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Patouchas O, Kulendra N, Medina-Serra R. Ipsilateral thoracic limb block and Horner's syndrome associated with bupivacaine in a dog undergoing thoracotomy. Vet Anaesth Analg 2024; 51:399-400. [PMID: 38772849 DOI: 10.1016/j.vaa.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/09/2024] [Accepted: 03/19/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Odyssefs Patouchas
- North Downs Specialist Referrals, Bletchingley, UK; Eastcott Referrals, Swindon, UK
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Wong S, Hon S, Parry S, Boesch JM, Pearson E, de Miguel Garcia C. Image analysis comparison of nerve staining with food dye, methylene blue or tissue marker. Vet Anaesth Analg 2024; 51:35-43. [PMID: 38016893 DOI: 10.1016/j.vaa.2023.09.073] [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: 01/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Novel locoregional techniques use dye studies to confirm successful nerve targeting. The goal was to objectively quantify and compare nerve staining characteristics of dye mixtures commonly reported in the literature using image analysis software. STUDY DESIGN Prospective, randomized cadaveric study. METHODS Thirty-six brachial plexus nerves from unpreserved pig cadavers were randomized into three groups of 12: FD (1:10 mixture of blue food dye and bupivacaine 0.5%), MB (methylene blue 1%) and TM (0.1:10 mixture of blue tissue marker and lidocaine 2%). Nerves were immersed in dye for 1, 15, 30 or 60 minutes (n = 3 each). Images of nerves before immersion (baseline) and at each time point with epineurium intact (superficial staining) and after longitudinal bisection (deep staining) were processed using image analysis software. Color saturation values were divided into quartiles (dark, medium-dark, medium-light or light). Percentage of stained nerve area in each quartile was calculated and compared using two-way anova. RESULTS Superficially, at minute 1, dark saturation covered 40% of nerve area in FD versus 19% in MB (p = 0.04) and 0% in TM (p < 0.0001). In bisected nerves, dark and medium-dark saturations occurred only in FD; medium-light saturation comprised anywhere from 4% to 22.5% over time in FD versus <1% at any time in MB (p = 1.000; p = 0.343; p = 0.383; p = 0.262). Deep staining was not found in TM at any point. CONCLUSION AND CLINICAL RELEVANCE Food dye rapidly stains superficial and deep nerve layers. Based on these characteristics, investigators can choose the appropriate dye for their study.
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Affiliation(s)
- Shanna Wong
- Section of Anesthesiology and Pain Management, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Stephanie Hon
- Section of Anesthesiology and Pain Management, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
| | - Stephen Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY, USA
| | - Jordyn M Boesch
- Section of Anesthesiology and Pain Management, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Emily Pearson
- Laboratory Animal Resources, Binghamton University, Binghamton, NY, USA
| | - Cristina de Miguel Garcia
- Section of Anesthesiology and Pain Management, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Pentsou J, Vagias M, Davies T, Hoey S, Huuskonen V. Thoracolumbar Retrolaminar Block: Anatomical and Radiological Study of Injectate Pattern Distribution in Canine Cadavers. Animals (Basel) 2023; 13:3008. [PMID: 37835614 PMCID: PMC10571983 DOI: 10.3390/ani13193008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The retrolaminar block is a regional anaesthetic technique, first developed in humans, in which the local anaesthetic is deposited directly onto the dorsal aspect of the thoracic or lumbar vertebral lamina. This study aims to evaluate the distribution of landmark-guided thoracolumbar retrolaminar injections in greyhound cadavers. Thirteen injections of contrast-dye solution were performed in eight cadavers at the level of the twelfth thoracic vertebra (T12), with either 20 mL (n = 8, high volume, HV) or 10 mL (n = 5, low volume, LV) per site. The spread of the injectate was evaluated through computed tomography and transverse anatomical dissection. The groups were compared using the Mann-Whitney U test. The median (range) of the extent of the spread was 4 (2-5) and 3 (2-4) intervertebral foramina in the LV and HV groups, respectively. The median (range) of the spread along the retrolaminar space was 3 (2-3) retrolaminar segments in the LV and 3 (2-4) in the HV group. Epidural and retroperitoneal spread was identified in seven cadavers. Following landmark-guided retrolaminar injections, the injectate spread both in the retrolaminar and paravertebral spaces, without any obvious association between the volume of injectate and the extent of the spread. Further studies are warranted to determine the clinical efficacy of the technique.
