume (0.5 mL kg−1) or a high volume (1 mL kg−1) was equally divided at a two-point injection in the same hemithorax. Our results showed that the injection of the high-volume dye solution, equally injected at the third and sixth intercostal spaces using the transverse approach, achieved a consistent staining of from T2 to T7 intercostal nerves. This block could achieve adequate desensitization of the ventral chest wall during sternotomy in the dog. Clinical studies in live animals are necessary to confirm the efficacy of this technique. Abstract The transversus thoracis plane (TTP) block desensitizes the intercostal nerves that run through this plane, providing analgesia to the ventral thoracic wall. Two canine cadavers were used to assess the feasibility of the transverse approach for the TTP (t-TTP) under ultrasound guidance to inject a solution at the third and sixth intercostal spaces. Eight cadavers were used to compare the spread and number of intercostal nerves that were stained when a low volume (LV) 0.5 mL kg−1 or a high volume (HV) 1 mL kg−1 of a dye-lidocaine solution was injected into the same hemithorax, injecting the volume equally at these intercostal spaces using the transverse approach. Fisher’s exact test and Wilcoxon signed-rank test were used to contrast the spread of the different volume solutions. The injectate spread along the TTP after all injections, dying a median number (range) of 3 (2–5) and 6 (5–6) nerves with LV and HV, respectively (p = 0.011). The two-point injection of HV, using the t-TTP approach, is a feasible technique that provides a consistent staining from T2 to T7 intercostal nerves. The injection of HV instead of LV increases the spread and enhances the number of stained intercostal nerves.
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Erector spinae plane block at the thoracolumbar spine: a canine cadaveric study. Vet Anaesth Analg 2022; 49:656-663. [DOI: 10.1016/j.vaa.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
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Escalante GC, Ferreira TH, Hershberger-Braker KL, Schroeder CA. Evaluation of ultrasound-guided pecto-intercostal block in canine cadavers. Vet Anaesth Analg 2022; 49:182-188. [PMID: 35123875 DOI: 10.1016/j.vaa.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the technique for performing an ultrasound-guided pecto-intercostal fascial (PIF) block and compare two volumes of injectate in canine cadavers. STUDY DESIGN Prospective experimental cadaveric study. ANIMALS A total of 11 canine cadavers (11.8 ± 1.9 kg). METHODS Parasternal ultrasound-guided injections were performed within the PIF plane, between the deep pectoral and external intercostal muscles, at the intercostal space between ribs four and five. Each hemithorax was injected with 0.25 mL kg-1 (treatment low volume, LV) or 0.5 mL kg-1 (treatment high volume, HV) of 1% methylene blue dye. Treatments were randomly assigned to either right or left hemithorax, with each cadaver injected with both treatments, for a total of 22 injections. Anatomical dissections were performed to determine staining of ventral cutaneous branches of intercostal nerves, surrounding nerves and musculature and spread of injectate. The presence or absence of intrathoracic puncture was also noted. RESULTS The PIF plane was identified and injected in each hemithorax. No significant differences between treatments LV and HV were found for number of ventral cutaneous nerve branches stained or any other analyzed variable. The ventral cutaneous branches of intercostal nerves (T3-T8) were variably stained, and the most commonly stained nerves were T5 (6 and 10), T6 (8 and 9) and T7 (2 and 7) in treatments LV and HV, respectively. Staining outside the immediate parasternal region was noted in both treatments, with greater spread away from the parasternal region in treatment HV. No intrathoracic staining was found. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided PIF injections resulted in staining of ventral cutaneous branches and parasternal musculature; however, the spread observed was inadequate to provide effective analgesia to the sternum. In vivo studies are warranted to investigate this regional anesthetic technique in veterinary patients.
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Affiliation(s)
- Gabriela C Escalante
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Marchina-Gonçalves A, Gil F, Laredo FG, Soler M, Agut A, Belda E. Evaluation of High-Volume Injections Using a Modified Dorsal Quadratus Lumborum Block Approach in Canine Cadavers. Animals (Basel) 2021; 12:ani12010018. [PMID: 35011124 PMCID: PMC8749509 DOI: 10.3390/ani12010018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/10/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthesia technique. Its objective is to promote both visceral and somatic analgesia for abdominal procedures. Previous spread studies carried out in canine cadavers demonstrated its viability in this species but failed in consistently reach the spinal nerves responsible for the cranial abdominal wall innervation. Therefore, we hypothesize that a modified QL block technique, based on the administration of a higher volume of solution (0.6 mL kg−1) in a dorso-medial position compared to the interfascial injection point between the QL and psoas minor muscles, could enhance its cranial spread, and promote a consistent distribution spread through the ventral branches of the spinal nerves and sympathetic trunk. For this purpose, a solution of dye/contrast was ultrasound-guide injected into six canine cadavers. The results were assessed through computed tomography and dissection, showing that the proposed technique is viable, safe, and stained the median and caudal abdominal nerves and the sympathetic trunk up to T13 consistently. However, our modified technique of QL block did not increase the cranial distribution of dye/contrast to the thoracic spinal nerves, and may not provide adequate somatic analgesia of the cranial abdominal wall. Abstract The quadratus lumborum (QL) block targets the fascial plane surrounding the QL muscle providing abdominal somatic and visceral analgesia. The extension of its analgesic effects is a subject of research, as it could not cover areas of the cranial abdomen in dogs. This study assesses in eight thawed canine cadavers, the distribution of high-volume injections (0.6 mL kg−1 of a mixture of methylene blue and iopromide) injected between the psoas minor muscle and the vertebral body of L1. Anatomical features of the area of interest were studied in two cadavers. In another six dogs, QL blocks were performed bilaterally under ultrasound-guidance. The distribution of contrast was evaluated by computed tomography (CT). Hypaxial abdominal muscles were dissected to visualize the dye spread (spinal nerves and sympathetic trunk) in 5 cadavers. The remaining cadaver was refrozen and cross-sectioned. CT studies showed a maximum distribution of contrast from T10 to L7. The methylene blue stained T13 (10%), L1 (100%), L2 (100%), L3 (100%), L4 (60%) and the sympathetic trunk T10 (10%), T11 (20%), T12 (30%), T13 (70%), L1 (80%), L2 (80%), L3 (60%) and L4 (30%). These findings may suggest that despite the high volume of injectate administered, this modified QL block could not produce somatic analgesia of the cranial abdomen, although it could provide visceral analgesia in dogs.
