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Aitken MR, Floriano DA, Hopster K. Open Approach to the Transversus Abdominis Plane in Horses: A Cadaver Feasibility Study. Vet Sci 2024; 11:51. [PMID: 38275933 PMCID: PMC10818621 DOI: 10.3390/vetsci11010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
The study's objective was to evaluate the feasibility and dispersion of an open approach to the transversus abdominis plane (TAP) block in eight adult equine cadavers. A ventral midline incision was made, starting 2 cm cranial to the umbilicus and extending 25 cm cranially. In total, 0.5 mL/kg of new methylene blue (NMB) was injected per horse, divided into six injections. Using an 18 g, 8 cm Tuohy needle, three injections were made per side. The needle was guided blindly into the TAP using palpation. A 60 mL syringe was attached directly to the needle, depositing ~0.08 mL/kg at each site. The time to complete the injections was recorded for each cadaver. Following injection, the ventral body wall was dissected to determine if the dye was present within the TAP space as well as to measure the extent of the dispersion of the dye, the cranial to caudal extent, and the width of the dye's spread. Complete deposition of NMB into the TAP (six of six sites) was achieved in 5/8 horses. The median time needed to perform all the injections was 263 s. Increased adiposity (retroperitoneal fat) was associated with unsuccessful injections. This approach to the TAP was easily and quickly performed, though less successful in horses with increased retroperitoneal fat and increased BCS.
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Affiliation(s)
- Maia R. Aitken
- Department of Clinical Studies—New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA
| | - Dario A. Floriano
- Department of Clinical Science and Advanced Medicine—Matthew J. Ryan Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Klaus Hopster
- Department of Clinical Studies—New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA
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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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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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An Anatomical, Sonographic, and Computed Tomography Study of the Transversus Abdominis Plane Block in Cat Cadavers. Animals (Basel) 2022; 12:ani12192674. [PMID: 36230415 PMCID: PMC9559481 DOI: 10.3390/ani12192674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
This study compared the distribution of a bupivacaine-iopamidol-dye solution following ultrasound-guided in-plane TAP injection using a 1-point (TAP-L) or 2-point (TAP-SL) approach in cat cadavers. Two cadavers were used to study the TAP sonoanatomy while eight cadavers were enrolled in a randomized, prospective, blinded investigation. Each cat randomly received a TAP-L with 0.5 mL/kg in one hemiabdomen and a TAP-SL with 0.25 mL/kg/point in the contralateral hemiabdomen. After injection, computed tomography and dissection were performed to assess contrast distribution and number of stained target nerves. TAP-SL resulted in a wider contrast spread (mm) compared with TAP-L (87 ± 7 versus 71 ± 9; p = 0.002). The prevalence of nerve staining was higher using TAP-SL than TAP-L (p = 0.001). The ventral branches of T10, T11, T12, T13, L1 and L2 were stained in 2/8, 2/8, 5/8, 7/8, 4/8 and 1/8, and in 7/8, 7/8, 8/8, 8/8, 8/8 and 1/8 using TAP-L and TAP-SL approaches, respectively. Computed tomography and dissection identified minimal injectate intraperitoneally or within the falciform ligament fat following 1 TAP-L and 2 TAP-SL. Ultrasound-guided TAP-SL provided better injectate distribution around the thoracolumbar spinal nerve branches than TAP-L.
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DiGeronimo PM, da Cunha AF. Local and Regional Anesthesia in Zoological Companion Animal Practice. Vet Clin North Am Exot Anim Pract 2021; 25:321-336. [PMID: 34823697 DOI: 10.1016/j.cvex.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Local anesthetics provide analgesia and can be incorporated into multimodal anesthetic protocols. They work by blocking the voltage-dependent sodium ion channels along neurons that mediate nociception. Systemically, these drugs can be cardiotoxic in a dose-dependent manner. Lidocaine and bupivacaine are the most commonly used local anesthetics and their use has been reported in all classes of vertebrates. Despite anecdotal reports to the contrary, zoologic companion animals are unlikely to be more susceptible to the cardiotoxic effects of local anesthetics than domestic small animals. Local anesthetics can be clinically useful for analgesia and anesthesia in zoologic companion animal practice.