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Affiliation(s)
- Julia Pentsou
- Department of Veterinary Anaesthesia and Analgesia, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Michail Vagias
- Department of Small Animal Surgery, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK;
| | - Thomas Davies
- Bristol Vet Specialists, Unit 10, More Plus Central Park, Madison Way, Severn Beach, Bristol BS35 4ER, UK;
| | - Séamus Hoey
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04 W6F6 Dublin, Ireland; (S.H.); (V.H.)
| | - Vilhelmiina Huuskonen
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, UCD School of Veterinary Medicine, University College Dublin, D04 W6F6 Dublin, Ireland; (S.H.); (V.H.)
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A Two-Point Ultrasound-Guided Injection Technique for the Transversus Thoracis Plane Block: A Canine Cadaveric Study. Animals (Basel) 2022; 12:ani12172165. [PMID: 36077885 PMCID: PMC9454867 DOI: 10.3390/ani12172165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The transversus thoracis plane block is a locoregional technique recently described in canine cadavers to desensitize the intercostal nerves running through this plane. In canine cadavers, a transverse approach through a single injection point at the fifth intercostal space has been described, although consistent staining of the intercostal nerves was not completely achieved. The objective of this study was twofold: (1) to evaluate if the transverse approach is feasible at the third and sixth intercostal spaces and (2) to compare, by anatomical dissection, the spread of a dye solution and the staining of the intercostal nerves when a low volume (0.5 mL kg−1) or a high volume (1 mL kg−1) was equally divided at a two-point injection in the same hemithorax. Our results showed that the injection of the high-volume dye solution, equally injected at the third and sixth intercostal spaces using the transverse approach, achieved a consistent staining of from T2 to T7 intercostal nerves. This block could achieve adequate desensitization of the ventral chest wall during sternotomy in the dog. Clinical studies in live animals are necessary to confirm the efficacy of this technique. Abstract The transversus thoracis plane (TTP) block desensitizes the intercostal nerves that run through this plane, providing analgesia to the ventral thoracic wall. Two canine cadavers were used to assess the feasibility of the transverse approach for the TTP (t-TTP) under ultrasound guidance to inject a solution at the third and sixth intercostal spaces. Eight cadavers were used to compare the spread and number of intercostal nerves that were stained when a low volume (LV) 0.5 mL kg−1 or a high volume (HV) 1 mL kg−1 of a dye-lidocaine solution was injected into the same hemithorax, injecting the volume equally at these intercostal spaces using the transverse approach. Fisher’s exact test and Wilcoxon signed-rank test were used to contrast the spread of the different volume solutions. The injectate spread along the TTP after all injections, dying a median number (range) of 3 (2–5) and 6 (5–6) nerves with LV and HV, respectively (p = 0.011). The two-point injection of HV, using the t-TTP approach, is a feasible technique that provides a consistent staining from T2 to T7 intercostal nerves. The injection of HV instead of LV increases the spread and enhances the number of stained intercostal nerves.
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Escalante GC, Ferreira TH, Hershberger-Braker KL, Schroeder CA. Evaluation of ultrasound-guided pecto-intercostal block in canine cadavers. Vet Anaesth Analg 2022; 49:182-188. [PMID: 35123875 DOI: 10.1016/j.vaa.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the technique for performing an ultrasound-guided pecto-intercostal fascial (PIF) block and compare two volumes of injectate in canine cadavers. STUDY DESIGN Prospective experimental cadaveric study. ANIMALS A total of 11 canine cadavers (11.8 ± 1.9 kg). METHODS Parasternal ultrasound-guided injections were performed within the PIF plane, between the deep pectoral and external intercostal muscles, at the intercostal space between ribs four and five. Each hemithorax was injected with 0.25 mL kg-1 (treatment low volume, LV) or 0.5 mL kg-1 (treatment high volume, HV) of 1% methylene blue dye. Treatments were randomly assigned to either right or left hemithorax, with each cadaver injected with both treatments, for a total of 22 injections. Anatomical dissections were performed to determine staining of ventral cutaneous branches of intercostal nerves, surrounding nerves and musculature and spread of injectate. The presence or absence of intrathoracic puncture was also noted. RESULTS The PIF plane was identified and injected in each hemithorax. No significant differences between treatments LV and HV were found for number of ventral cutaneous nerve branches stained or any other analyzed variable. The ventral cutaneous branches of intercostal nerves (T3-T8) were variably stained, and the most commonly stained nerves were T5 (6 and 10), T6 (8 and 9) and T7 (2 and 7) in treatments LV and HV, respectively. Staining outside the immediate parasternal region was noted in both treatments, with greater spread away from the parasternal region in treatment HV. No intrathoracic staining was found. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided PIF injections resulted in staining of ventral cutaneous branches and parasternal musculature; however, the spread observed was inadequate to provide effective analgesia to the sternum. In vivo studies are warranted to investigate this regional anesthetic technique in veterinary patients.