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Affiliation(s)
- André Marchina-Gonçalves
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Francisco Gil
- Departamento de Anatomía y Embriología Veterinaria, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco G. Laredo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
- Correspondence:
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López-Ramis V, Canfrán S, Gómez de Segura IA. Caudal thoracic paravertebral block in a dog undergoing surgical adrenalectomy. Vet Anaesth Analg 2021; 49:219-220. [DOI: 10.1016/j.vaa.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
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Alaman M, Bonastre C, de Blas I, Gomez-Alvarez CM, Laborda A. Description of a novel ultrasound-guided approach for a dorsal quadratus lumborum block: a canine cadaver study. Vet Anaesth Analg 2021; 49:118-125. [PMID: 34852961 DOI: 10.1016/j.vaa.2021.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/09/2021] [Accepted: 09/04/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe an ultrasound-guided approach to the dorsal aspect of the quadratus lumborum muscle (D-QL) and to evaluate the spread of methylene blue dye in canine cadavers. STUDY DESIGN Prospective, experimental anatomical study. ANIMALS A total of 12 canine cadavers. METHODS The ultrasonographic landmarks and injection technique for the D-QL approach were determined in two cadavers. Correct needle tip position was confirmed by computed tomography. Bilateral ultrasound-guided injections were performed in 10 cadavers between the QL muscle, the vertebral body and the ventrocaudal aspect of the transverse process of the first lumbar vertebra (L1) using two volumes of methylene blue: low volume (LV) 0.3 mL kg-1 or high volume (HV) 0.5 mL kg-1. Staining of the main thoracolumbar trunk, dorsal and ventral branches of the thoracic (T) and lumbar (L) spinal nerves, sympathetic trunk and epidural space were assessed following dissection. Data between groups were compared using Mann-Whitney U test. Data are presented as median (range). RESULTS The ventral branches of spinal nerves T12, T13, L1, L2, L3 and L4 were stained in 10%, 70%, 100%, 90%, 60%, 0% and 30%, 100%, 100%, 100%, 50% and 30% after LV and HV injections, respectively. Multisegmental spread of the sympathetic trunk was found on 3 (3-4) and 5 (3-6) vertebral spinal levels following LV and HV injections, respectively (p = 0.005). The T13 segment of the sympathetic trunk was stained after all HV injections. Epidural spread was found in 20% and 30% of LV and HV injections, respectively. CONCLUSIONS AND CLINICAL RELEVANCE The injection of HV versus LV dye using the D-QL approach provided more consistent staining of the thoracolumbar nerve structures which innervate the abdominal wall and viscera. Clinical studies are required to evaluate the analgesic efficacy of the D-QL block for abdominal procedures in dogs in vivo.
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Affiliation(s)
- Manuel Alaman
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Hospital Veterinario Anicura Valencia Sur, Silla, Spain
| | - Cristina Bonastre
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Instituto Universitario de Investigación Mixto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Zaragoza, Spain.
| | - Ignacio de Blas
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Instituto Universitario de Investigación Mixto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Zaragoza, Spain
| | | | - Alicia Laborda
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain
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Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers. Animals (Basel) 2021; 11:ani11092657. [PMID: 34573624 PMCID: PMC8466234 DOI: 10.3390/ani11092657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary In humans, the aim of the transversus thoracis plane block is to desensitise the intercostal nerves running through this plane, providing analgesia to the anterior chest wall. Our objective was twofold: describing an ultrasound-guided transverse approach to the transversus thoracis plane and evaluating the spread of two injectable volumes in canine cadavers. Gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages were described in two dog cadavers. Eight cadavers were used to describe this approach and were subsequently dissected to evaluate the injectate spread and the intercostal nerves staining after low volume (0.5 mL kg−1) and high volume (1 mL kg−1) dye-lidocaine injection. After all injections, the injectable solution was distributed along the transversus thoracis plane, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with low and high volume, respectively (p = 0.014). The transverse approach to the transversus thoracis plane is a feasible, single injection point technique that provides the staining of several intercostal nerves. The injection of high versus low volume increases the number of stained nerves. Abstract Transversus thoracis plane (TTP) block has demonstrated to produce analgesia in humans undergoing median sternotomy. The objectives of the study were to describe an ultrasound-guided transverse approach to the transversus thoracis plane (t-TTP) and to evaluate the spread of two injectable volumes in canine cadavers. Two cadavers were used to describe relevant gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages. Then, eight cadavers were used to describe the ultrasound-guided injection into the TTP and were dissected to evaluate the injectate spread and the intercostal nerves staining with two different dye-lidocaine volumes: low volume (LV) 0.5 mL kg−1 and high volume (HV) 1 mL kg−1. To compare the spread between both volumes the Fisher’s exact test and Wilcoxon signed-rank test were used. The solution spread along the TTP after all injections, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with LV and HV, respectively (p = 0.014). The injection of HV versus LV increases the number of stained nerves. Ultrasound-guided t-TTP is a feasible technique that provides staining of several intercostal nerves with a single injection site, so it could be useful to provide analgesia to the ventral chest wall.
