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Ienello L, Byrne J, Tearney C, Franzen-Klein D, Ahlmann-Garcia A, Wendt-Hornickle E. Ultrasound-guided sciatic nerve block injections in barred owl (Strix varia) cadavers. Vet Anaesth Analg 2024; 51:558-565. [PMID: 39054197 DOI: 10.1016/j.vaa.2024.06.012] [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: 01/31/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To describe an ultrasound-guided approach to the sciatic nerve and the distribution of nerve staining using two injectate volumes of dye in barred owls. STUDY DESIGN Descriptive, randomized, assessor-blinded, cadaveric study. ANIMALS Twelve barred owl cadavers. METHODS The sciatic nerve was visualized with a 13-6 MHz linear ultrasound probe placed on the medial aspect of the proximal femur in barred owl cadavers. A needle was inserted at the proximal caudal thigh, and cranially advanced in-plane until the tip was immediately adjacent and ventral to the sciatic nerve. Eleven owls were injected bilaterally with a 1:1 solution of 1% methylene blue and 0.5% ropivacaine, with high-volume (HV; 0.4 mL kg-1) and low-volume (LV; 0.2 mL kg-1) treatments. Nerve staining ≥ 1 cm circumferentially was determined by dissection 15 minutes post-injection. The coelom was then opened to inspect for aberrant dye spread. In one barred owl cadaver, a 1:1 solution of 1% methylene blue and 74% ioversol contrast was injected, and computed tomography was performed immediately before and 15 minutes after injection for evaluation of injectate spread. RESULTS The HV treatment (0.4 mL kg-1) resulted in successful nerve staining in 100% of injections, whereas the LV treatment (0.2 mL kg-1) resulted in successful nerve staining in 91% of injections. There was no leakage of injectate into undesired locations (e.g. coelomic cavity) in any cadaver. CONCLUSIONS AND CLINICAL RELEVANCE In barred owls, the sciatic nerve can be visualized with ultrasound and injecting a ropivacaine/dye solution under ultrasound guidance successfully stained the sciatic nerve in the majority of cases. This technique holds potential for providing analgesia distal to the stifle joint; however, further investigations are necessary to evaluate its practical application in a clinical setting.
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Affiliation(s)
- Lauren Ienello
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA.
| | - Jessica Byrne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Caitlin Tearney
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | | | | | - Erin Wendt-Hornickle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
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Campos S, Picavet P, Bertrand O, Sandersen C, Tutunaru A. Immobilisation and Epidural Anaesthesia in a Eurasian Lynx ( Lynx lynx) Undergoing Pelvic Limb Orthopaedic Surgery. Case Rep Vet Med 2024; 2024:6373424. [PMID: 39157579 PMCID: PMC11329305 DOI: 10.1155/2024/6373424] [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: 11/19/2023] [Revised: 03/29/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024] Open
Abstract
Immobilisation and anaesthesia of wild felids may be complex and potentially dangerous events, making it difficult to implement more advanced anaesthetic techniques such as neuraxial anaesthesia. A Eurasian lynx was referred for femur fracture repair after it was seen with lameness of the left pelvic limb sustained in its natural environment. The animal was remotely darted using a combination of ketamine (5 mg/kg) and xylazine (5 mg/kg) intramuscularly. Once immobilised, the lynx was transported to the veterinary hospital in a restraining cage. After induction and endotracheal intubation, pelvic limb radiographs confirmed a closed, comminuted fracture of the left femur that required open reduction and internal stabilisation. A sacrococcygeal epidural was performed before surgery using lidocaine (2 mg/kg) and morphine (0.1 mg/kg) to complement the ketamine-xylazine-isoflurane anaesthesia, which allows a low-end-tidal isoflurane concentration. Clinical signs were continuously monitored and remained stable during the entire procedure, with the exception of a temperature that decreased to 35.8°C. No intraoperative analgesic rescues were necessary. Recovery was smooth and uneventful. The lynx showed no signs of motor weakness after surgery or other side effects related to the anaesthetic procedure. The successful management of this surgical case suggests that the described anaesthetic protocol could be recommended in orthopaedic procedures of the pelvic limbs in wild Felidae.
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Affiliation(s)
- Sonia Campos
- CECAV-Veterinary and Animal Research CentreFaculty of Veterinary MedicineLusófona University, Lisbon, Portugal
| | - Pierre Picavet
- University Veterinary ClinicFaculty of Veterinary MedicineLiége University, Liége, Belgium
| | | | - Charlotte Sandersen
- University Veterinary ClinicFaculty of Veterinary MedicineLiége University, Liége, Belgium
| | - Alexandru Tutunaru
- University Veterinary ClinicFaculty of Veterinary MedicineLiége University, Liége, Belgium
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Portela DA, Romano M, Koehler P, Donati PA, Zamora GA, Gandi KY, Vettorato E, Chiavaccini L, Otero PE. Greater ischiatic notch plane versus parasacral block in dogs undergoing pelvic limb surgery: a retrospective noninferiority cohort study on perioperative opioid consumption. Vet Anaesth Analg 2024:S1467-2987(24)00132-6. [PMID: 39153955 DOI: 10.1016/j.vaa.2024.07.008] [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: 03/05/2024] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To compare perioperative opioid consumption in dogs undergoing pelvic limb surgeries and receiving a lumbosacral plexus block by combining a lumbar [lateral pre-iliac (LPI)] block with a lumbosacral trunk [i.e. parasacral (PS group) or greater ischiatic notch plane (GIN group)] block. Study design Retrospective, descriptive, exploratory, noninferiority cohort study. METHODS Medical records of 37 client-owned dogs were analyzed. Intraoperative (primary outcome) and postoperative (24 hours) opioid use, 24 hour cumulative pain scores and prevalence of complications were compared between the two groups. Opioid use was quantified in morphine equivalents (ME, mg kg-1 ). The noninferiority limit for intraoperative opioid consumption was set at 0.05 ME kg-1 hour-1. Demographic data, procedure duration, surgery type and perioperative dexmedetomidine and ketamine use were also collected. A t-test or Wilcoxon rank-sum test, a Fisher's exact test and multivariable linear regression were used. Significance was set at p < 0.05. RESULTS The GIN and PS groups comprised 17 and 20 dogs, respectively. Total intraoperative ME consumption was 0.17 (0.11-0.21) and 0.22 (0.16-0.30) mg kg-1 hour-1 for the GIN and PS groups, respectively (p = 0.077). The noninferiority analysis adjusted by surgery type and body mass revealed that the mean difference between the groups (GIN - PS) was -0.039 (95% CI -0.11-0.03, p = 0.247) ME mg kg-1 hour-1, indicating that the GIN group was not inferior to the PS group regarding intraoperative ME consumption. Dexmedetomidine and ketamine use, postoperative ME consumption and pain scores were similar between groups. CONCLUSIONS AND CLINICAL RELEVANCE This retrospective study and preliminary observations support the clinical use of the GIN plane block, demonstrating its noninferiority to the PS block when combined with the LPI block for multimodal perioperative analgesia in dogs undergoing pelvic limb surgeries.
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Affiliation(s)
- Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - Marta Romano
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Perry Koehler
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Pablo A Donati
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo A Zamora
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Keith Y Gandi
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Enzo Vettorato
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, 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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Redondo JI, Martínez-Taboada F, Viscasillas J, Doménech L, Marti-Scharfhausen R, Hernández-Magaña EZ, Otero PE. Anaesthetic mortality in cats: A worldwide analysis and risk assessment. Vet Rec 2024; 195:e4147. [PMID: 38959210 DOI: 10.1002/vetr.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Patient safety is essential in small animal anaesthesia. This study aimed to assess anaesthesia-related deaths in cats worldwide, identify risk and protective factors and provide insights for clinical practice. METHODS A prospective multicentre cohort study of 14,962 cats from 198 veterinary centres across different countries was conducted. Data on anaesthesia-related deaths, from premedication up to 48 hours postextubation, were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs. RESULTS The anaesthesia-related mortality was 0.63%, with 74.5% of deaths occurring postoperatively. Cats with cachexia, a higher ASA status or who underwent abdominal, orthopaedic/neurosurgical or thoracic procedures exhibited elevated mortality. Mechanical ventilation use was associated with increased mortality. Mortality odds were reduced by the use of alpha2-agonist sedatives, pure opioids in premedication and locoregional techniques. LIMITATIONS Limitations include non-randomised sampling, potential biases, unquantified response rates, subjective death cause classification and limited variable analysis. CONCLUSIONS Anaesthetic mortality in cats is significant, predominantly postoperative. Risk factors include cachexia, higher ASA status, specific procedures and mechanical ventilation. Protective factors include alpha2-agonist sedatives, pure opioids and locoregional techniques. These findings can help improve anaesthesia safety and outcomes. However, further research is required to improve protocols, enhance data quality and minimise risks.
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Affiliation(s)
- José I Redondo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Fernando Martínez-Taboada
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- 3A Animal Anaesthesia and Analgesia, Victoria, Australia
| | | | - Luis Doménech
- Departamento de Matemáticas, Física y Ciencias Tecnológicas, Escuela Superior de Enseñanzas Técnicas, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | | | - Eva Z Hernández-Magaña
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Pablo E Otero
- Department of Anaesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
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Otero PE, Guerrero JA, Tarragona L, Micieli F, Sanchez MF, Donati PA, Ceballos MR, Portela DA. Ultrasound-Guided Greater Ischiatic Notch Plane Block Combined with the Caudal Quadratus Lumborum Block (GIN-TONIC Block) in Dogs Undergoing Pelvic Limb Surgery: Preliminary Results. Animals (Basel) 2024; 14:1764. [PMID: 38929383 PMCID: PMC11201028 DOI: 10.3390/ani14121764] [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: 05/16/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
This study assessed the analgesic and motor effects of the GIN-TONIC block, a combination of the greater ischiatic notch plane block and the caudal lateral quadratus lumborum block, in 24 dogs undergoing pelvic limb surgery. Dogs were randomly divided into two equal groups: GA received acepromazine [(20 µg kg-1 intravenously (IV)] as premedication, and GD received dexmedetomidine (2 µg kg-1 IV). General anesthesia was maintained with isoflurane, and both groups received a GIN-TONIC block using 2% lidocaine. Nociception during surgery and postoperative pain [assessed using the Glasgow Composite Measure Pain Score (GCMPS-SF)] were assessed. Fentanyl (2 µg kg-1 IV) was administered if nociception was noted and morphine (0.5 mg kg-1 IV) was administered during recovery if the pain scores exceeded the predefined threshold. Motor function was assessed during the recovery period using descriptors previously reported. All dogs received analgesics at the 4 h mark before being discharged. Three and two dogs in GD and GA required fentanyl once. Postoperative pain scores remained ≤4/20 for all dogs except one. Dogs achieved non-ataxic ambulation within 38.9 ± 10.3 and 35.1 ± 11.1 min after extubation in GD and GA, respectively. This study highlighted the potential of the GIN-TONIC block as a feasible regional anesthesia method for delivering perioperative analgesia in dogs undergoing pelvic limb orthopedic surgery.