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Affiliation(s)
- Gabriela C Escalante
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Santoro F, Franci P, Grandis A, Valgimigli S. Distribution of injectates in the thoracic paravertebral space of the dog and cat: A cadaveric study. Open Vet J 2021; 11:27-35. [PMID: 33898280 PMCID: PMC8057219 DOI: 10.4314/ovj.v11i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Thoracic paravertebral block (TPVB) entails injecting a local anesthetic inside the thoracic paravertebral space (TPVS). Loss of resistance to air injection (air-LOR) was the first technique described in humans to locate the TPVS. To date, no study has investigated the spread of any substance after injection into the TPVS using the air-LOR technique nor has described the cranial and caudal limits of the space. Aim: To identify the boundaries of the TPVS, to determine whether the air-LOR technique is reliable for the identification of the TPVS and to examine the relationship between the volume of injectate and its spread. Methods: After a preliminary phase, the thorax of five cat and five dog cadavers was accessed and eviscerated. After TPVS probing, the polyurethane foam was injected, and the cranial and caudal borders were recorded after its maximum spread. Different volumes of a mixture of new methylene blue and ioversol were injected in the TPVS after its localization with a Tuohy needle and air-LOR technique in fourteen dog and six cat cadavers. Lateral radiographs of the vertebral column were used to document needle positioning, spread pattern and extension. The thorax of these subjects was then accessed and eviscerated to observe and record the spread of the mixture. Results: Injecting a dye into the TPVS, localized by an air-LOR technique, resulted in multi-segmental and often bilateral subpleural staining of paravertebral, intercostal, and dorsal mediastinal structures in dog and cat cadavers. The lateral radiographs most often showed a mixed cloud-like and linear spread pattern, which could be a predictor of the longitudinal spread of the dye. The foam injected into the TPVS at the cranial and the caudal level revealed anatomical communication with the cervical, axillar, and lumbar paravertebral regions. Conclusion: TPVS localization by air-LOR technique and injection results in a longitudinal multi-segmental spread in dog and cat cadavers. The communication of the TPVS with the axillary and lumbar regions could be of clinical interest for the brachial plexus and the lumbar intercostal nerve blocks in a clinical setting.
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Affiliation(s)
- Francesco Santoro
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Paolo Franci
- Department of Veterinary Medical Science, Largo Paolo Braccini, Grugliasco, Italy
| | - Annamaria Grandis
- Department of Veterinary Medical Science, University of Bologna, Ozzano dell'Emilia, Italy
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Thomson ACS, Portela DA, Romano M, Otero PE. Evaluation of the effect of ultrasound guidance on the accuracy of intercostal nerve injection: a canine cadaveric study. Vet Anaesth Analg 2020; 48:256-263. [PMID: 33583728 DOI: 10.1016/j.vaa.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop an ultrasound-guided approach to intercostal nerve injection and to compare the success rate of intercostal nerve injections using blind or ultrasound-guided technique in canine cadavers. STUDY DESIGN Prospective, randomized, descriptive, experimental anatomic study. ANIMALS A total of 14 mid-sized adult canine cadavers. METHODS Ultrasound landmarks were identified by dissection of four cadavers and used to develop an ultrasound-guided technique. The remaining 10 cadavers were randomly assigned to blind (five cadavers) or ultrasound-guided (five cadavers) injections of the third to the ninth intercostal nerves bilaterally with 0.03 mL kg-1 of colorant per injection. The target for intercostal injections was the caudal border of the respective rib, between the internal intercostal membrane and the parietal pleura. Additionally, displacement of the parietal pleura without visible intramuscular distribution was considered the end point for ultrasound-guided injections. For each cadaver, a practitioner in training performed the blocks on one hemithorax, while an experienced practitioner performed the blocks on the opposite hemithorax. Injections were considered successful if ≥1 cm of the target nerve was stained with colorant upon dissection. Success rates and length of nerve staining were analyzed with Fisher's exact and t tests, respectively. Data were considered statistically different with p < 0.05. RESULTS Success rates of blind and ultrasound-guided technique were 57.1% and 91.4%, respectively (p < 0.0001). The length of intercostal nerve staining was 3.1 ± 1.2 cm and 3.6 ± 1.0 cm using blind and ultrasound-guided techniques, respectively (p = 0.02). No differences were observed between the two practitioners for blind (p = 0.33) and ultrasound-guided techniques (p = 0.67). CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound guidance improves the accuracy of intercostal nerve injections when compared with blind technique, independently of the level of expertise in regional anesthesia.