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Use of a thoracic paravertebral catheter to control severe trauma-related pain in a dog. Vet Anaesth Analg 2021; 48:809-811. [PMID: 34219015 DOI: 10.1016/j.vaa.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022]
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Zublena F, Briganti A, De Gennaro C, Corletto F. Ultrasound-guided parasternal injection in dogs: a cadaver study. Vet Anaesth Analg 2021; 48:563-569. [PMID: 34059462 DOI: 10.1016/j.vaa.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/09/2020] [Accepted: 12/30/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the technique of performing an ultrasound-guided distal parasternal intercostal block and to determine the distribution of two volumes of methylene blue dye solution injected in canine cadavers. STUDY DESIGN Prospective cadaver study. ANIMALS A group of seven canine cadavers weighing 12-34 kg. METHODS The space between the transversus thoracic and the internal intercostal muscles is a virtual cavity. Ultrasound-guided injections in the distal (parasternal) intercostal space were performed using dye solution at 0.05 mL kg-1 in each intercostal space from the second to seventh (LV, low volume, six injections per dog) in one hemithorax, and 0.1 mL kg-1 in the third, fifth and seventh intercostal spaces (HV, high volume, three injections in each dog) on the contralateral side. Anatomical dissection was carried out to describe dye spread characteristics and staining of intercostal nerves. RESULTS The ultrasonographic landmarks for injection were identified in each cadaver. In the LV group the solution was found in every intercostal space (36/36), whereas the HV injection stained six intercostal spaces in two dogs, five in two, and in two dogs the solution was found in four and three spaces, respectively, demonstrating multisegmental distribution. Intrapleural staining was observed after two injections. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided injection of 0.05 mL kg-1 at the distal intercostal space resulted in staining of the intercostal nerve in all dogs when performed in every space and may be an appropriate alternative to previously reported techniques. A single injection of 0.1 mL kg-1 may anaesthetize more than one intercostal nerve, but not consistently. Clinical investigations are warranted to better characterize and to refine this locoregional technique.
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Affiliation(s)
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Italy
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Delgado OBD, Louro LF, Rocchigiani G, Verin R, Humphreys W, Senior M, Campagna I. Ultrasound-guided erector spinae plane block in horses: a cadaver study. Vet Anaesth Analg 2021; 48:577-584. [PMID: 33934991 DOI: 10.1016/j.vaa.2020.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe dye distribution and spinal nerve involvement after a simulated erector spinae plane (ESP) block performed on fresh equine cadavers. STUDY DESIGN Experimental cadaver study. ANIMALS A group of 11 adult equine cadavers. METHODS The spinal region surrounding the sixteenth thoracic vertebra (Th16) of one cadaver was removed and underwent magnetic resonance imaging. In 10 adult equine cadavers [body weight, 549 ± 58 kg (mean ± standard deviation)], 0.2 mL kg-1 of a 50:1 2% lidocaine/dye solution was injected bilaterally (n = 20 injections) into the fascial plane between the transverse process of Th16 and the erector spinae muscles. An in-plane ultrasound-guided technique with a convex transducer was used to guide injection. Dissection was performed immediately following injection. The craniocaudal and lateral extent of dye distribution was measured (cm) and the number of vertebral bodies involved were counted (n = 20). Abdominal and thoracic cavities as well as the epidural space were also examined for presence of dye (yes/no) (n = 20). Further dissection was performed to evaluate if staining of the dorsal and ventral rami of the spinal nerves and sympathetic chain occurred (n = 14). RESULTS The thoracolumbar fascia was stained in 17/20 (85%) injections and three injections terminated intramuscularly. Multisegmental staining of the dorsal rami was observed in the 14 injections in which staining was evaluated. Ventral rami staining was observed in 3/14 injections where staining was evaluated. Epidural migration was observed in 4/20 (20%) injections. No evidence of dye was found in the thoracic and abdominal cavities or on the sympathetic chain. CONCLUSIONS AND CLINICAL RELEVANCE The ESP block may prove beneficial to desensitize structures innervated by the dorsal rami of the thoracic spinal nerves. Further investigation is necessary to evaluate complications caused by epidural contamination.