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Affiliation(s)
- Pablo E. Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWO, Argentina; (J.A.G.); (L.T.); (M.F.S.); (P.A.D.); (M.R.C.)
| | - Jorge A. Guerrero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWO, Argentina; (J.A.G.); (L.T.); (M.F.S.); (P.A.D.); (M.R.C.)
| | - Lisa Tarragona
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWO, Argentina; (J.A.G.); (L.T.); (M.F.S.); (P.A.D.); (M.R.C.)
| | - Fabiana Micieli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy;
| | - María Fernanda Sanchez
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWO, Argentina; (J.A.G.); (L.T.); (M.F.S.); (P.A.D.); (M.R.C.)
| | - Pablo A. Donati
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWO, Argentina; (J.A.G.); (L.T.); (M.F.S.); (P.A.D.); (M.R.C.)
| | - Martin R. Ceballos
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWO, Argentina; (J.A.G.); (L.T.); (M.F.S.); (P.A.D.); (M.R.C.)
| | - Diego A. Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0123, USA;
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Polo-Paredes G, Soler M, Gil F, Laredo FG, Agut A, Carrillo-Flores S, Belda E. Description and Evaluation of Dye and Contrast Media Distribution of Ultrasound-Guided Rectus Sheath Block in Cat Cadavers. Animals (Basel) 2024; 14:1743. [PMID: 38929362 PMCID: PMC11200878 DOI: 10.3390/ani14121743] [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: 05/12/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The rectus sheath block is an ultrasound-guided anaesthetic technique which aims to provide analgesia to the abdominal midline. This study aimed to assess the distribution of 0.4 mL kg-1 of a mixture of methylene blue and iopromide injected into each hemiabdomen in the internal rectus sheath in cat cadavers. We hypothesise that this technique would be feasible and would cover the rami ventrales of the last thoracic and the first lumbar spinal nerves. The study was divided into two phases. Phase 1 aimed to study the anatomical structures of the ventral abdominal wall (four cats were dissected). Phase 2 (ten cadavers) consisted of an ultrasound-guided injection of the mixture mentioned above and the assessment of its distribution by computed tomography and anatomical dissection. The results showed the staining of the cranioventral abdominal wall with a craniocaudal spread of four (three to eight) vertebral bodies. Methylene blue stained three (one to four) rami ventrales, affecting T10 (60%), T11 (100%), T12 (90%), T13 (50%) and L1 (5%). Based on these results, it could be stated that this technique could supply anaesthesia to the midline of the abdominal midline cranial to the umbilicus in clinical patients, but it may not be able to provide anaesthesia to the middle and caudal midline abdominal region.
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Affiliation(s)
- Gonzalo Polo-Paredes
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
- Escuela Internacional de Doctorado de la Universidad de Murcia, Programa en Ciencias Veterinarias, Universidad de Murcia, 30100 Murcia, Spain
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco Gil
- Departamento de Anatomía y Anatomía Patológica Comparada, 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; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
| | | | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (M.S.); (F.G.L.); (A.A.)
- Hospital Veterinario Universidad de Murcia, 30100 Murcia, Spain;
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Graff SM, Wilson DV, Déjardin LM, Nelson NC. A comparison of the motor effects and analgesic efficacy following lumbar plexus block combined with sciatic nerve block or epidural in dogs undergoing tibial plateau leveling osteotomy. Vet Anaesth Analg 2024; 51:271-278. [PMID: 38102032 DOI: 10.1016/j.vaa.2023.10.034] [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: 04/05/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To compare motor effects and analgesic efficacy following an ultrasound-guided lateral approach to lumbar plexus blockade at L7 and sciatic nerve blockade (LPSNB) against epidural injection in dogs undergoing tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Prospective, randomized, blinded clinical trial. ANIMALS A total of 27 healthy adult dogs undergoing unilateral TPLO surgery. METHODS Dogs were allocated to either LPSNB (bupivacaine 2 mg kg-1, 0.75%) or epidural (morphine PF 0.1 mg kg-1 and bupivacaine 0.5 mg kg-1, 0.75%). Other aspects of clinical management were identical, including anesthetic drug protocol, area of presurgical clipping and bladder care. Time to perform the block, response to surgical stimuli, pain scores, rescue analgesia, time to stand and walk, motor score and time to first urination were recorded. One evaluator, unaware of treatment status, performed all evaluations. Student's t-test or Mann-Whitney U test was used to compare continuous variables between groups, and Fisher's exact test for categorical variables. RESULTS Median (range) times to stand and walk were shorter for LPSNB [60 (40-120) minutes and 90 (60-150) minutes, respectively, p = 0.003] than for epidural [150 (120-240) minutes and 180 (120-360) minutes, respectively, p = 0.006]. Four dogs required rescue intraoperatively (three in epidural group, one in LPSNB group, p = 0.438). Pain scores over the 24 hour evaluation period were similar, and not significantly different, for each group. Time to spontaneous urination [LPSNB, 330 (240-360) minutes; epidural, 300 (120-1440) minutes, p = 1.0] did not differ between groups. CONCLUSIONS AND CLINICAL RELEVANCE An ultrasound-guided lateral paravertebral approach to the lumbar plexus within the psoas compartment at L7, combined with sciatic nerve blockade, allows faster return to normal motor function, with similar pain control and impact on urination when compared with epidural in dogs after TPLO surgery.
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Affiliation(s)
- Sophie M Graff
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Deborah V Wilson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
| | - Loic M Déjardin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Nathan C Nelson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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Otero PE, Fuensalida SE, Tarragona L, Díaz A, Sanchez MF, Micieli F, Waxman S, Zaccagnini AC, Donati PA, Portela DA. Ultrasound-guided caudal quadratus lumborum block combined with the greater ischiatic notch plane block as motor-protective analgesia for the pelvic limb in dogs. Vet Anaesth Analg 2024; 51:97-106. [PMID: 38000928 DOI: 10.1016/j.vaa.2023.11.001] [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: 08/07/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE To develop an ultrasound-guided caudal quadratus lumborum block (C-QLB) technique in canine cadavers and to compare sensory and motor blockade resulting from the combination of ultrasound-guided greater ischiatic notch (GIN) plane and C-QLB approaches (GIN-CQLB group) versus a lumbosacral plexus (LSP group) approach [combination of lateral pre-iliac (LPI) and parasacral (PS) techniques] in dogs. STUDY DESIGN Descriptive anatomical study and prospective randomized, blinded, experimental crossover trial. ANIMALS A total of six canine cadavers and six adult Beagle dogs. METHODS Phase I: following ultrasound-guided C-QLB injections of 0.3 mL kg-1 of dye, using the interfascial plane located lateral to the quadratus lumborum muscle at the level of the sixth lumbar vertebra (L6) as injection point, the spread of injectate and nerve staining was evaluated using gross anatomical dissection. PHASE II sensory and motor blockade achieved with the GIN-CQLB or LSP blocks in Beagle dogs were evaluated and compared. The assigned technique was performed with 2% lidocaine: 0.2 mL kg-1 for the GIN and PS approaches and 0.3 mL kg-1 for the C-QLB and LPI approaches. RESULTS Dissection revealed distribution of dye around the lumbar hypaxial musculature, extending into the paravertebral spaces, with staining of 3 (2-4) [median (interquartile range)] spinal nerves, spanning L3 to L6. The median motor blockade in the GIN-CQLB and LSP groups was 7 (7-8) versus 16 (10-16) (p = 0.026), whereas the median sensory blockade was 5 (4-5) versus 3 (3-3) (p = 0.025), respectively. CONCLUSION AND CLINICAL SIGNIFICANCE The GIN-CQLB approach desensitized the thigh dermatomes effectively. Compared with the LSP approaches, GIN-CQLB exhibits a motor-protective effect by preserving tonic muscle function.
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Affiliation(s)
- Pablo E Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina.
| | - Santiago E Fuensalida
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
| | - Lisa Tarragona
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
| | - Alfredo Díaz
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
| | - María Fernanda Sanchez
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
| | - Fabiana Micieli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Samanta Waxman
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina; National Scientific and Technical Research Council (Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, CONICET), Buenos Aires, Argentina
| | - Andrea C Zaccagnini
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
| | - Pablo A Donati
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
| | - Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
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Polo-Paredes G, Laredo FG, Gil F, Soler M, Agut A, Belda E. Modified Ultrasound-Guided Dorsal Quadratus Lumborum Block in Cat Cadavers. Animals (Basel) 2023; 13:3798. [PMID: 38136835 PMCID: PMC10741190 DOI: 10.3390/ani13243798] [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: 10/31/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthesia technique which aims to provide analgesia to the abdomen. The main objective of this study was to assess a modified ultrasound-guided dorsal QL block in cat cadavers. For this purpose, a volume of 0.4 mL kg-1 of a mixture of iopromide and methylene blue was administered between the psoas minor muscle and the vertebral body (VB) of the first lumbar vertebra, and its distribution was assessed in thirteen cat cadavers. We hypothesized that this injection point would be feasible, offering a more cranial distribution of the injectate and a more consistent staining of the truncus sympathicus. The study was divided into two phases. Phase 1 consisted of an anatomical study (three cadavers were dissected). Phase 2 consisted of the ultrasound-guided administration of the injectate and the assessment of its distribution by computed tomography and anatomical dissection. The results showed a consistent distribution of contrast media within five (4-8) VBs from T10 to L5. Methylene blue stained three (2-6) rami ventrales, affecting T11 (10%), T12 (20%), T13 (60%), L1 (85%), L2 (95%) and L3 (65%). The truncus sympathicus was dyed in all cadavers with a spread of five (3-7) VBs. Finally, the splanchnicus major nerve was stained in all cadavers (100%). These results suggest that this technique could provide analgesia to the abdominal viscera and the abdominal wall, probably with the exception of the cranial aspects of the abdominal wall.