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Affiliation(s)
- Alexander C S Thomson
- Department of Comparative Diagnostic and Population Medicine, University of Florida College of Veterinary Medicine, Gainesville, FL, USA
| | - Diego A Portela
- Department of Comparative Diagnostic and Population Medicine, University of Florida College of Veterinary Medicine, Gainesville, FL, USA.
| | - Marta Romano
- Department of Comparative Diagnostic and Population Medicine, University of Florida College of Veterinary Medicine, 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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de Miguel Garcia C, Whyte M, St James M, Ferreira TH. Effect of contrast and local anesthetic on dye spread following transversus abdominis plane injection in dog cadavers. Vet Anaesth Analg 2020; 47:391-395. [DOI: 10.1016/j.vaa.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
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St James M, Ferreira TH, Schroeder CA, Hershberger-Braker KL, Schroeder KM. Ultrasound-guided rectus sheath block: an anatomic study in dog cadavers. Vet Anaesth Analg 2019; 47:95-102. [PMID: 31786077 DOI: 10.1016/j.vaa.2019.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers. STUDY DESIGN Blinded, prospective, experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 8.9 ± 1.6 kg. METHODS Ultrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg-1 (low volume; LV) and 0.50 mL kg-1 (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves. RESULTS Fewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 ± 0 and 2.90 ± 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranial-caudal dye distribution was observed in the LV group than in the HV group (7.1 ± 1.8 cm and 9.2 ± 1.8 cm, respectively; p = 0.03). There was no significant difference in medial-lateral spread of dye, number of test doses or ultrasound image quality scores between groups. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.
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Affiliation(s)
- Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Portela DA, Romano M, Otero PE. Locoregional Anesthesia of the Thoracic Limbs and Thorax in Small Animals. Vet Clin North Am Small Anim Pract 2019; 49:1063-1083. [PMID: 31492541 DOI: 10.1016/j.cvsm.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incorporation of nerve stimulation and ultrasound guidance to veterinary regional anesthesia allows accurate performance of techniques to block the thoracic limb and the thorax. When performed correctly, regional anesthesia can either constitute an alternative to the use of opioids and other systemic analgesics, or have a significant opioid-sparing effect. This article provides an overview of some techniques described using objective methods of nerve location, which can be used to provide perioperative locoregional anesthesia and analgesia to the thoracic limb and thorax. The approaches described may be used to decrease the perioperative use of opioids in small animals.
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Affiliation(s)
- Diego A Portela
- Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100123, Gainesville, FL 32610-0136, USA.