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Affiliation(s)
| | - Luis Filipe Louro
- Department of Small Animal Clinical Science, University of Liverpool, Liverpool, UK
| | - Guido Rocchigiani
- Department of Veterinary Pathology and Public Health, University of Liverpool, Liverpool, UK
| | - Ranieri Verin
- Department of Veterinary Pathology and Public Health, University of Liverpool, Liverpool, UK; Department of Comparative Biomedicine and Food Science, University of Padova, Padova, Italy
| | - William Humphreys
- Department of Small Animal Clinical Science, University of Liverpool, Liverpool, UK
| | - Mark Senior
- Department of Equine Clinical Science, University of Liverpool, Liverpool, UK
| | - Ivo Campagna
- Department of Small Animal Clinical Science, University of Liverpool, Liverpool, UK; Department of Equine Clinical Science, University of Liverpool, Liverpool, UK
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Scallan EM, Voges AK, Chaney KP, Coursey CD, Simon BT. The Effects of Content Delivery Methods on Ultrasound Knobology and Image Quality Recognition Training in First-Year Veterinary Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:65-70. [PMID: 31738682 DOI: 10.3138/jvme.2019-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As new technologies are incorporated into the practice of veterinary medicine, it is imperative we utilize the most effective and impactful content delivery methods. Ultrasound technology has become more affordable and compact for veterinary hospitals, leading to easier incorporation into practice. This study compares three methods of delivering ultrasound knobology content to first-year veterinary students at Texas A&M University College of Veterinary Medicine and Biomedical Sciences. In a prospective study, first-year veterinary students were randomly selected to receive one of three content delivery methods: self-directed active learning (SDL), in-person instructor demonstration, or online module instruction. Knowledge acquisition was assessed using a 10-question quiz for short-term understanding followed by a 10-question quiz after a 6-week period to assess long-term knowledge retention. Student demographics were analyzed using the Chi-square test. Quiz scores were analyzed between groups using Kruskal-Wallis tests followed by Dunn's post-tests for multiple comparisons. Values of p ≤ .05 were considered significant. On the short-term and retention quiz questions, students participating in SDL scored significantly higher (10 [5-10]) than those receiving in-person instructor demonstration (9 [3-10] p = .01 and 8 [2-10] p = .0004, respectively) or the online module instruction training (Group C) (6 [1-10] p < 0.0001 and 8 [4-10] p < .001, respectively). Based on quiz scores, veterinary students exhibited better ultrasound knobology and image quality recognition proficiency immediately and at 6-weeks following SDL when compared with other content delivery methods. Self-directed learning methods are recommended when teaching ultrasonography to veterinary students.
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Santoro F, Franci P, Grandis A, Valgimigli S. Distribution of injectates in the thoracic paravertebral space of the dog and cat: A cadaveric study. Open Vet J 2021; 11:27-35. [PMID: 33898280 PMCID: PMC8057219 DOI: 10.4314/ovj.v11i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Thoracic paravertebral block (TPVB) entails injecting a local anesthetic inside the thoracic paravertebral space (TPVS). Loss of resistance to air injection (air-LOR) was the first technique described in humans to locate the TPVS. To date, no study has investigated the spread of any substance after injection into the TPVS using the air-LOR technique nor has described the cranial and caudal limits of the space. Aim: To identify the boundaries of the TPVS, to determine whether the air-LOR technique is reliable for the identification of the TPVS and to examine the relationship between the volume of injectate and its spread. Methods: After a preliminary phase, the thorax of five cat and five dog cadavers was accessed and eviscerated. After TPVS probing, the polyurethane foam was injected, and the cranial and caudal borders were recorded after its maximum spread. Different volumes of a mixture of new methylene blue and ioversol were injected in the TPVS after its localization with a Tuohy needle and air-LOR technique in fourteen dog and six cat cadavers. Lateral radiographs of the vertebral column were used to document needle positioning, spread pattern and extension. The thorax of these subjects was then accessed and eviscerated to observe and record the spread of the mixture. Results: Injecting a dye into the TPVS, localized by an air-LOR technique, resulted in multi-segmental and often bilateral subpleural staining of paravertebral, intercostal, and dorsal mediastinal structures in dog and cat cadavers. The lateral radiographs most often showed a mixed cloud-like and linear spread pattern, which could be a predictor of the longitudinal spread of the dye. The foam injected into the TPVS at the cranial and the caudal level revealed anatomical communication with the cervical, axillar, and lumbar paravertebral regions. Conclusion: TPVS localization by air-LOR technique and injection results in a longitudinal multi-segmental spread in dog and cat cadavers. The communication of the TPVS with the axillary and lumbar regions could be of clinical interest for the brachial plexus and the lumbar intercostal nerve blocks in a clinical setting.