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Affiliation(s)
- Gonzalo Polo-Paredes
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (F.G.L.); (M.S.); (A.A.)
| | - Francisco G. Laredo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (F.G.L.); (M.S.); (A.A.)
| | - Francisco Gil
- Departamento de Anatomía y Anatomía Patológica Comparada, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain;
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (F.G.L.); (M.S.); (A.A.)
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (F.G.L.); (M.S.); (A.A.)
| | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (G.P.-P.); (F.G.L.); (M.S.); (A.A.)
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10
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Lima MPAD, Silva RA, Duarte PDC, Rocha Júnior SDS, Branco SEMT, Paz CFR, Otero PE, Faleiros RR, Beier SL. Effects of two different topographic approaches for combined sciatic and femoral nerve block in calves, guided by ultrasound and neurostimulation. Vet Anim Sci 2023; 22:100315. [PMID: 37781167 PMCID: PMC10539659 DOI: 10.1016/j.vas.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
To evaluate the sensory and motor effects promoted by a combined sciatic and femoral nerve block in calves using two approaches. Six calves were used, in a crossover study. Ultrasound combined with neurostimulation, was used to perform the following block combinations: the proximal approach (PA), which consisted of the association of the parasacral approach (sciatic nerve block) and ventral to the ilium approach (femoral nerve block); distal approach (DA) consisted of the association of a lateral approach to the pelvic limb approach (sciatic nerve block), and an inguinal approach, underneath the femoral trigone (femoral nerve block). Pressure algometry and motor function of the limb where evaluated. Mechanical nociceptive threshold (MNT) increase, and ataxia duration means were 9.5 ± 0.7 kg and 10.4 ± 3.9 hr for PA and 10.4 ± 3.9 kg and 12.7 ± 1.9 hr for DA, respectively with no significant difference. There was no significant difference between MNT elevation time and the duration of ataxia using the same approach. The DA treatment showed significant MNT elevation in 72% of the tested regions, while the PA treatment showed an elevation in 100% regions tested. Topographic approaches closer to where the spinal nerves emerge produced a larger desensitised area.
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Affiliation(s)
- Marcos Paulo Antunes de Lima
- Veterinary Medicine Course, Biological and Health Sciences Institute, Pontifícia Universidade Católica de Minas Gerais, Minas Gerais, Brazil
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renata Andrade Silva
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Patrícia de Castro Duarte
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sérgio da Silva Rocha Júnior
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Cahuê Francisco Rosa Paz
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pablo Ezequiel Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Rafael Resende Faleiros
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Suzane Lilian Beier
- Department of Veterinary Clinic and Surgery, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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11
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Citarella G, Mauri N, Schmitz T, Bettschart-Wolfensberger R. An ultrasound-guided brachial plexus block using an interscalene approach in an Huacaya alpaca. Vet Anaesth Analg 2023; 50:526-528. [PMID: 37723008 DOI: 10.1016/j.vaa.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Gerardo Citarella
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Nico Mauri
- Section of Diagnostic Imaging, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; Vetimage Diagnostik AG, Oberentfelden, Switzerland
| | - Thomas Schmitz
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Regula Bettschart-Wolfensberger
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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12
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Koehler P, Otero PE, Chiavaccini L, Romano M, Stern AW, Cavalcanti M, Portela DA. A non-inferiority study comparing the ultrasound-guided parasacral with a novel greater ischiatic notch plane approach in canine cadavers. Vet Anaesth Analg 2023; 50:439-445. [PMID: 37331905 DOI: 10.1016/j.vaa.2023.05.003] [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: 02/08/2023] [Revised: 05/05/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To describe the gross and ultrasound anatomy of the parasacral region and an ultrasound-guided greater ischiatic notch (GIN) plane approach aimed at staining the lumbosacral trunk (LST) in canine cadavers. To evaluate if the ultrasound-guided GIN plane approach is non-inferior to the previously described ultrasound-guided parasacral approach at staining the LST. STUDY DESIGN Prospective, randomized, non-inferiority experimental anatomic study. ANIMALS A total of 17 (23.9 ± 5.2 kg) mesocephalic canine cadavers. METHODS Anatomic and echographic landmarks, and the feasibility of performing a GIN plane technique were evaluated using two canine cadavers. The remaining 15 cadavers had each hemipelvis randomly assigned to be administered either parasacral or GIN plane injection of 0.15 mL kg-1 dye solution. The parasacral region was dissected after injections to assess the staining of LST, cranial gluteal nerve, pararectal fossa and pelvic cavity. The stained LST were removed and processed for histological evaluation of intraneural injections. A one-sided z-test for non-inferiority (non-inferiority margin -14%) was used to statistically evaluate the success of the GIN plane versus the parasacral approach. Data were considered statistically significant when p < 0.05. RESULTS The GIN plane and parasacral approach stained the LST in 100% and 93.3% of the injections, respectively. The success rate difference between treatments was 6.7% [95% confidence interval, -0.6 to 19.0%; p < 0.001 for non-inferiority]. The GIN plane and parasacral injections stained the LST for 32.7 ± 16.8 mm and 43.1 ± 24.3 mm, respectively (p = 0.18). No evidence of intraneural injection was found. CONCLUSIONS AND CLINICAL RELEVANCE The ultrasound-guided GIN plane technique resulted in nerve staining that was non-inferior to the parasacral technique and may be considered an alternative to the parasacral approach to block the LST in dogs.
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Affiliation(s)
- Perry Koehler
- Department of Comparative, Diagnostic, and Population Medicine, 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
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Romano
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Adam W Stern
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Mariana Cavalcanti
- 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.
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13
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Marchina-Gonçalves A, Laredo FG, Gil F, Soler M, Agut A, Redondo JI, Belda E. An Ultrasound-Guided Latero-Ventral Approach to Perform the Quadratus Lumborum Block in Dog Cadavers. Animals (Basel) 2023; 13:2214. [PMID: 37444012 DOI: 10.3390/ani13132214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/23/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
The QL block is a high-level locoregional anesthesia technique, which aims to provide analgesia to the abdomen. Several approaches of the QL block have been studied to find out which one allows a greater distribution of the injectate. The aim of this study is to compare the traditional interfascial QL block (IQL) with a new latero-ventral approach (LVQL). We hypothesize that this new approach could be safer and easier to perform, since the injectate is administered more superficially and further away from vital structures. Our second objective is to assess whether a higher volume of injectate (0.6 mL/kg) could reach the ventral branches of the last thoracic nerves, leading to a blockade of the cranial abdomen. Six thawed canine cadavers (12 hemiabdomens) were used for this purpose. Both approaches were performed in all cadavers. A combination of methylene blue/iopromide was administered to each hemiabdomen, randomly assigned to the LVQL or IQL. No differences were found regarding the ease of perform the LVQL with respect to IQL. The results show that both techniques reached the ventral branches from L1 to L3, although only the IQL consistently stained the sympathetic trunk (5/6 IQL vs. 1/6 LVQL). The use of a higher volume did not enhance a more cranial distribution of the injectate.
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Affiliation(s)
- André Marchina-Gonçalves
- Escuela Internacional de Doctorado, Programa en Ciencias Veterinarias, Universidad de Murcia, 30100 Murcia, Spain
| | - Francisco G Laredo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain
| | - Francisco Gil
- Departamento de Anatomía y Anatomía Patológica Comparada, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain
| | - José Ignacio Redondo
- Departamento Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain
| | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain
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14
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Portela DA, Cavalcanti M, Teixeira JG, Gandy KY, Zamora G, Stern AW, Jones R, Fuensalida SE, Chiavaccini L, Romano M, Otero PE. Lumbosacral plexus block using a combination of ultrasound-guided lateral pre-iliac and parasacral approaches in cats. Vet Anaesth Analg 2023; 50:188-196. [PMID: 36775670 DOI: 10.1016/j.vaa.2023.01.003] [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: 10/28/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe an ultrasound-guided lateral pre-iliac (LPI) and parasacral (PS) approach in feline cadavers (phase I) and compare the perioperative analgesic use and complications in cats administered LPI and PS blocks (group PNB) or epidural anesthesia (group EPI) for pelvic limb surgery (phase II). STUDY DESIGN Experimental uncontrolled, anatomic and retrospective cohort study. ANIMALS A group of eight feline cadavers and 52 medical records. METHODS Bilateral LPI and PS approaches with 0.1 mL kg-1 of dye to stain the femoral and obturator nerves and the lumbosacral trunk, respectively, were performed on each cadaver. Nerve staining effect was evaluated upon dissections (phase I). Perioperative analgesics use, and complication rates were retrospectively compared between groups PNB and EPI (phase II). Continuous data were compared using the Mann-Whitney U test and the prevalence of events with Fisher's exact test. Differences were considered significant when p < 0.05. RESULTS Dissections revealed that the LPI approach stained 94% and 75% of the femoral and obturator nerves, respectively. The PS approach stained 100% of the lumbosacral trunks. Cats enrolled in group PNB (n = 23) were administered lower doses of intraoperative opioids than those in group EPI (n = 25) (p = 0.006). Intraoperative rescue analgesia was required in 60% and 17.4% of cats enrolled in groups EPI and PNB, respectively (p = 0.003). Group PNB required more intraoperative anticholinergics than group EPI (p = 0.02). There were no differences in postoperative pain scores, analgesic use and complication rates. CONCLUSIONS AND CLINICAL RELEVANCE The ultrasound-guided LPI and PS approach stained the femoral/obturator nerves and the lumbosacral trunk, respectively, in feline cadavers. Furthermore, PNB was associated with lower intraoperative opioid use and similar postoperative pain and analgesic use compared with epidural anesthesia in a cohort of cats undergoing surgery of the pelvic limb.