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Affiliation(s)
- Peter M DiGeronimo
- Adventure Aquarium, 1 Riverside Drive, Camden, NJ 08103, USA; Animal & Bird Health Care Center, 1785 Springdale Road, Cherry Hill, NJ 08003, USA.
| | - Anderson F da Cunha
- College of Veterinary Medicine, Midwestern University, 5715 W Utopia Road, Glendale, AZ 85308, USA
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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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Ultrasound-Guided Lateral Transversus Abdominis Plane (TAP) Block in Rabbits: A Cadaveric Study. Animals (Basel) 2021; 11:ani11071953. [PMID: 34208857 PMCID: PMC8300137 DOI: 10.3390/ani11071953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
The aims of the study were to describe the ultrasonographic-guided lateral TAP block in rabbit cadavers and evaluate the spread of a lidocaine/methylene blue solution through a single fascial infiltration. The US-guided block and anatomical dissections were performed in 17 New Zealand rabbit cadavers. The probe was placed perpendicular to the column, one centimetre ventrally to the transverse processes, halfway between the iliac crest and the costal margin. External oblique (EO), internal oblique (IO), and transversus abdominis (TA) muscles were visualised, and 1 mL/kg of lidocaine 2% plus methylene blue 1% was injected. After dissection, the branches of spinal nerves stained were measured. Moreover, the percentage of length and height of the area marked were calculated. A good visualisation of the TAP was obtained in all 34 hemiabdomens. T11 nerve eminence was successfully stained in 52% of cases. T12, L1, and L2 were stained in 75%, 95%, and 100% of cases, respectively. L3 and L4 were stained in 60% and 40% of cases, respectively. The lateral TAP block with a single point of injection can be easily performed in rabbits, but it is not sufficient to cover the nerve eminences of the cranial abdomen. The two-point TAP block (lateral and subcostal) could represent a better option, particularly when large surgical incisions are required.
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Harfoush M, Wilson D, Kim SY, Claude A. Open approach to the ventral transversus abdominis plane in the dog: evaluation and injectate dispersion in cadavers. Vet Anaesth Analg 2021; 48:767-774. [PMID: 34281772 DOI: 10.1016/j.vaa.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate a direct intra-abdominal approach to injection of the ventral transversus abdominis plane (TAP) and compare the dispersion of two volumes of injectate. STUDY DESIGN Prospective anatomic and feasibility study. ANIMALS A total of 10 canine cadavers weighing 9 ± 4 kg. METHODS A ventral incision was made extending through the linea alba, from the umbilicus and extending 5 cm caudally. A single injection of an isovolumic mixture of iopamidol and new methylene blue was performed with a hypodermic needle placed within the TAP of each hemiabdomen, alternating between 0.5 mL kg-1 in low-volume group (LV) and 1 mL kg-1 in high-volume group (HV). Surgical staples marked the incision. Computed tomography and three-dimensional reconstruction of the tomographic images evaluated the dimensions, cranial and caudal spread beyond the incision and the total area of the injectate. Dissection determined the extent of nerve staining within the TAP adjacent to the abdominal incision. Wilcoxon signed rank (stain) or paired t test was used to compare variables between groups. Data are reported as mean ± standard deviation or median (range). RESULTS Injectate spread was within the ventral TAP. Length of spread was 2.5 ± 1.6 cm greater in group HV than in group LV. There was a strong positive correlation between the surface area (p = 0.02, r = 0.71) and cranial-caudal spread of injectate (p = 0.041, r = 0.65) with volume. All but two LV injections were associated with staining of all nerves adjacent to the incision. Additional nerves caudal to the incision were stained in group HV (p = 0.02). CONCLUSIONS This approach to the TAP was easily performed, with volume of injectate positively influencing distribution. CLINICAL RELEVANCE This technique is easily applied and future prospective studies are warranted to determine its analgesic efficacy.