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Affiliation(s)
- Francesco Santoro
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Paolo Franci
- Department of Veterinary Medical Science, Largo Paolo Braccini, Grugliasco, Italy
| | - Annamaria Grandis
- Department of Veterinary Medical Science, University of Bologna, Ozzano dell'Emilia, Italy
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Medina-Serra R, Foster A, Plested M, Sanchis S, Gil-Cano F, Viscasillas J. Lumbar erector spinae plane block: an anatomical and dye distribution evaluation of two ultrasound-guided approaches in canine cadavers. Vet Anaesth Analg 2020; 48:125-133. [PMID: 33334690 DOI: 10.1016/j.vaa.2020.07.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/24/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the anatomy of the lumbar epaxial region and to describe two different ultrasound-guided approaches for the lumbar erector spinae plane (ESP) block in dogs. STUDY DESIGN An anatomical and experimental cadaver study. ANIMALS A group of 19 canine cadavers. METHODS The anatomy was described following dissection of two cadavers. Bilateral ultrasound-guided ESP injections with 0.4 mL kg-1 of contrast dye were performed in 17 adult Beagle cadavers using either transversal (TVS) or parasagittal (PST) approaches. Computed tomography was performed to measure the total length of the contrast dye column and the epidural, intravascular, hypaxial and intra-abdominal migration. Dissections were performed to assess the spread of the contrast dye and to determine the degree of staining of the dorsal branches of the spinal nerves (DBSN). Mann-Whitney U and chi-square tests were used to compare data between groups. RESULTS Using both techniques, the contrast dye was observed within the ESP compartment. There was no difference in the total length of the contrast dye column between TVS and PST approaches (p = 0.056). Using the TVS approach, multisegmental staining of the DBSN was visible with 100% (17/17) of injections, while complete staining of the DBSN was achieved at 94% of the injection sites. Using the PST approach, these values were 29% (5/17) and 23% (4/17), respectively. The TVS approach stained more DBSN than the PST approach (p = 0.001), with a median (range) of 2 (2-3) versus 0 (0-3) DBSN, respectively. Using the TVS approach, epidural and intravascular migration were present in 2/17 (p = 0.485) and 3/17 (p = 0.227) injections, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Both ultrasound-guided approaches resulted in a spread of the contrast dye within the ESP compartment. Although there were no differences in the total length of the contrast dye column, the TVS approach was superior to the PST approach in staining DBSN.
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Affiliation(s)
- Roger Medina-Serra
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK.
| | - Andrew Foster
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Mark Plested
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Sandra Sanchis
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Francisco Gil-Cano
- Department of Veterinary Anatomy and Embryology, University of Murcia, Murcia, Spain
| | - Jaime Viscasillas
- Departamento de Medicina y Cirugia Animal, Facultad de Veterinaria, Instituto de Ciencias Biomedicas, Universidad CEU Cardenal Herrera, Valencia, Spain
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Hussain N, Brull R, Noble J, Weaver T, Essandoh M, McCartney CJ, Abdallah FW. Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery. Reg Anesth Pain Med 2020; 46:3-12. [PMID: 33168651 DOI: 10.1136/rapm-2020-101917] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
The novel erector spinae plane block (ESPB) has been reported to provide important postoperative analgesic benefits following a variety of truncal and abdominal surgical procedures. However, evidence of its analgesic efficacy following breast cancer surgery, compared with parenteral analgesia, is unclear. This meta-analysis evaluates the analgesic benefits of adding ESPB to parenteral analgesia following breast cancer surgery.Databases were searched for breast tumor resection trials comparing ESPB to parenteral analgesia. The two co-primary outcomes examined were 24-hour postoperative oral morphine equivalent consumption and area-under-curve of rest pain scores. We considered reductions equivalent to 3.3 cm.h and 30 mg oral morphine in the first 24 hours postoperatively for the two co-primary outcomes, respectively, to be clinically important. We also assessed opioid-related side effects and long-term outcomes, including health-related quality of life, persistent postsurgical pain and opioid dependence. Results were pooled using random effects modeling.Twelve trials (699 patients) were analyzed. Moderate quality evidence suggested that ESPB decreased 24-hour morphine consumption and area-under-curve of rest pain by a mean difference (95% CI) of -17.60 mg (-24.27 to -10.93) and -2.74 cm.h (-3.09 to -2.39), respectively; but these differences were not clinically important. High-quality evidence suggested that ESPB decreased opioid-related side effects compared with parenteral analgesia by an OR (95% CI) of 0.43 (0.28 to 0.66). None of the studies evaluated long-term block benefits.Adding ESPB to parenteral analgesia provides statistically significant but clinically unimportant short-term benefits following breast cancer surgery. Current evidence does not support routine use of ESPB. Given the very modest short-term benefits and risk of complications, the block should be considered on a case-by-case basis.
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Affiliation(s)
- Nasir Hussain
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Brull
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada.,Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Noble
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tristan Weaver
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Essandoh
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Colin Jl McCartney
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraj W Abdallah
- Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada .,Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bianchi C, Adami C, Dirrig H, Cuff A, d'Ovidio D, Monticelli P. Mandibular nerve block in juvenile Nile crocodile: a cadaveric study. Vet Anaesth Analg 2020; 47:835-842. [PMID: 33046377 DOI: 10.1016/j.vaa.2020.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/10/2020] [Accepted: 04/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a technique for performing the mandibular nerve block in Nile crocodiles. STUDY DESIGN Experimental cadaveric study. ANIMALS A total of 16 juvenile Nile crocodile heads. METHODS To study the course of the mandibular nerve, one head was dissected. Computed tomography (CT) examination was performed in two heads to identify useful landmarks. Thereafter, a hypodermic needle was inserted through the external mandibular fenestra of 17 hemimandibles (13 heads), and a mixture of methylene blue and iohexol was injected. Injection volumes were 0.5 (n = 7) and 1.0 mL (n = 10) for hemimandibles < 15 and ≥ 15 cm long, respectively. Iohexol spread and nerve staining with methylene blue were assessed with CT and anatomical dissection, respectively. Data were analysed with one-sample t test or Mann-Whitney U test. Significance was set at p < 0.05. RESULTS Both anatomical dissection and imaging confirmed the external mandibular fenestra as a useful anatomical landmark for needle insertion. The CT images acquired after needle positioning confirmed that its tip was located on the medial bony mandibular surface formed by the fusion of the angular and coronoid bones in 100% cases. In all the hemimandibles, the rostrocaudal spread of contrast was > 23 mm. The length of the stained mandibular nerve in the temporal region and of the stained medial branch of the mandibular nerve, as well as the dorsoventral and mediolateral spread of iohexol, was greater in group 1.0 than in group 0.5 (p < 0.001). The caudal spread of iohexol was greater in group 1.0 than in group 0.5 (p = 0.01). CONCLUSIONS AND CLINICAL RELEVANCE The technique developed in this study is feasible. Both injection volumes resulted in staining of the mandibular nerve. The spread of contrast in the anatomical region of interest may result in successful sensory block.