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Affiliation(s)
- Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - Mariana Cavalcanti
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Jorge G Teixeira
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Keith Y Gandy
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Gustavo Zamora
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Adam W Stern
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Rachel Jones
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Santiago E Fuensalida
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Romano
- Department of Comparative, Diagnostic, and Population Medicine, 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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15
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Stabile M, Lacitignola L, Acquafredda C, Scardia A, Crovace A, Staffieri F. Evaluation of a constant rate intravenous infusion of dexmedetomidine on the duration of a femoral and sciatic nerve block using lidocaine in dogs. Front Vet Sci 2023; 9:1061605. [PMID: 36713886 PMCID: PMC9880291 DOI: 10.3389/fvets.2022.1061605] [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: 10/04/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Objectives This study investigated the effects of 1 μg/kg/h intravenous constant rate infusion (CRI) of dexmedetomidine on the sensory and motor blockade for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Materials and methods Client-owned dogs referred for stifle surgery were enrolled in this prospective, randomized, blinded study. Dogs were pre-medicated with acepromazine (0.005-0.01 mg/kg intramuscularly, IM); anesthesia was induced with propofol intravenously and maintained with isoflurane in a mixture of air and oxygen. Electrolocation-guided sciatic and femoral nerve blocks with lidocaine 2% (0.15 mL/kg) were performed using the parasacral and lateral pre-iliac approaches, respectively. After performing local block, a systemic infusion of saline solution (group C) or dexmedetomidine (group D) was started at a CRI at 1 ml/kg/h and continued until the end of surgery. Dexmedetomidine was infused at a dose of 1 μg/kg/h. Respiratory and hemodynamic variables were recorded during surgery. Sensory and motor blockade was evaluated by response to pinching the skin innervated by the sciatic/femoral nerves, with forceps and by observing the dogs' ability to walk and testing proprioception at 30, 60, 120, 180, and 240 min after extubation. Analgesia was monitored with SF-GCPS. Methadone IM was administered as rescue analgesia. Intraoperative data were analyzed by analysis of variance, while postoperative data were analyzed by the independent two-tailed t-test and a Kaplan-Meier test (p < 0.05). Results Twenty dogs were included in this study (10/group). A significant difference in the recovery of sensory nerve function was observed between the groups. The mean durations of the sensory blockade for femoral and sciatic nerves, respectively, was longer (p < 0.001) for group D [168 (146-191, 95% CI), 161 (143-179, 95% CI) min] than in group C [120 (96.1-144, 95% CI), 116 (90.9-142, 95% CI]. No differences in the recovery of patellar and tibial reflexes, proprioceptive function, and ability to walk were found among groups. The overall postoperative rescue analgesia requirement was significantly different (p = 0.019) between groups, with an incidence of 5/10 (50%) dogs in group D and 10/10 (100%) dogs in group C. Conclusion Dexmedetomidine administered as a CRI (1 μg/kg/h) combined with local lidocaine increases the duration of the sensory component of the sciatic and femoral nerve blocks and reduces the requirement for additional analgesia during the immediate postoperative hours.
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16
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Ruíz‐López P, Felisberto R, Haardt H, Martens A, Schauvliege S. Ultrasound‐guided sciatic nerve block in two alpacas (
Vicugna pacos
) as part of an anaesthesia plan for hindlimb fractures. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Patricia Ruíz‐López
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine University of Ghent Merelbeke Belgium
| | | | - Hanna Haardt
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine University of Ghent Merelbeke Belgium
| | - Ann Martens
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine University of Ghent Merelbeke Belgium
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine University of Ghent Merelbeke Belgium
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17
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Gavet M, Conde Ruiz C. Partial intravenous anaesthesia and opioid‐sparing analgesia in a dog undergoing surgical management of insulinoma. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Paolini A, Santoro F, Bianchi A, Collivignarelli F, Vignoli M, Scialanca S, Parrillo S, Falerno I, De Bonis A, Rosto M, Tamburro R. Use of Transversus Abdominis Plane and Intercostal Blocks in Bitches Undergoing Laparoscopic Ovariectomy: A Randomized Controlled Trial. Vet Sci 2022; 9:604. [PMID: 36356081 PMCID: PMC9694432 DOI: 10.3390/vetsci9110604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 10/28/2022] [Indexed: 10/17/2023] Open
Abstract
In humans and dogs, loco-regional anesthesia is associated with lower peri-operative opioid consumption and less related side effects. The combination of transversus abdominis plane (TAP) and intercostal blocks can be used to desensitize the entire abdominal wall in dogs. The aim of this study was to evaluate the effectiveness of TAP and intercostal blocks in bitches undergoing laparoscopic ovariectomy. Twenty client-owned bitches were enrolled in this double-blinded randomized controlled trial. After premedication with dexmedetomidine, methadone and ketamine, the animals were randomized into two groups. Dogs in the TAP group received intercostal blocks from T8 to T10 and a TAP block with ropivacaine. Dogs in the FEN group received a fentanyl bolus and a constant rate infusion for the entire duration of the procedure. Intra-operative cardiovascular stability, post-operative pain scores, rescue opioid requirement, dysphoria during recovery, time to attain sternal recumbency and interest in food at 6 h post-extubation were compared. Bitches in the TAP group received a statistically significant lower amount of rescue fentanyl intra-operatively and methadone post-operatively. Pain scores were lower in the TAP group until 6 h post-extubation. No difference was found for dysphoric recoveries, time to attain sternal recumbency and appetite at 6 h post-extubation. No adverse event was recorded for any of the dogs. The combination of TAP and intercostal blocks can be part of an effective multi-modal analgesic strategy in bitches undergoing laparoscopic ovariectomy.
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Affiliation(s)
- Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Francesco Santoro
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield AL9 7TA, UK
| | - Amanda Bianchi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | | | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Silvia Scialanca
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Salvatore Parrillo
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Andrea De Bonis
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Martina Rosto
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
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19
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Cavaco JS, Otero PE, Ambrósio AM, Neves ICB, Perencin FM, Pereira MAA, Matera JM, Fantoni DT. Analgesic efficacy of ultrasound-guided transversus abdominis plane block in dogs undergoing ovariectomy. Front Vet Sci 2022; 9:1031345. [PMID: 36387373 PMCID: PMC9659733 DOI: 10.3389/fvets.2022.1031345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
Background In medicine, the transversus abdominis plane (TAP) block has been shown as an effective method of analgesia in several surgical procedures. In this context, this prospective, randomized, blinded study aimed to evaluate the analgesic efficacy of TAP block, guided by ultrasound in female dogs submitted to ovariectomy. Methods Therefore, 32 animals randomly assigned in two groups (n = 16) were used. Groups consisted of TAP block control (TBC) which received water injection (0.2 ml kg−1 point), and TAP block bupivacaine (TBB) which received bupivacaine (0.2 ml kg−1 point at 0.25%); both groups were submitted to four-point approach. Animals were pre-medicated with acepromazine (0.03 mg kg−1) and meperidine (2 mg kg−1) IM, propofol was used as anesthetic induction (3–5 mg kg−1) IV, and isoflurane was used to maintain. To standardize groups, the animals received a continuous infusion of remifentanil (0.2μg kg−1 min) and rocuronium (0.6 mg kg−1) IV in the intraoperative period. Variables measured were the heart and respiratory rates, blood pressure, temperature, peripheral oxyhemoglobin saturation, exhaled carbon dioxide concentration, exhaled isoflurane concentration, serum cortisol, analgesia, and sedation. Before the pre-anesthetic medication (Baseline) and 1, 2, 4, 6, and 8 h after extubation, pain and sedation were assessed using a numeric rating scale (NRS), Glasgow composite measure pain scale (GCMPS-SF), and sedation scale. Moreover, serum cortisol was measured at different moments. Results The results show that in the intraoperative period, there was no significant difference between groups. After surgery, in TBC, 13 out of 16 animals required analgesic rescue, whereas, in TBB, this occurred only in one animal. Regarding the measurement of serum cortisol, the TBC group showed a significant difference when compared to the baseline time in the traction of the first ovary (p < 0.0001), 2 h (p = 0.0441), and 8 h (p = 0.0384) after extubation. In TBB, cortisol showed a significant increase only in the traction of the first ovary and 2 h after extubation (p < 0.0001). Conclusion The technique using ultrasound-guided TAP block in two points approach by hemiabdomen with 0.2 ml kg−1 bupivacaine 0.25% was effective in providing post-operative analgesia in dogs undergoing ovariectomy.
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Affiliation(s)
- Jéssica Sperandio Cavaco
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
- *Correspondence: Jéssica Sperandio Cavaco
| | - Pablo Ezequiel Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Aline Magalhães Ambrósio
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Ieda Cristina Boni Neves
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Felipe Montanheiro Perencin
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Marco Aurélio Amador Pereira
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Julia Maria Matera
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Denise Tabacchi Fantoni
- Department of Surgery, Faculty of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
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20
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Monteiro BP, Lascelles BDX, Murrell J, Robertson S, Steagall PVM, Wright B. 2022
WSAVA
guidelines for the recognition, assessment and treatment of pain. J Small Anim Pract 2022. [DOI: 10.1111/jsap.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. P. Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. D. X. Lascelles
- Comparative Pain Research Laboratory and Surgery Section North Carolina State University 4700 Hillsborough Street Raleigh NC USA
| | - J. Murrell
- Highcroft Veterinary Referrals 615 Wells Rd, Whitchurch Bristol BS149BE UK
| | - S. Robertson
- Senior Medical Director Lap of Love Veterinary Hospice 17804 N US Highway 41 Lutz FL 33549 USA
| | - P. V. M. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. Wright
- Mistral Vet 4450 Thompson Pkwy Fort Collins CO 80534 USA
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Campoy L. Development of Enhanced Recovery After Surgery (ERAS) protocols in veterinary medicine through a one-health approach: the role of anesthesia and locoregional techniques. J Am Vet Med Assoc 2022; 260:1751-1759. [DOI: 10.2460/javma.22.08.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Enhanced Recovery After Surgery (ERAS) is a new and emerging concept in human medicine that involves rethinking the preoperative, intraoperative, and postoperative periods. The ultimate, overarching aim is to improve patient outcome following surgery and, thus, return to a normal daily routine as soon as possible. The development and implementation of locoregional anesthetic techniques in humans is one of the key elements driving these protocols. In veterinary medicine, we are no exception: the rapidly growing interest, development, and refinement of these techniques in our veterinary species is changing the way we think of anesthesia and analgesia. The potential real benefits are yet to be determined, as this concept is implemented into our veterinary hospitals in general, and our surgical patients in particular, in a more systematic and routine way. In this article, we will introduce the reader to the concept of ERAS protocols and the role of regional anesthesia in some common surgical procedures.