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Affiliation(s)
- Muhammad Harfoush
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
| | - Deborah Wilson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Sun Young Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Andrew Claude
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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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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Küls N, Trujanovic R, Otero PE, Larenza-Menzies MP. Ultrasound-Guided Transversus Abdominis Plane Block in Shetland Ponies: A Description of a Three-Point Injection Technique and Evaluation of Potential Analgesic Effects. J Equine Vet Sci 2020; 90:102994. [PMID: 32534772 DOI: 10.1016/j.jevs.2020.102994] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
Colic surgery is one of the most painful procedures carried out in horses. Common strategies to alleviate immediate postsurgical abdominal pain include the administration of potent systemic analgesics; however, these may cause unwanted adverse effects such as cardiovascular depression, ileus, and ataxia. The administration of local anesthetics at the incision site in form of an ultrasound-guided subcostal transversus abdominis plane (TAP) block may therefore be preferred to provide adequate analgesia without significant side effects. To date, no technique for a TAP block in horses undergoing median celiotomy has been described. The objective of the study was to develop a TAP block technique, which will lead to the desensitization of the ventrolateral abdominal wall and adjacent skin area of experimental Shetland Ponies using bupivacaine 0.125%. This is a prospective, blinded, self-controlled trial. A cadaver study was performed to determine the ideal injection points and the volume required to stain the nerves responsible for the sensation of the ventrolateral abdominal wall and skin in Shetland pony cadavers (i.e., T9-L 2). Subsequently, using the ideal injectate volume and the landmarks obtained in the first phase of the study, six Shetland ponies received a bilateral TAP injection, either with a local anesthetic solution (bupivacaine 0.125%) or with saline in a randomized, crossover, blinded fashion. Effectiveness was determined over a 4 hour postinjection time, by using a pinprick technique. Significant differences were found to the responses of the pinprick evaluation between the bupivacaine- and saline-treated sides after 30 minutes of TAP block injection. Reported "learned behavior" could have affected the results of the pinprick testing. The TAP block technique reported in this study using bupivacaine 0.125% appeared effective in desensitizing the lower abdomen of ponies for up to 2 hours. Further research is required to apply this technique in horses undergoing celiotomy. Potentially larger volumes and/or higher concentrations of bupivacaine may be necessary to provide longer duration of action of the block.
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Affiliation(s)
- Nina Küls
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Vetmeduni Vienna, Vienna, Austria.
| | - Robert Trujanovic
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Vetmeduni Vienna, Vienna, Austria
| | - Pablo E Otero
- Department of Anaesthesiology, Faculty of Veterinary Medicine, University of Buenos Aires, Argentina
| | - M Paula Larenza-Menzies
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Vetmeduni Vienna, Vienna, Austria
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Freitag FAV, Reis JA, Fagundes LD, Argus APDV, Martini R, Lange RR, Moreno JCD. Transversus abdominis plane block in two marmosets (Callithrix sp.) undergoing laparotomy. J Exot Pet Med 2020. [DOI: 10.1053/j.jepm.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Saldanha A, Martini R, Basseto JE, do Carmo MPW, Freitag FAV, Lange RR, Duque JC. Use of transversus abdominis plane block in chinchillas (Chinchilla lanigera). J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Portela DA, Verdier N, Otero PE. Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description. Vet J 2018; 238:27-40. [PMID: 30103913 DOI: 10.1016/j.tvjl.2018.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/24/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Abstract
Increasing interest in using peripheral nerve blocks in small animals is evident, given the numerous studies published recently on this topic in important veterinary journals. Initially, research was focused on intraoperative analgesia to the pelvic limb, and several descriptions of lumbosacral plexus, femoral and sciatic nerve blocks have been described in studies. There is recent interest in developing techniques for somatosensory blockade of the abdominal wall. This article is the second part of a two-part review of regional anesthesia (RA) in small animals, and its aim is to discuss the most relevant studies in the veterinary literature, where objective methods of nerve location have been used, and to illustrate in pictures the currently used techniques for providing RA to the abdominal wall and the pelvic limb in small animals.