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Affiliation(s)
- Cristina Bianchi
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Chiara Adami
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Helen Dirrig
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Andrew Cuff
- Hull York Medical School, University of York, Heslington, York, UK
| | - Dario d'Ovidio
- Private Practitioner, Naples, Italy; Clinica Veterinaria Malpensa, Samarate(VA), Italy
| | - Paolo Monticelli
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK.
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A novel ultrasound-guided lateral quadratus lumborum block in dogs: a comparative cadaveric study of two approaches. Vet Anaesth Analg 2020; 47:810-818. [PMID: 32981838 DOI: 10.1016/j.vaa.2020.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe an ultrasound-guided lateral quadratus lumborum (LQL) block technique and the spread characteristics of lidocaine-dye injected in the LQL plane using a transversal (LQL-T) or a longitudinal (LQL-L) approach. STUDY DESIGN Experimental anatomic study. ANIMALS A total of eight canine cadavers. METHODS Bilateral ultrasound-guided injections in the fascial plane lateral to the quadratus lumborum muscle and medial to the thoracolumbar fascia (LQL plane) with the needle directed at the first lumbar (L1) transverse process were performed using lidocaine-dye (0.3 mL kg-1). Anatomical dissection determined the dye distribution, sympathetic trunk staining and number of spinal nerves stained circumferentially >1 cm. RESULTS The LQL fascial plane was ultrasonographically recognized in all cadavers and filled with lidocaine-dye in all eight cadavers with the LQL-T approach and in six with LQL-L. The injectate spread ventral to the lumbar transverse processes, around the quadratus lumborum muscle and dorsal to the transversalis fascia, affecting the ventral branches of the spinal nerves and the sympathetic trunk. A median (range) of 4 (3-5) and 3 (0-4) ventral branches of the thoracolumbar nerves were dyed with LQL-T and LQL-L approaches, respectively (p = 0.04). The most cranial nerve stained was the twelfth thoracic (T12) with the LQL-T approach and T13 with LQL-L, and the most caudal was L3 with both approaches. The incidence of sympathetic trunk staining was significantly higher using LQL-T (six injections) compared with LQL-L (one injection; p = 0.04). Dye was not observed in the lumbar plexus, epidural space or abdominal cavity. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided LQL-T approach resulted in a more consistent spread toward the spinal nerves and sympathetic trunk compared with LQL-L approach. Further studies are necessary to assess the LQL block effectiveness and success rate in live dogs.
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de Miguel Garcia C, Whyte M, St James M, Ferreira TH. Effect of contrast and local anesthetic on dye spread following transversus abdominis plane injection in dog cadavers. Vet Anaesth Analg 2020; 47:391-395. [DOI: 10.1016/j.vaa.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
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Touzot-Jourde G, Geffroy O, Tallaj A, Gauthier O, Denoix JM. Ultrasonography-Guided Perineural Injection of the Ramus ventralis of the 7 and 8th Cervical Nerves in Horses: A Cadaveric Descriptive Pilot Study. Front Vet Sci 2020; 7:102. [PMID: 32158773 PMCID: PMC7052177 DOI: 10.3389/fvets.2020.00102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/11/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe the feasibility and dye diffusion of selective perineural injection of the 7 and 8th cervical nerve (C7 and C8) ramus ventralis under ultrasonographic guidance in horses. Study design: Prospective experimental pilot cadaver study. Animals: Four equine cadavers of similar body weight (420-480 kg) and neck conformation. Methods: Five C7 and five C8 rami were perineurally injected with a dye solution. Anatomic dissections including vertebral canal opening were conducted to confirm nerve dye staining and describe the extent of color diffusion. Results: The ramus ventralis of the spinal cervical nerves was visualized in all cadavers. All the injections were successful in staining a portion of the nerve trunk. Eight rami had a uniform transversal staining of the nerve trunk that longitudinally covered a distance >2 cm. One C7 and one C8 nerve trunk showed incomplete transversal staining with a more concentrated color on its half cranial aspect and a longitudinal coverage of <2 cm. Five injections resulted in dye extending proximally and medially into the epidural space. Volume had no appreciable effect on the extent of nerve staining. A greater proportion of epidural diffusion was found with injections done within less than one cm distally to the articular processes. All injections were considered to be selective for the targeted nerve. Conclusion and clinical relevance: Ultrasonography-guided perineural injection of C7 and C8 ramus ventralis is a feasible technique that may have multiple applications in multimodal analgesia in horses. Further clinical study will be necessary to determine the appropriate drug, dosage, and volume to inject and to confirm its usefulness.