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Affiliation(s)
- Luis Campoy
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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22
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Ultrasound-guided and nerve stimulator-assisted sciatic and saphenous nerve blocks in a goat undergoing tarsal fracture repair. Vet Anaesth Analg 2022; 49:676-677. [PMID: 36182643 DOI: 10.1016/j.vaa.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
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Comparison of dorsoventral and ventrodorsal approaches for the ultrasound-guided quadratus lumborum block in cats: a cadaver study. Vet Anaesth Analg 2022; 49:481-489. [DOI: 10.1016/j.vaa.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/04/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022]
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Gomez‐Martinez MI, Adams J, Langley‐Hobbs S, Khenissi L. Use of an ultrasound‐guided sciatic and saphenous nerve block as a part of the multimodal analgesic management in a cria for the stabilisation of a left tibial eminence avulsion fracture. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - James Adams
- Farm Animal Practice Langford Vets University of Bristol Bristol UK
| | | | - Latifa Khenissi
- Small Animal Referral Hospital Langford Vets University of Bristol Bristol UK
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Maidanskaia EG, Spadavecchia C, Vincenti S, Mirra A. Anaesthetic Management of a Labrador Retriever Undergoing Adrenalectomy for Phaeochromocytoma Excision, a Case Report. Front Vet Sci 2022; 9:789101. [PMID: 35372541 PMCID: PMC8966683 DOI: 10.3389/fvets.2022.789101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Perioperative management of cases undergoing phaeochromocytoma removal should aim at normalising blood pressure and heart rate, restoring volume depletion, and preventing catecholamine release induced by surgical manipulation. In this case report, a novel pharmacological approach in a dog undergoing surgical tumour excision is described. A 7-year-old 25-kg spayed female Labrador Retriever presented for repeated episodes of generalised weakness, pale mucous membranes, tachycardia, tremor, panting, vomiting, and hypertension over the last month was referred for surgical treatment of a left-sided adrenal tumour with invasion of the caudal vena cava. Severe hypertensive episodes occurred repeatedly, starting early during the anaesthetic period, while clipping and cleaning the abdominal area, and continued intraoperatively when the tumour was handled. Moderate hypotension occurred once the tumour was isolated and worsened during temporary caudal vena cava flow interruption and cavotomy. The patient was treated preoperatively with phenoxybenzamine to prevent hypertensive crises. Intraoperatively, magnesium sulphate and urapidil were used to control blood pressure. This treatment was effective in reducing the magnitude of blood pressure spikes but not sufficient to prevent hypertensive peaks, especially during tumour manipulation. Hypotension was treated with synthetic colloid and crystalloid boli, and noradrenaline continuous infusion. Blood transfusion was performed in response to acute bleeding during cavotomy. The dog recovered successfully from anaesthesia and its quality of life was deemed excellent by the owner at the last follow up, 22 months after surgery. The histopathology confirmed the diagnosis of phaeochromocytoma with an invasion of the phrenicoabdominal vein. In the present case, we obtained a successful outcome but failed to provide haemodynamic stability throughout the procedure.
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Affiliation(s)
- Ekaterina Gámez Maidanskaia
- Anaesthesiology and Pain Therapy Division, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- *Correspondence: Ekaterina Gámez Maidanskaia
| | - Claudia Spadavecchia
- Anaesthesiology and Pain Therapy Division, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Simona Vincenti
- Surgery Division, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Alessandro Mirra
- Anaesthesiology and Pain Therapy Division, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Papadopoulos G, Duckwitz V, Doherr MG. Femoral and sciatic nerve blockade of the pelvic limb with and without obturator nerve block for tibial plateau levelling osteotomy surgery in dogs. Vet Anaesth Analg 2022; 49:407-416. [DOI: 10.1016/j.vaa.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 07/25/2021] [Accepted: 09/10/2021] [Indexed: 10/18/2022]
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Felisberto R, Flaherty D, Tayari H. Ultrasound-Guided Saphenous Nerve Block in Rabbits (Oryctolagus cuniculus): A Cadaveric Study Comparing Two Injectate Volumes. Animals (Basel) 2022; 12:ani12050624. [PMID: 35268193 PMCID: PMC8909879 DOI: 10.3390/ani12050624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/01/2023] Open
Abstract
Simple Summary General anesthesia in rabbits is associated with significantly higher mortality than in dogs and cats. In addition, as prey animals, rabbits tend to mask signs of pain, making early detection particularly difficult. Loco-regional anesthesia represents a fundamental component of a multimodal approach to pain management and is an effective strategy to reduce the need for systemic anesthetic and analgesic drugs, thereby limiting their associated side effects. The saphenous nerve is the largest sensory branch of the femoral nerve and provides sensory supply to areas of the hind-limb. Saphenous nerve blockade allows for analgesia of the front and inner parts of the pelvic limb without affecting femoral nerve motor function, thus allowing optimal pain relief but permitting continued mobilization, which may be of particular importance in rabbits as it allows preservation of normal physiological prey behavior (e.g., hiding, kicking). This cadaveric study describes an ultrasound-guided saphenous nerve block technique in rabbits and compares the length of the nerves stained following injection of two different dye volumes. The results show that both volumes consistently stained the saphenous but not the femoral nerve. This technique has the potential to provide hind-limb analgesia while preserving femoral motor function in rabbits. Abstract Ultrasound-guided (US-guided) loco-regional anesthesia techniques allow direct visualization and blockade of sensory nerves. The saphenous nerve (SN), a terminal branch of the femoral nerve (FN), is strictly a sensory nerve for which electrical locator devices are ineffective for localization as no effector muscle contractions can be evoked. US-guided SN block in species other than rabbits produces hind-limb analgesia without affecting FN motor function. The aims of this study were to develop a US-guided SN block technique in rabbits and to compare the spread obtained using two different dye volumes. Twelve hind-limbs from six cadavers (1.6 ± 0.1 kg) were included; after randomization, the SN block was performed on the right or left hind-limb, injecting 0.05 mL kg−1 or 0.1 mL kg−1 of tissue dye in lidocaine (1:50 v:v). Subsequent dissections allowed nerve staining measurements. All SNs were identified, and 17.8 ± 4.6% and 31.0 ± 8.9% of the SN length were stained using low-volume and high-volume of the dye, respectively. Regardless of the volume used, the SN was consistently stained while the motor branch of the FN was not. This US-guided technique may provide hind-limb analgesia without affecting FN motor function in rabbits undergoing mid-distal hind-limb surgeries.
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Felisberto R, Flaherty D, Tayari H. Ultrasound‐ and nerve stimulation‐guided sciatic and saphenous nerve blocks in a pet rabbit (
Oryctolagus cuniculus
) undergoing calcaneal fracture repair. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ricardo Felisberto
- Anaesthesia Department Southern Counties Veterinary Specialists Ringwood UK
| | - Derek Flaherty
- Anaesthesia Department Southern Counties Veterinary Specialists Ringwood UK
| | - Hamaseh Tayari
- Anaesthesia Department Southern Counties Veterinary Specialists Ringwood UK
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Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. J Feline Med Surg 2022; 24:4-30. [PMID: 34937455 PMCID: PMC10845386 DOI: 10.1177/1098612x211066268] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PRACTICAL RELEVANCE Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. CLINICAL CHALLENGES Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. EVIDENCE BASE These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors' experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.
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Affiliation(s)
- Paulo V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Universite de Montréal, Saint-Hyacinthe, Canada; and Department of Veterinary Clinical Sciences and Centre for Companion Animal Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | | | - Bradley Simon
- Department of Small Animal Clinical Sciences, Texas A&M College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Leon N Warne
- Veterinary Anaesthesia & Pain Management Australia, Perth, Western Australia; and Veterinary Cannabis Medicines Australia, Perth, Western Australia, Australia
| | - Yael Shilo-Benjamini
- Koret School of Veterinary Medicine, The Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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30
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Ward R, Po E, Gozalo‐Marcilla M. Nerve stimulation‐guided femoral and sciatic blocks in an alpaca (
Vicugna pacos
) for the removal of a sequestrum from the distal femur. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Robert Ward
- Queens Veterinary School Hospital University of Cambridge Cambridge, UK
- Royal (Dick) School of Veterinary Studies Easter Bush Vet Centre Edinburgh, UK
| | - Eleonora Po
- Queens Veterinary School Hospital University of Cambridge Cambridge, UK
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Acquafredda C, Stabile M, Lacitignola L, Centonze P, Di Bella C, Crovace A, Fiorentino M, Staffieri F. Clinical efficacy of dexmedetomidine combined with lidocaine for femoral and sciatic nerve blocks in dogs undergoing stifle surgery. Vet Anaesth Analg 2021; 48:962-971. [PMID: 34607765 DOI: 10.1016/j.vaa.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2021] [Accepted: 05/12/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the effects of dexmedetomidine administered perineurally or intramuscularly (IM) on sensory, motor function and postoperative analgesia produced by lidocaine for sciatic and femoral nerve blocks in dogs undergoing unilateral tibial tuberosity advancement surgery. STUDY DESIGN Prospective, blinded, clinical study. ANIMALS A group of 30 dogs. METHODS Dogs were anaesthetized with acepromazine, propofol and isoflurane in oxygen/air. Electrolocation-guided femoral and sciatic nerve blocks were performed: group L, 0.15 mL kg-1 2% lidocaine (n = 10); group LDloc, lidocaine and 0.15 μg kg-1 dexmedetomidine perineurally (n = 10); group LDsys, lidocaine and 0.3 μg kg-1 dexmedetomidine IM (n = 10). After anaesthesia, sensory blockade was evaluated by response to forceps pinch on skin innervated by the saphenous/femoral, common fibular and tibial nerves. Motor blockade was evaluated by observing the ability to walk and proprioception. Analgesia was monitored with Short Form of Glasgow Composite Pain Scale for up to 4 hours after extubation. Methadone IM was administered as rescue analgesia. Data were analysed by linear mixed effect models and Kaplan-Meier test (p < 0.05). RESULTS Median duration of the sensory blockade for all nerves was longer (p < 0.001) for group LDloc than for groups L and LDsys and was longer (p = 0.0011) for group LDsys than for group L. Proprioception returned later (p < 0.001) for group LDloc [285 (221-328) minutes] compared with group L [160 (134-179) minutes] or LDsys [195 (162-257) minutes]. Return of the ability to walk was similar among all groups. Dogs in group LDloc required postoperative rescue analgesia later (p = 0.001) than dogs in groups LDsys and L. CONCLUSIONS AND CLINICAL RELEVANCE Dexmedetomidine administered perineurally with lidocaine prolonged sensory blockade and analgesia during the immediate postoperative period. Systemic dexmedetomidine also prolonged the sensory blockade of perineural lidocaine.
