Description of an Ultrasound-Guided Erector Spinae Plane Block and Comparison to a Blind Proximal Paravertebral Nerve Block in Cows: A Cadaveric Study

Abstract

The proximal paravertebral nerve block is commonly used to provide anaesthesia to the flank during standing surgical procedures in adult cattle. It has been reported that additional anaesthetic infiltration may be necessary to provide complete anaesthesia. In humans as well as animal species, another technique—the ultrasound (US)-guided erector spinae plane block (ESPB)—has been described. The goal of the present study was to develop and investigate an US-guided ESPB in comparison to a blind proximal paravertebral nerve block (PPNB) in cow cadavers. In 10 cadaver specimens, injections of methylene blue-lidocaine (1:1) were performed at the level of T13, L1 and L2 vertebras, on one side doing an ESPB block and, on the other side, a PPNB. Five cadavers were injected with high (40 mL per injection for PPNB and 20 mL for ESPB) and five with low (20 and 15 mL, respectively) volumes of injectate. For the ESPB, the ultrasound probe was oriented craniocaudally, and the ventral-cranial aspect of the articular processes (T13, L1 and L2) was targeted for injection. The dye spreading was evaluated by dissection. The landmarks for US-guided injection were easily visualized; however, injections were accidentally performed at T12, T13 and L1. Nevertheless, L2 was stained in 60% of ESPBs. Epidural spreading was observed with both techniques and all volumes. Viscera puncture was reported in two PPNBs. The ESPB resulted in similar nerve staining compared to the PPNB while using a lower volume of injectate. Even better staining is expected with a T13-L2 instead of a T12-L1 ESPB approach. Further studies are warranted to evaluate the clinical efficacy.

Clinical application of a described erector spinae plane block for locoregional anaesthesia technique in a cow undergoing standing laparotomy

“…In veterinary medicine, this block has recently been investigated in several species, including dogs, 20,21 cats, 22 pigs, 19 horses [23][24][25] and cows. 26 Epidural spreading has been described in cadaveric studies using the US-guided ESP block (67%), as well as the blind paravertebral (53%) techniques in cattle. 26 Similar findings have been reported for the use of ESP in horses.…”

“…26 Epidural spreading has been described in cadaveric studies using the US-guided ESP block (67%), as well as the blind paravertebral (53%) techniques in cattle. 26 Similar findings have been reported for the use of ESP in horses. 23 Epidural spreading was reported in the cadaveric study in 20% of horses; however, in  of  standing sedation they did not report ataxia or recumbency.…”

“…Five millilitres of lidocaine 2% (Lidocain 2% Streuli; Streuli Pharma) was injected subcutaneously using a 21 G needle to desensitise the sites where a 20 gauge, 3 ½'' (0.9 × 90 mm) spinal needle K-3 lancet point (Dahlhausen & Co.) would enter. We performed the US-guided ESP block as described in the cadaveric study from d' Anselme et al 26 The ultrasound probe was positioned parasagittally and orientated in long axis. Once the articular process of T13 was identified, the spinal needle was inserted…”

“…[16][17][18] This block has been investigated in pigs, 19 dogs, 20,21 cats 22 and recently in horses. [23][24][25] A recent cadaveric study by d' Anselme et al 26 demonstrated the feasibility of an ultrasound-guided erector spinae plane block in cows. Compared to the traditional blind technique, the study found that the ESP block offers several advantages consistent with those reported for other facial plane blocks.…”

“…A recent cadaveric study by d'Anselme et al 26 . demonstrated the feasibility of an ultrasound‐guided erector spinae plane block in cows.…”