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Affiliation(s)
- D A Portela
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - N Verdier
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
| | - P E Otero
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Cátedra de Anestesiología y Algiología, Buenos Aires, Argentina
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Ultrasound-guided lateral and subcostal transversus abdominis plane block in calves: a cadaveric study. Vet Anaesth Analg 2018; 45:384-391. [PMID: 29625919 DOI: 10.1016/j.vaa.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/25/2018] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe and assess the ultrasound-guided transversus abdominis plane (TAP) block feasibility in calf cadavers, to compare two injection volumes and to evaluate possible undesired solution spreads. STUDY DESIGN Prospective, descriptive, anatomic study. ANIMALS A group of 15 bovine cadavers weighing 47±11 kg (mean±standard deviation). METHODS Lateral (n = 24) and subcostal (n = 12) TAP block approaches were assessed. For each approach, two volumes (0.2 or 0.4 mL kg-1) of toluidine blue and contrast medium were injected using both sides of the animals. Nerve staining was assessed by anatomical dissection and spread of injectate by contrast-enhanced computed tomography. Objective and subjective technique feasibility was evaluated by a specific score (poor, good, excellent). RESULTS Using the lateral approach, 58%, 92% and 25% and 75%, 83% and 25% of the thirteenth thoracic, first and second lumbar nerves were stained by 0.2 and 0.4 mL kg-1, respectively. Craniocaudal and dorsoventral solution spread and number of blocks that adequately stained an individual nerve were not significantly different between the volumes. Using the subcostal approach, 67%, 83%, 67%, 67% and 50%, and 83%, 100%, 83%, 83% and 50% of the eighth, ninth, tenth, eleventh, twelfth thoracic nerves were stained by 0.2 and 0.4 mL kg-1, respectively. With both techniques, no intraspinal and one intraperitoneal spread were observed. Objective and subjective feasibility score was excellent for both approaches in the majority of the cases. CONCLUSIONS AND CLINICAL RELEVANCE TAP injections were easy to perform with both techniques in calf cadavers. The volume of injectate did not influence spread. The authors conclude that a combination of the two approaches is necessary, but perhaps not sufficient, to stain all of the nerves innervating the ventral abdominal wall. Further studies are required to refine the technique and evaluate its efficacy in preventing nociception in calves.
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Skouropoulou D, Lacitignola L, Centonze P, Simone A, Crovace AM, Staffieri F. Perioperative analgesic effects of an ultrasound-guided transversus abdominis plane block with a mixture of bupivacaine and lidocaine in cats undergoing ovariectomy. Vet Anaesth Analg 2018; 45:374-383. [PMID: 29627201 DOI: 10.1016/j.vaa.2018.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/12/2017] [Accepted: 01/20/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the perioperative analgesic effects of a transversus abdominis plane (TAP) block with a mixture of lidocaine and bupivacaine administered to cats undergoing ovariectomy. STUDY DESIGN Controlled, randomized, prospective, blinded clinical study. ANIMALS A group of 20 healthy cats. METHODS Robenacoxib (2 mg kg-1) was administered subcutaneously 0.5 hour before intramuscular (IM) administration of ketamine (5 mg kg-1), methadone (0.1 mg kg-1) and dexmedetomidine (0.01 mg kg-1). General anesthesia was induced with intravenous (IV) propofol and maintained with isoflurane. An ultrasound-guided TAP block was performed by injecting 0.5% bupivacaine (0.2 mL kg-1) diluted in a total volume of 1.5 mL 2% lidocaine bilaterally (TAP group, n = 10) or the same volume of saline solution bilaterally in controls (CTR group, n = 10). During surgery, a 20% increase in heart rate and respiratory frequency was treated with IV fentanyl (0.001 mg kg-1). Before premedication and at 1, 2, 3, 4, 6, 8, 12, 16, 20 and 24 hours after extubation, pain was assessed with a simple descriptive pain scale, that ranged from 0 (no pain) to 4 (intense pain). For pain scores ≥3, IM methadone (0.1 mg kg-1) was administered. Data were analyzed with the Friedman or the analysis of variance (anova) test, and p < 0.05 was considered statistically significant. RESULTS Only two cats in the CTR group were administered one dose of fentanyl during surgery. At 2, 6, 8, 12, 16, 20 and 24 hours after surgery, the pain score was higher in the CTR group. A mean dose of 0.5 ± 0.2 mg kg-1 methadone was administered to all cats in the CTR groups within 24 hours. Methadone was not administered to the TAP group (pain score < 3). CONCLUSIONS AND CLINICAL RELEVANCE Ultrasound-guided TAP block can be a reliable adjunctive technique, providing analgesia for up to 24 hours in cats undergoing ovariectomy.
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Affiliation(s)
- Despoina Skouropoulou
- Transplants of Organs and Tissues and Cellular Therapies, D.E.O.T., University of Bari, Italy; Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Luca Lacitignola
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Paola Centonze
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Angela Simone
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Alberto M Crovace
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy
| | - Francesco Staffieri
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production, "Aldo Moro" University of Bari, Bari, Italy.