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Affiliation(s)
- Claudia Acquafredda
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Paola Centonze
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Caterina Di Bella
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy; PhD Course in Organs and Tissues Transplantation and Celluar Therapies, Department of Emergency and Organ Transplantations, Aldo Moro University, Bari, Italy
| | - Antonio Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Marco Fiorentino
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy.
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Thomson R, Deutsch J. Transverse abdominal plane block in a llama undergoing midline coeliotomy. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Robyn Thomson
- Department of Anaesthesia The Ralph Veterinary Referral Centre Marlow UK
| | - Julia Deutsch
- Department of Anaesthesia Langford Vets Small Animal Referral Hospital Langford UK
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Stenger V, Zeiter S, Buchholz T, Arens D, Spadavecchia C, Schüpbach-Regula G, Rohrbach H. Is a Block of the Femoral and Sciatic Nerves an Alternative to Epidural Analgesia in Sheep Undergoing Orthopaedic Hind Limb Surgery? A Prospective, Randomized, Double Blinded Experimental Trial. Animals (Basel) 2021; 11:2567. [PMID: 34573533 PMCID: PMC8467810 DOI: 10.3390/ani11092567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
Peripheral nerve blocks are commonly used in human and veterinary medicine. The aim of the study was to compare the analgesic efficacy of a combined block of the femoral and sciatic nerves with an epidural injection of ropivacaine in experimental sheep undergoing orthopaedic hind limb surgery. Twenty-five sheep were assigned to two groups (peripheral nerve block; sciatic and femoral nerves (P); epidural analgesia (E)). In group P 10 mL ropivacaine 0.5% was injected around the sciatic and the femoral nerves under sonographic guidance and 10 mL NaCl 0.9% into the epidural space while in group E 10 mL ropivacaine 0.5% was injected into the epidural space and 10 mL NaCl 0.9% to the sciatic and the femoral nerves. During surgery, heart rate, respiratory rate and mean blood pressure were used as indicators of nociception. In the postoperative phase, nociception was evaluated every hour by use of a purposefully adapted pain score until the animal showed painful sensation at the surgical site. The mean duration of analgesia at the surgical wound was 6 h in group P and 8 h in group E. Mean time to standing was 4 h in group P and 7 h in group E. In conclusion time to standing was significantly shorter in group P while the duration of nociception was comparable in both groups. The peripheral nerve block can be used as an alternative to epidural analgesia in experimental sheep.
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Affiliation(s)
- Valentina Stenger
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Stephan Zeiter
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Tim Buchholz
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Daniel Arens
- AO Research Institute Davos, Clavadelerstrase 8, 7270 Davos Platz, Switzerland; (V.S.); (S.Z.); (T.B.); (D.A.)
| | - Claudia Spadavecchia
- Department of Clinical Veterinary Medicine, Anaesthesia Section, Vetsuisse Faculty Bern, 3012 Bern, Switzerland;
| | | | - Helene Rohrbach
- Department of Clinical Veterinary Medicine, Anaesthesia Section, Vetsuisse Faculty Bern, 3012 Bern, Switzerland;
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Marchese GA, Pascal M. Effect of methylene blue used as medical dye on blood pressure in a dog undergoing partial pancreatectomy. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Manuela Pascal
- Anaesthesia and Analgesia Southfields Veterinary Specialists Basildon UK
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Della Valle G, Caterino C, Aragosa F, Micieli F, Costanza D, Di Palma C, Piscitelli A, Fatone G. Outcome after Modified Maquet Procedure in dogs with unilateral cranial cruciate ligament rupture: Evaluation of recovery limb function by use of force plate gait analysis. PLoS One 2021; 16:e0256011. [PMID: 34379677 PMCID: PMC8357168 DOI: 10.1371/journal.pone.0256011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Cranial cruciate ligament failure is one of the principal causes of canine lameness. Several surgical procedures were proposed to achieve joint stabilisation; among these, the Modified Maquet Procedure involves using a titanium foam wedge to achieve and maintain the tibial tuberosity advancement. The force-plate analysis provides to objectively assess normal and abnormal gait and the outcome of different surgical techniques. The study evaluates the outcome of limbs that underwent Modified Maquet Procedure using land-force plate analysis comparing the operated limb with its healthy contralateral one as a control. Materials and methods Thirty-five dogs with unilateral cranial cruciate ligament rupture were evaluated. Outcome after surgery was assessed by orthopaedic and radiographic evaluations and force plate gait analysis performed before surgery, at 15, 30 and 90 days after surgery. For objective comparison of ground reaction forces, data of operated limb were compared to contralateral limb on each time control and Symmetry Index at 90 days was determined. Healing radiographic signs, minor and major complication were reported. Results A significant improvement in ground reaction forces was reached in all the treated limbs between set time intervals. The median percentage increase in ground reaction forces was constant from 15 to 90 days, with a Symmetry Index >9 in 54.2% of patients suggesting a normal gait symmetry. A complete bone healing was noticed at 90 days follow-up radiographic assessment. We experienced three major (8.5%) and one minor (2.8%) complications. Conclusions To the Authors’ knowledge, this is the first study in the veterinary literature that assessed outcomes of dogs undergoing Modified Maquet Procedure for the treatment of cranial cruciate ligament rupture using force plate gait analysis and healthy contralateral limb as a control group. Our results confirm that Modified Maquet Procedure is an effective method to stabilise the stifle joint.
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Affiliation(s)
- Giovanni Della Valle
- Department of Veterinary Medicine and Animal Production, University of Naples “Federico II”, Naples, Italy
| | - Chiara Caterino
- Department of Veterinary Medicine and Animal Production, University of Naples “Federico II”, Naples, Italy
- * E-mail:
| | - Federica Aragosa
- Department of Veterinary Medicine and Animal Production, University of Naples “Federico II”, Naples, Italy
| | - Fabiana Micieli
- Department of Veterinary Medicine and Animal Production, University of Naples “Federico II”, Naples, Italy
| | - Dario Costanza
- Interdepartmental Center of Veterinary Radiology, University of Naples “Federico II”, Naples, Italy
| | - Cristina Di Palma
- Department of Veterinary Medicine and Animal Production, University of Naples “Federico II”, Naples, Italy
| | - Alfonso Piscitelli
- Department of Agricultural Sciences, University of Naples “Federico II”, Portici, Italy
| | - Gerardo Fatone
- Department of Veterinary Medicine and Animal Production, University of Naples “Federico II”, Naples, Italy
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Dos-Santos JD, Ginja M, Alves-Pimenta S, Otero PE, Ribeiro L, Colaço B. A description of an ultrasound-guided technique for a quadratus lumborum block in the cat: a cadaver study. Vet Anaesth Analg 2021; 48:804-808. [PMID: 34362691 DOI: 10.1016/j.vaa.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/16/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the ultrasonographic (US) anatomy of the sublumbar region at the level of second lumbar vertebra (L2), to assess the feasibility of US-guided quadratus lumborum (QL) injections and to evaluate the dye distribution pattern in feline cadavers. STUDY DESIGN Descriptive feline cadaver study. ANIMALS A total of eight cat cadavers. METHODS Using a linear probe (6-14 MHz), with the cadavers in lateral recumbency, the QL and psoas muscles (Pm) were identified at the level of L2 and landmarks recorded. Using an in-plane technique, a spinal needle was inserted in a ventrodorsal direction to reach the interfascial plane between the QL and Pm. Using a ropivacaine, dye and iohexol solution, a total volume of 0.4 mL kg-1 was injected. Computed tomography (CT) scanning and anatomic dissection were performed to evaluate the spread of injectate. Presence of dye on the sympathetic trunk was compared between assessment methods using kappa coefficient of agreement (κ). RESULTS Using US guidance, the QL-Pm interfascial plane was identified and dye solution was present in the target fascial plane in all animals. Injectate was distributed on the ventral roots of the spinal nerves between the first and third lumbar vertebrae in 6/8 cats, and on the sympathetic trunk from the thirteenth thoracic to the third lumbar vertebrae in 7/8. Dye was found on the major splanchnic nerve in 7/8 cats and on the minor splanchnic nerve and coeliac ganglion pathways in all animals. Agreement between dissection and CT images dye distribution on the sympathetic trunk was κ = 0.72. CONCLUSIONS AND CLINICAL RELEVANCE The US-guided QL injection was feasible and injectate was present in the QL-Pm interfascial plane in all feline cadavers. In vivo studies are warranted to evaluate the analgesic efficacy of this technique for abdominal surgical procedures.