| | - Marta Romano
- Anesthesiology and Pain Management, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, PO Box 100123, Gainesville, FL 32610-0136, USA
| | - Pablo E Otero
- Anesthesiology and Pain Management Department, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Avenida Chorroarín 280 (C1427CWO), Buenos Aires, Argentina
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Serra RM, Jimenez CP, Monticelli P, Plested M, Viscasillas J. Assessment of an ultrasound-guided technique for catheterization of the caudal thoracic paravertebral space in dog cadavers. Open Vet J 2019; 9:230-237. [PMID: 31998616 PMCID: PMC6794404 DOI: 10.4314/ovj.v9i3.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background The caudal thoracic paravertebral (CTPV) block is a regional anesthesia technique currently used in human medicine to provide analgesia in abdominal surgical procedures. Aim The objectives of this study are to describe an ultrasound-guided technique to place catheters in CTPV space in canine cadavers and evaluate the distribution of a 50:50 contrast-dye solution administered through them. Methods Eight thawed adult beagle cadavers (9.2 ± 2.0 kg body total weight) were used. Thirteen catheters were placed. In the first phase, a volume of 0.3 ml kg-1 of the contrast-dye was administered in all cases. After the injections, computed tomography (CT) scans were carried out to assess the distribution of the contrast-dye. In the second phase, an extra 0.2 ml kg-1 of the contrast-dye was administered through eight catheters, followed by a second CT scan. Two cadavers were dissected to assess the distribution of the contrast-dye. The injection site varied between T8-9 and T12-13. Results The evaluation of the CT scans showed contrast-dye within the paravertebral space in 92% (12/13) of the injections. The distribution pattern observed after the injections performed within the TPV space was linear and intercostal in all cases. The median (range) linear spread of the contrast was 7 (5-10) spinal nerves and involved 3 (2-8) intercostal spaces. The contrast-dye reached lumbar regions in 42% of the injections (5/12). A larger spread of the contrast-dye was not observed after the administration of a second dose of the injectate. No signs of epidural, intrapleural/intrapulmonary, intravascular, or intraabdominal spread were observed. The dissection of the two cadavers confirmed the spread of the contrast-dye along the sympathetic trunk and intercostal spaces. Conclusion The administration of 0.3 ml kg-1 of the contrast-dye in the CTPV space resulted in a distribution compatible with the block of nerves responsible for the innervation of the majority of the abdominal viscera and cranial abdominal wall.
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Affiliation(s)
- Roger Medina Serra
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | | | - Paolo Monticelli
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Mark Plested
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK
| | - Jaime Viscasillas
- Departament de Medicina y Cirugia Animal, Facultad de Veterinaria, Instituto de Ciencias Biomedicas, Universidad CEU Cardenal Herrera, Valencia, Spain
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Ferreira TH, St James M, Schroeder CA, Hershberger-Braker KL, Teixeira LBC, Schroeder KM. Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers. Vet Anaesth Analg 2019; 46:516-522. [PMID: 31029460 DOI: 10.1016/j.vaa.2019.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe a technique to perform an ultrasound-guided erector spinae plane (ESP) block and determine the distribution and potential complications after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN Prospective experimental cadaveric study. ANIMALS A total of eight dog cadavers weighing 9.3 ± 1.9 kg. METHODS Ultrasound-guided injections dorsal to the transverse process and ventral to the erector spinae muscles aimed at the fifth thoracic transverse process were performed bilaterally in each dog using 0.5 and 1.0 mL kg-1 dye solution [low volume (LV) and high volume (HV) treatments, respectively]. Treatments were randomly assigned to the right or left side of each dog, resulting in a total of 16 injections. Anatomical dissections determined dye spread characteristics, including epaxial muscles spread, staining of spinal nerves, dorsal rami, ventral rami (intercostal nerves) and sympathetic trunk spread. Staining indicating potential complications (epidural, mediastinal and intrapleural spread) was recorded. RESULTS There was complete staining of at least one dorsal ramus following all injections. A more extensive spread was observed along the muscles in the HV compared with LV (p = 0.036). No significant difference between multisegmental dorsal rami spread (six out of eight injections in each treatment) was noted. Out of 16 injections, one in LV treatment resulted in multisegmental spinal nerve staining and one in HV treatment resulted in ventral ramus (intercostal nerve) staining. Use of anatomic landmarks resulted in inaccurate identification of the fifth transverse process in at least six out of 16 injections (38%). No sympathetic trunk, epidural, mediastinal or intrapleural staining was observed. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided ESP injections resulted in extensive staining along the epaxial muscles, as well as staining of the dorsal rami in all dogs. The incidence of dorsal rami mutisegmental spread was the same in both treatments.
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Affiliation(s)
- Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
| | - Mariko St James
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Carrie A Schroeder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Hershberger-Braker
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Leandro B C Teixeira
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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