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Zoff A, Dugdale A, Coates AN, Rioja E. Transversus abdominis plane block in two calves undergoing umbilical herniorrhaphy. VETERINARY RECORD CASE REPORTS 2017. [DOI: 10.1136/vetreccr-2017-000447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Aurora Zoff
- Willows Veterinary Centre and Referral CentreSolihullUK
| | | | - A N Coates
- Division of Livestock Health and WelfareUniversity of LiverpoolLiverpoolUK
| | - Eva Rioja
- University of Liverpool School of Veterinary ScienceNestonUK
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Portela DA, Romano M, Briganti A. Retrospective clinical evaluation of ultrasound guided transverse abdominis plane block in dogs undergoing mastectomy. Vet Anaesth Analg 2014; 41:319-24. [PMID: 24754569 DOI: 10.1111/vaa.12122] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
HISTORY Eleven female dogs of different breeds undergoing unilateral radical (n = 7) or regional abdominal mastectomy (n = 4) received an ultrasound guided transverse abdominis plane block (TAP-block). PHYSICAL EXAMINATION Subjects showed single or multiple mammary tumours. Serum biochemistry, CBC and electrocardiogram were unremarkable. Eight animals were classified as ASA physical status II and 3 as ASA III. MANAGEMENT Dogs were premedicated with methadone [0.1 or 0.2 mg kg(-1) intravenously (IV) or intramuscularly respectively] or fentanyl (2.5 μg kg(-1) IV). Anaesthesia was induced with propofol and maintained with isoflurane or sevoflurane. Unilateral ultrasound guided TAP blocks were performed in the caudal and cranial abdomen with bupivacaine 0.25% (0.3 to 0.35 mL kg(-1) ). Intercostal nerve blocks (T4 to T11 ) with bupivacaine 0.25% (0.013 to 0.04 mL kg(-1) ) completed the blocked area in dogs undergoing radical mastectomy. FOLLOW UP The median (range) of end-expired isoflurane and sevoflurane necessary to maintain anaesthesia was 1.15 (1.07-1.22) and 2.07 (2.05-2.2) vol% respectively. A single administration of fentanyl (2.5 μg kg(-1) , IV) was administered to control nociception (defined as an increased heart rate or mean arterial blood pressure above 20% of the pre-incisional value) in four of 11 dogs. All dogs received carprofen (2 mg kg(-1) subcutaneously) at the end of surgery. Post-operative pain, assessed for 120 minutes using the short form of Glasgow Composite Pain Scale (0-24), was always lower than 3. No rescue analgesia (allowed by the protocol) was required in this time. CONCLUSION Transverse abdominis plane block combined with intercostal nerve blocks may be useful to produce intraoperative anti-nociception and short term post-operative analgesia in dogs undergoing unilateral mastectomy.
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Affiliation(s)
- Diego A Portela
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, San Piero a Grado, Italy
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Bruggink SM, Schroeder KM, Baker-Herman TL, Schroeder CA. Weight-based volume of injection influences cranial to caudal spread of local anesthetic solution in ultrasound-guided transversus abdominis plane blocks in canine cadavers. Vet Surg 2012; 41:455-7. [PMID: 22380877 DOI: 10.1111/j.1532-950x.2012.00972.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if the volume of injected local anesthetic solution affects cranial to caudal spread when performing ultrasound-guided transversus abdominis plane (TAP) blocks in dogs. STUDY DESIGN Prospective experimental study. ANIMALS Adult Beagle cadavers (n = 20) METHODS Bilateral TAP blocks using ultrasound guidance was performed in 20 Beagle cadavers (mean ± SD weight, 9.3 ± 1.4 kg) using a 1:1 solution of methylene blue/bupivacaine injected at volumes of 0.25, 0.5, 0.75, and 1.0 mL/kg. Cadavers were dissected to determine injectate spread within the transversus abdominis fascial plane. RESULTS The transversus abdominis fascial plane was adequately identified by ultrasonography, injected, and dissected in 38 beagle hemi-abdominal walls; injectate was not identified in 2 hemi-abdominal walls. Dermatomal spread (number of ventral nerve roots saturated by injected solution) was volume dependent (P = .026, Kruskal Wallis): 2.9 ± 0.74 nerve roots for 0.25 mL/kg; 3.4 ± 1.1 for 0.5 mL/kg; 4.0 ± 0.67 for 0.75 mL/kg; and 4.2 ± 1.2 for 1 mL/kg. CONCLUSION In Beagle cadavers, the volume of injected local anesthetic solution significantly affects cranial to caudal spread within the TAP during ultrasound-guided TAP blocks. The volume of local anesthetic injected could potentially be used to augment the spread of analgesic coverage for a given surgical procedure in dogs.
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Affiliation(s)
- Sean M Bruggink
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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