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Affiliation(s)
- José Diogo Dos-Santos
- VetOeiras - Veterinary Hospital, Oeiras, Portugal; CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Department of Veterinary Science, University Lusófona, Lisbon, Portugal.
| | - Mário Ginja
- CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Sofia Alves-Pimenta
- CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Pablo E Otero
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
| | - Lénio Ribeiro
- Department of Veterinary Science, University Lusófona, Lisbon, Portugal
| | - Bruno Colaço
- CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; CECAV - Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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Calice I, Kau S, Knecht C, Otero PE, Larenza Menzies MP. Combined caudal retrocostal and lateral ultrasound-guided approach for transversus abdominis plane injection: A descriptive pilot study in pig cadavers. PLoS One 2021; 16:e0248131. [PMID: 33690705 PMCID: PMC7946305 DOI: 10.1371/journal.pone.0248131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/21/2021] [Indexed: 11/25/2022] Open
Abstract
Transversus abdominis plane (TAP) block is a regional anesthetic technique used to desensitize the abdominal wall in several species. This study aimed to describe the anatomical characteristics of the abdominal wall and to identify a feasible approach for an US-guided TAP injection that would result in adequate staining of the relevant nerves in the abdominal wall in pig cadavers. Fresh cadavers from five Landrace pigs (age, 12 weeks; body weight, 35.5 ± 1.6 kg) were used. One pig (n = 1) was anatomically dissected, and four pigs (n = 4; i.e., 8 hemiabdomens) were used for TAP injections and evaluation of dye spread. The volume of 0.3 mL/kg/injection point of methylene blue was injected bilaterally. In the caudal retrocostal approach, the injection was performed ventral to the most caudal part of the costal arch. In the lateral approach, the injection was performed between the last rib and iliac crest. A needle was inserted in plane for the caudal retrocostal and the lateral approach caudocranially and craniocaudally, respectively. Successful staining was defined as presence of dye on the nerve for a length of >1 cm in its entire circumference. The TAP was found between different muscle layers in the described anatomical regions. In the caudal retrocostal approach the TAP was found between the external abdominal oblique and transversus abdominis muscle bellies. In the lateral approach the TAP was found between the internal abdominal oblique and transversus abdominis muscles. The approach combining lateral and caudal retrocostal injections at the studied volume stained a median of 5 (3–6) target nerves from the fourth-last thoracic nerve to L2 (six nerves). Combined caudal retrocostal and lateral TAP injections of 0.3 mL/kg/injection point, resulted in staining of target nerve branches which supply the periumbilical and caudal abdominal wall in pig cadavers.
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Affiliation(s)
- Ivana Calice
- Clinical Unit of Anesthesiology and Perioperative Intensive-Care Medicine, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
| | - Silvio Kau
- Institute of Topographic Anatomy, Department of Pathobiology, Vetmeduni Vienna, Vienna, Austria
| | - Christian Knecht
- Department for Farm Animals and Veterinary Public Health, Vetmeduni Vienna, University Clinic for Swine, Vienna, Austria
| | - Pablo E Otero
- Department of Anesthesiology, Faculty of Veterinary Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - M Paula Larenza Menzies
- Clinical Unit of Anesthesiology and Perioperative Intensive-Care Medicine, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
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Kalamaras AB, Aarnes TK, Moore SA, Jones SC, Pereira CR, Peng J, Kieves NR. Effects of perioperative saphenous and sciatic nerve blocks, lumbosacral epidural or morphine-lidocaine-ketamine infusion on postoperative pain and sedation in dogs undergoing tibial plateau leveling osteotomy. Vet Anaesth Analg 2021; 48:415-421. [PMID: 33814330 DOI: 10.1016/j.vaa.2021.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the quality of postoperative analgesia and sedation after preoperative saphenous and sciatic nerve blockade, preoperative lumbosacral epidural injection and perioperative intravenous (IV) morphine, lidocaine and ketamine infusions in dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy (TPLO) under general anesthesia. STUDY DESIGN Prospective, blinded, randomized, clinical comparison study. ANIMALS A total of 45 dogs weighing 33.9 (15.9-56.7) kg and aged 5.2 (1.0-12.0) years, mean (range), undergoing elective unilateral TPLO for spontaneous cranial cruciate ligament rupture. METHODS Client-owned dogs were enrolled. Dogs were randomly assigned to one of three groups: group MLK, perioperative IV morphine, lidocaine and ketamine infusion; group EPID, lumbosacral epidural with ropivacaine and morphine; or group SSNB, saphenous and sciatic nerve blockade with ropivacaine. Routine stifle arthroscopy followed by TPLO surgery was performed. Sedation and pain scores were assessed at 0, 2, 4, 8 and 24 hours following extubation. Rescue analgesia was administered as prescribed by Glasgow composite pain score-short form score >5. RESULTS Sedation scores for MLK were higher than EPID and SSNB. Pain scores for SSNB were lower than those for EPID and MLK. No significant differences were found in anesthesia duration or surgery duration among groups. No dogs required rescue analgesia. CONCLUSIONS AND CLINICAL RELEVANCE Although analgesia was adequate in all groups, the best combination of analgesia without increased sedation was recorded for SSNB.
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Affiliation(s)
- Alexandra B Kalamaras
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Turi K Aarnes
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Stephen C Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Carolina Ricco Pereira
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Juan Peng
- Department of Biomedical Informatics, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Nina R Kieves
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
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Ravasio G, Brioschi FA, Rabbogliatti V, Gioeni D, Di Cesare F, Corletto F, Oltolina M, Carnevale L. Case Report: Ultrasound Sciatic and Saphenous Nerve Blocks for Tibial Malunion Surgical Correction in a Pediatric African Leopard ( Panthera pardus). Front Vet Sci 2020; 7:538883. [PMID: 33330680 PMCID: PMC7728615 DOI: 10.3389/fvets.2020.538883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022] Open
Abstract
Little information is available regarding ultrasound-guided locoregional anesthesia in non-domestic species. Locoregional techniques have been shown to reduce intraoperative anesthetic requirements and provide postoperative pain relief. Decreasing dosage of general anesthetics allows more stable cardiopulmonary function during anesthesia and reduces the probability of side effects. An 11-week-old African leopard (Panthera pardus) was referred for treatment of a malunion angular limb deformity secondary to a tibial and fibular fracture. The animal was scheduled to undergo angular correction of the tibia via closing wedge osteotomy and fixation with a locking plate system. Following preanesthetic medication and induction of general anesthesia, a saphenous nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed under ultrasound guidance and a sciatic nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed using ultrasound and a peripheral nerve stimulator. Intraoperative anesthetic plane was considered light, yet no abrupt cardiocirculatory changes were seen, nor was rescue analgesia required. This case report suggests that sciatic and saphenous blockade could therefore be recommended as part of a multimodal plan of analgesia for orthopedic surgeries in pediatric exotic felids.
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Affiliation(s)
- Giuliano Ravasio
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | | | - Vanessa Rabbogliatti
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Daniela Gioeni
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Federica Di Cesare
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milan, Italy
| | | | - Maurizio Oltolina
- Head of Veterinary Service, Zoological Park "Le Cornelle", Valbrembo, Italy
| | - Liliana Carnevale
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
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Douglas H, Welsh S, Barr C. Clinical techniques in veterinary dermatology: regional anaesthesia of the canine and feline distal limb. Vet Dermatol 2020; 32:90-e17. [PMID: 33245205 DOI: 10.1111/vde.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local anaesthesia for procedures involving the distal limb are a useful component of balanced protocols to achieve effective procedural analgesia for patients. A ring block is an effective and straightforward technique. HYPOTHESIS/OBJECTIVE To review and describe the ring block technique for local anaesthesia of the canine and feline distal limb. ANIMALS Images of hospitalized patients were used. These photographs were obtained with owner permission. RESULTS The clinical technique for the ring block of the canine or feline distal limb is described. CONCLUSIONS AND CLINICAL IMPORTANCE The ring block can be implemented simply and successfully for a variety of procedures involving the distal limb to provide effective analgesia.
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Affiliation(s)
- Hope Douglas
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce Street, Philadelphia, PA, 19104, USA
| | - Stephanie Welsh
- Rood and Riddle Equine Hospital, 2150 Georgetown Road, Lexington, KY, 40511, USA
| | - Ciara Barr
- Rood and Riddle Equine Hospital, 2150 Georgetown Road, Lexington, KY, 40511, USA
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Micieli F, Chiavaccini L, Mennonna G, Della Valle G, Prisco F, Meomartino L, Vesce G. An ultrasound-guided subparaneural approach to the sciatic nerve in the dog: a cadaver study. Vet Anaesth Analg 2020; 48:107-115. [PMID: 33339710 DOI: 10.1016/j.vaa.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/19/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the gross and microscopic anatomy of the sciatic nerve paraneural sheath and to report an ultrasound (US)-guided subparaneural approach to the sciatic nerve in dogs, comparing two different volumes of injectate. STUDY DESIGN Prospective, randomized, anatomical study. ANIMALS A group of nine middle-sized adult Mongrel canine cadavers (18 limbs). METHODS The sciatic nerves of three pelvic limbs of two canine cadavers were identified, exposed and isolated between the greater trochanter and the popliteal fossa for gross anatomical and microscopic examination. An additional three pelvic limbs were surgically dissected on the lateral surface of the limb; the sciatic nerves were isolated, and a 26 gauge over-the-needle catheter was inserted through the paraneural sheath under direct visualization. A methylene blue solution was then slowly injected into the subparaneural compartment through the catheter under US visualization using an 8-13 MHz linear-array transducer. Subsequently, 12 pelvic limbs (six cadavers) were randomly allocated to one of two groups; using US-guided percutaneous subparaneural approach, either 0.1 or 0.05 mL kg-1of a 1:1 solution of methylene blue and 0.5% bupivacaine was injected. The spread of the dye solution and the amount of nerve staining were macroscopically scored. The stained sciatic nerves with their sheaths were then harvested for microscopic examination. RESULTS The paraneural sciatic nerve sheath was easily identified distinct from the nerve trunk both macroscopically and with US visualization, and microscopically. Complete staining was achieved in five of six (83.3%) sciatic nerves in each group; no difference was found in the amount of staining between the two groups. Microscopically, no signs of sciatic nerve intraneural injection were observed. CONCLUSIONS AND CLINICAL RELEVANCE The US-guided subparaneural injection of 0.05 mL kg-1 of a dye injectate resulted in satisfactory nerve staining without evidence of sciatic nerve intraneural injection.