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Affiliation(s)
- Gwenola Touzot-Jourde
- INSERM, UMR 1229, Regenerative Medecine and Skeleton, University of Nantes, ONIRIS, Department of Veterinary Clinical Sciences, Nantes, France
| | - Olivier Geffroy
- INSERM, UMR 1229, Regenerative Medecine and Skeleton, University of Nantes, ONIRIS, Department of Veterinary Clinical Sciences, Nantes, France
| | - Amélie Tallaj
- INRA/ENVA, UMR 957, Biomechanics and Equine Locomotor Pathology Research Unit, Centre for Imaging and Research in Equine Locomotor Disorders (CIRALE), National Veterinary School of Alfort, Maisons-Alfort, France
| | - Olivier Gauthier
- INSERM, UMR 1229, Regenerative Medecine and Skeleton, University of Nantes, ONIRIS, Department of Veterinary Clinical Sciences, Nantes, France
| | - Jean-Marie Denoix
- INRA/ENVA, UMR 957, Biomechanics and Equine Locomotor Pathology Research Unit, Centre for Imaging and Research in Equine Locomotor Disorders (CIRALE), National Veterinary School of Alfort, Maisons-Alfort, France
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Garbin M, Portela DA, Bertolizio G, Garcia-Pereira F, Gallastegui A, Otero PE. Description of ultrasound-guided quadratus lumborum block technique and evaluation of injectate spread in canine cadavers. Vet Anaesth Analg 2019; 47:249-258. [PMID: 32014397 DOI: 10.1016/j.vaa.2019.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe a quadratus lumborum (QL) block technique in canine cadavers and the spread of injectate. STUDY DESIGN Prospective, randomized, descriptive, experimental anatomic study. ANIMALS A group of 12 adult canine cadavers. METHODS Gross and ultrasound anatomy of the sublumbar musculature and the relationship with the spinal nerves was studied in two cadavers. Bilateral ultrasound-guided injections were performed in eight cadavers in the fascial plane between the QL and psoas muscle using a dye-lidocaine solution [low volume (LV) 0.15 mL kg-1 or high volume (HV) 0.3 mL kg-1]. The ultrasound transducer was positioned caudal and parallel to the proximal aspect of the last rib, and an insulated needle was introduced in-plane using a ventrolateral to dorsomedial approach. Dissections were performed to determine the number of spinal nerves successfully stained (>1 cm) and the presence of injectate in the epidural space or abdominal cavity. Additionally, two cadavers were transversally cryosectioned after QL injection. RESULTS Ventral branches of the last thoracic and first three lumbar spinal nerves ran between the bundles of the QL muscle and between the QL and psoas muscles. The target fascial plane was ultrasonographically identified and filled with the dye solution following all injections. Ventral branches of the thirteenth thoracic and first, second and third lumbar nerves were stained by 0.0%, 71.4%, 100%, 100%, and 25%, 100%, 100%, 100% using LV and HV, respectively. Multisegmental spread stained the lumbar sympathetic trunk on 0 (0-3) and 3 (0-4) vertebral levels with LV and HV, respectively. No abdominal or epidural spread was identified. CONCLUSION AND CLINICAL RELEVANCE Although no significant differences were found, HV resulted in a higher percentage of stain on spinal nerves and sympathetic trunk than LV. Further studies are warranted to determine if the QL block provides somatic and visceral abdominal analgesia in dogs.
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Affiliation(s)
- Marta Garbin
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - Gianluca Bertolizio
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Fernando Garcia-Pereira
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Aitor Gallastegui
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Pablo E Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
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St James M, Ferreira TH, Schroeder CA, Hershberger-Braker KL, Schroeder KM. Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers. Vet Anaesth Analg 2019; 47:95-102. [PMID: 31786077 DOI: 10.1016/j.vaa.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers. STUDY DESIGN Blinded, prospective, experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 8.9 ± 1.6 kg. METHODS Ultrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg-1 (low volume; LV) and 0.50 mL kg-1 (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves. RESULTS Fewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 ± 0 and 2.90 ± 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranial-caudal dye distribution was observed in the LV group than in the HV group (7.1 ± 1.8 cm and 9.2 ± 1.8 cm, respectively; p = 0.03). There was no significant difference in medial-lateral spread of dye, number of test doses or ultrasound image quality scores between groups. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.
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Affiliation(s)
- Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Portela DA, Romano M, Otero PE. Locoregional Anesthesia of the Thoracic Limbs and Thorax in Small Animals. Vet Clin North Am Small Anim Pract 2019; 49:1063-1083. [PMID: 31492541 DOI: 10.1016/j.cvsm.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incorporation of nerve stimulation and ultrasound guidance to veterinary regional anesthesia allows accurate performance of techniques to block the thoracic limb and the thorax. When performed correctly, regional anesthesia can either constitute an alternative to the use of opioids and other systemic analgesics, or have a significant opioid-sparing effect. This article provides an overview of some techniques described using objective methods of nerve location, which can be used to provide perioperative locoregional anesthesia and analgesia to the thoracic limb and thorax. The approaches described may be used to decrease the perioperative use of opioids in small animals.
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Affiliation(s)
- Diego A Portela
- Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100123, Gainesville, FL 32610-0136, USA.
| | - Marta Romano
- Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100123, Gainesville, FL 32610-0136, USA
| | - Pablo E Otero
- Anesthesiology and Pain Management Department, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Avenida Chorroarín 280 (C1427CWO), Buenos Aires, Argentina
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.