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Affiliation(s)
- Fabiana Micieli
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Naples, Italy.
| | - Ludovica Chiavaccini
- Department of Medical Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Giuseppina Mennonna
- Interdepartmental Center of Veterinary Radiology, University of Napoli Federico II, Naples, Italy
| | - Giovanni Della Valle
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Naples, Italy
| | - Francesco Prisco
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Naples, Italy
| | - Leonardo Meomartino
- Interdepartmental Center of Veterinary Radiology, University of Napoli Federico II, Naples, Italy
| | - Giancarlo Vesce
- Department of Veterinary Medicine and Animal Productions, University of Napoli Federico II, Naples, Italy
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Freitag FAV, Muehlbauer E, Gaio TD, Dos Santos AAM, Machado M, Sanchez A, Duque JCM. Evaluation of injection volumes for the transversus abdominis plane block in dog cadavers: a preliminary trial. Vet Anaesth Analg 2020; 48:142-146. [PMID: 33257280 DOI: 10.1016/j.vaa.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/20/2020] [Accepted: 10/04/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate staining of nerve branches after the injection of different volumes during ultrasound-guided transversus abdominis plane (TAP) block in dog cadavers. STUDY DESIGN Prospective randomized study. ANIMALS A total of 15 frozen/thawed adult dog cadavers. METHODS Hemiabdomens were randomly allocated to one of four groups. In groups G0.3, G0.6 and G1.0, ropivacaine-methylene blue solution (0.3, 0.6 and 1.0 mL kg-1 in seven, eight and eight hemiabdomens, respectively) was injected at the midpoint between the iliac crest and the last rib at the height of the shoulder. In group G0.3×2 (seven hemiabdomens), two injections (0.3 mL kg-1) were performed, caudal to the last rib and cranial to the iliac crest at the same height. Total time for injection was recorded; after 30 minutes, cadavers were dissected and spread of dye was evaluated. RESULTS Accuracy of injection site was 80% and injection time was 71 (48-120) seconds for all groups together. Craniocaudal spread was 6.4 ± 1.6, 9.1 ± 2.6, 11.4 ± 2.3 and 11.2 ± 3.8 cm for G0.3, G0.6, G1.0 and G0.3×2, respectively [G0.3 to G0.3×2 (p = 0.044) and G1.0 (p = 0.034)]. There was no difference in dorsoventral spread among groups. Number of ventral nerve branches stained was 3 (2-4), 3 (2-4), 3 (3-4) and 3 (2-4) for G0.3, G0.6, G1.0 and G0.3×2, respectively, including nerve branches from twelfth thoracic to third lumbar (L3) in different proportions among groups. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that a single-injection TAP block, using 0.3 mL kg-1, stains comparable number of nerve branches as higher volumes or two-point injection. Despite the volume or technique, consistent staining of the innervation of the caudal abdomen (L1-L3) was observed. Additional cadaveric studies are necessary to identify the optimal technique for complete abdominal wall staining.
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Affiliation(s)
- Flavio A V Freitag
- Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil; Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Eloisa Muehlbauer
- Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Thalise daS Gaio
- Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Amanda A M Dos Santos
- Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Marcello Machado
- Anatomy Department, Biological Science Sector, Federal University of Paraná, Curitiba, PR, Brazil
| | - Andrea Sanchez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Juan C M Duque
- Veterinary Sciences Graduate Program, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, Brazil.
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Shippy SG, Romano M, Portela DA. Lumbosacral plexus block in a goat undergoing pelvic limb amputation. Vet Anaesth Analg 2020; 48:151-152. [PMID: 33168449 DOI: 10.1016/j.vaa.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sarah G Shippy
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Romano
- 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
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Romano M, Portela DA, Otero PE, Thomson A. Mirroring artefact during postoperative transversus abdominis plane (TAP) block in two dogs. Vet Anaesth Analg 2020; 47:727-728. [DOI: 10.1016/j.vaa.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
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Otero PE, Fuensalida SE, Sánchez F, Verdier N, Tarragona L, Briganti A, Portela DA. Development of a lateral ultrasound-guided approach for the proximal radial, ulnar, median and musculocutaneous (RUMM) nerve block in cats. Vet Anaesth Analg 2020; 47:686-693. [PMID: 32739251 DOI: 10.1016/j.vaa.2020.04.008] [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: 01/13/2020] [Revised: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe a lateral ultrasound (US)-guided approach to the radial, ulnar, median and musculocutaneous (RUMM) nerves through a single proximal in-plane insertion in cats and to determine whether one or two injection points are required to successfully stain all the target nerves. STUDY DESIGN Prospective study. ANIMALS A total of eight client-owned healthy cats and 12 cat cadavers. METHODS In live cats, the US anatomy of the brachium, the landmarks and the site for needle accesses were determined. Then, 12 thawed feline cadavers were used to assess the spread of dye solution and nerve staining following the US-guided proximal-lateral-humeral RUMM injection using one and two injection points. Each cadaver was injected with 0.15 mL kg-1 of a 0.25% new methylene blue solution in either a single injection aimed for the radial nerve of one limb (G1) or via two sites delivering 0.1 mL kg-1 and 0.05 mL kg-1 aimed for the radial and musculocutaneous nerves of the opposite limb, respectively (G2). Upon dissection, staining of the target nerves around their circumference for length of >1 cm was considered successful. RESULTS Sonoanatomy was consistent with anatomy upon dissection and target nerves were identified in all cadavers. Staining was 100% successful for the radial, median and ulnar nerves in both groups, and 41.7% and 100% for the musculocutaneous nerve in G1 and G2, respectively. CONCLUSIONS AND CLINICAL RELEVANCE This novel lateral US-guided approach for the proximal RUMM nerve block allowed a good identification of the nerves and related structures, and it provided a consistent muscular structure through which the needle could be easily guided. An injection performed in two aliquots (within the caudal and cranial compartments of the neurovascular sheath) appeared to be necessary to successfully stain all the target nerves.
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Affiliation(s)
- Pablo E Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Santiago E Fuensalida
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernanda Sánchez
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natali Verdier
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Lisa Tarragona
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
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Trujanovic R, Otero PE, Larenza Menzies MP. Combined ultrasound/electrostimulation‐guided block of the lumbosacral plexus in a cat undergoing pelvic limb amputation. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Robert Trujanovic
- Anesthesia and perioperative Intensive care UnitDepartment of Small Animals and HorsesUniversity of Veterinary MedicineViennaAustria
| | - Pablo E Otero
- Anesthesiology DepartmentVeterinary Science FacultyUniversity of Buenos AiresBuenos AiresArgentina
| | - Maria Paula Larenza Menzies
- Anesthesia and perioperative Intensive care UnitDepartment of Small Animals and HorsesUniversity of Veterinary MedicineViennaAustria
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Grubb T, Lobprise H. Local and regional anaesthesia in dogs and cats: Descriptions of specific local and regional techniques (Part 2). Vet Med Sci 2020; 6:218-234. [PMID: 31965749 PMCID: PMC7196680 DOI: 10.1002/vms3.218] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 07/27/2019] [Accepted: 10/27/2019] [Indexed: 11/30/2022] Open
Abstract
Pain management in veterinary patients is a crucial component of appropriate patient care. Local anaesthetic drugs used in local and regional blockade can completely block the transmission of nociceptive impulses, decreasing both intra‐operative nociception and postoperative pain, while decreasing the potential incidence of adverse effects that can be associated with systemic boluses of drugs. For efficacy and safety, this class of drugs is recommended as part of the analgesic protocol in the majority of surgical procedures and traumatic injuries. Numerous local and regional blocks are proven effective in dogs and cats, thus providing the clinician with ample opportunity to include these blocks in practice. This manuscript, Part 2 of a two‐part instalment, focuses on brief descriptions of select commonly used local/regional anaesthesia techniques for dogs and cats that cover a multitude of painful surgeries/injuries and that can be implemented in any practice. In Part 1 of this topic, detailed information on local anaesthetic drugs commonly used in small animal practice was reviewed (Grubb & Lobprise, 2020).
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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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Abstract
The field of locoregional anesthesia is showing good and promising results for intraoperative and postoperative analgesia, reducing opioid requirements and improving early postoperative recovery. Peripheral nerve blocks are being reinvigorated as a viable option to decrease the administration of opioids and some of the consequences of their use and yet provide high-quality analgesia. In this article, techniques to block the pelvic limb are discussed.
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Ultrasound-guided erector spinae plane block in canine cadavers: relevant anatomy and injectate distribution. Vet Anaesth Analg 2019; 47:229-237. [PMID: 31980367 DOI: 10.1016/j.vaa.2019.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the distribution and nerve staining of two volumes of lidocaine-dye solution after ultrasound-guided erector spinae plane (ESP) injections in canine cadavers. STUDY DESIGN Experimental cadaveric study. ANIMALS A total of nine canine cadavers. METHODS ESP injections were performed between the longissimus thoracis muscle and the dorsolateral edge of the ninth thoracic transverse process. Two cadavers were transversally cryosectioned after unilateral ESP injections [0.6 mL kg-1; high volume (HV)]. In seven cadavers, bilateral ESP injections with HV or low volume (0.3 mL kg-1; LV) were performed. Gadodiamide was added to the injectate for two cadavers and magnetic resonance imaging (MRI) was performed pre- and post-injection. Injectate distribution and nerve staining of the branches of the spinal nerves were recorded after gross anatomical dissection. The thoracic paravertebral and epidural spaces were examined for dye solution. RESULTS Cryosections, MRI and gross dissections showed that the injectate spread dorsally to the transverse processes, over the ventromedial aspect of the longissimus thoracis muscle where the medial and lateral branches of the dorsal branches of the spinal nerves are located. LV and HV stained a median (range) of 4 (2-7) and 4 (3-8) medial branches, respectively (p = 0.52). LV and HV stained 4 (2-5) and 5 (4-7) lateral branches (p = 0.26), respectively. Ventral branches were not stained, and dye was not identified in the epidural or paravertebral spaces. CONCLUSIONS and clinical relevance Medial and lateral branches were consistently stained over several spinal segments. The number of nerves stained was not different with HV or LV, and the ventral branches of the spinal nerves were not stained in any cadaver. ESP block may find a clinical application to desensitize structures innervated by the medial and lateral branches of the dorsal branches of the thoracic spinal nerves.
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