Methods
Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.
Results
Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.
Conclusions
We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.
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Serra RM, Jimenez CP, Monticelli P, Plested M, Viscasillas J. Assessment of an ultrasound-guided technique for catheterization of the caudal thoracic paravertebral space in dog cadavers. Open Vet J 2019; 9:230-237. [PMID: 31998616 PMCID: PMC6794404 DOI: 10.4314/ovj.v9i3.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background The caudal thoracic paravertebral (CTPV) block is a regional anesthesia technique currently used in human medicine to provide analgesia in abdominal surgical procedures. Aim The objectives of this study are to describe an ultrasound-guided technique to place catheters in CTPV space in canine cadavers and evaluate the distribution of a 50:50 contrast-dye solution administered through them. Methods Eight thawed adult beagle cadavers (9.2 ± 2.0 kg body total weight) were used. Thirteen catheters were placed. In the first phase, a volume of 0.3 ml kg-1 of the contrast-dye was administered in all cases. After the injections, computed tomography (CT) scans were carried out to assess the distribution of the contrast-dye. In the second phase, an extra 0.2 ml kg-1 of the contrast-dye was administered through eight catheters, followed by a second CT scan. Two cadavers were dissected to assess the distribution of the contrast-dye. The injection site varied between T8-9 and T12-13. Results The evaluation of the CT scans showed contrast-dye within the paravertebral space in 92% (12/13) of the injections. The distribution pattern observed after the injections performed within the TPV space was linear and intercostal in all cases. The median (range) linear spread of the contrast was 7 (5-10) spinal nerves and involved 3 (2-8) intercostal spaces. The contrast-dye reached lumbar regions in 42% of the injections (5/12). A larger spread of the contrast-dye was not observed after the administration of a second dose of the injectate. No signs of epidural, intrapleural/intrapulmonary, intravascular, or intraabdominal spread were observed. The dissection of the two cadavers confirmed the spread of the contrast-dye along the sympathetic trunk and intercostal spaces. Conclusion The administration of 0.3 ml kg-1 of the contrast-dye in the CTPV space resulted in a distribution compatible with the block of nerves responsible for the innervation of the majority of the abdominal viscera and cranial abdominal wall.
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Affiliation(s)
- Roger Medina Serra
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | | | - Paolo Monticelli
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Mark Plested
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Jaime Viscasillas
- Departament de Medicina y Cirugia Animal, Facultad de Veterinaria, Instituto de Ciencias Biomedicas, Universidad CEU Cardenal Herrera, Valencia, Spain
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Ferreira TH, St James M, Schroeder CA, Hershberger-Braker KL, Teixeira LBC, Schroeder KM. Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers. Vet Anaesth Analg 2019; 46:516-522. [PMID: 31029460 DOI: 10.1016/j.vaa.2019.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe a technique to perform an ultrasound-guided erector spinae plane (ESP) block and determine the distribution and potential complications after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN Prospective experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 9.3 ± 1.9 kg. METHODS Ultrasound-guided injections dorsal to the transverse process and ventral to the erector spinae muscles aimed at the fifth thoracic transverse process were performed bilaterally in each dog using 0.5 and 1.0 mL kg-1 dye solution [low volume (LV) and high volume (HV) treatments, respectively]. Treatments were randomly assigned to the right or left side of each dog, resulting in a total of 16 injections. Anatomical dissections determined dye spread characteristics, including epaxial muscles spread, staining of spinal nerves, dorsal rami, ventral rami (intercostal nerves) and sympathetic trunk spread. Staining indicating potential complications (epidural, mediastinal and intrapleural spread) was recorded. RESULTS There was complete staining of at least one dorsal ramus following all injections. A more extensive spread was observed along the muscles in the HV compared with LV (p = 0.036). No significant difference between multisegmental dorsal rami spread (six out of eight injections in each treatment) was noted. Out of 16 injections, one in LV treatment resulted in multisegmental spinal nerve staining and one in HV treatment resulted in ventral ramus (intercostal nerve) staining. Use of anatomic landmarks resulted in inaccurate identification of the fifth transverse process in at least six out of 16 injections (38%). No sympathetic trunk, epidural, mediastinal or intrapleural staining was observed. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided ESP injections resulted in extensive staining along the epaxial muscles, as well as staining of the dorsal rami in all dogs. The incidence of dorsal rami mutisegmental spread was the same in both treatments.
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Affiliation(s)
- Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Leandro B C Teixeira
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Regional anesthetic techniques for the thoracic limb and thorax in small animals: A review of the literature and technique description. Vet J 2018; 241:8-19. [DOI: 10.1016/j.tvjl.2018.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
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Ferreira TH, Teixeira LB, Schroeder CA, de Miguel Garcia C, Schroeder KM. Description of an ultrasound-guided thoracic paravertebral block technique and the spread of dye in dog cadavers. Vet Anaesth Analg 2018; 45:811-819. [DOI: 10.1016/j.vaa.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022]
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Rawlinson JE, Bass L, Campoy L, Lesser C, Prytherch B. Evaluation of the equine mental foramen block: cadaveric and in vivo injectate diffusion. Vet Anaesth Analg 2018; 45:839-848. [DOI: 10.1016/j.vaa.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
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