POCUS: Nerve Blocks – Neuroaxial

Otero, Pablo E.; Portela, Diego A.

doi:10.1002/9781119461005.ch33

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…A possible explanation for the difference is the better matching between the spinal metamers innerving the body area operated and the local anesthetic block in the LL group [ 5 , 19 ]. The more cranial LA injection into the epidural space may have allowed for a more cranial spread of the LA throughout the epidural canal, thus providing a more profound nerve block of the L4–L6 spinal metamers from which the femoral nerve derives [ 18 , 22 ]. In addition, the abundant fat surrounding the cauda equina, which works as a reservoir of LA, may limit the cranial spread of LA when an epidural injection is given at the lumbosacral intervertebral space.…”

Section: Discussionmentioning

confidence: 99%

Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites

Sarotti¹,

Ala

Franci

2022

J. Vet. Med. Sci.

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This prospective clinical trial evaluated the effects of epidural anesthesia (EA) placed at the lumbosacral compared to the L5-L6 junction in dogs undergoing hindlimb orthopedic surgery. In all, 98 dogs were randomly assigned to receive injection at either L7-S1 (LS group) or L5-L6 (LL group) at the same local anesthetic regimen (1 mg/kg bupivacaine 0.5% and 0.1 mg/kg morphine 1%).Fentanyl (1 µg/kg) was the intraoperative rescue analgesia (iRA) administered if mean arterial pressure increased by 30% above pre-stimulation value. Procedural failure, iRA, hypotension, motor block resolution, and postoperative side effects were recorded. There were 7/47 (15%) epidural procedural failures in the LS group and 8/51 (16%) (P=1.00) in the LL group; iRA was administered in 21/40 (52%) LS group dogs and in 13/43 (30%) LL group dogs, respectively (P=0.047). The incidence of hypotension was 10/40 (25%) and 16/43 (37%) in the LS group and the LL group, respectively (P=0.25). Proprioceptive residual deficit at 8 hr after EA was recorded in 3/26 (12%) in group LS dogs and in 13/26 (50%) group LL dogs, respectively (P=0.01). The proprioceptive residual deficit at 24 hr in one dog (LL group) resolved within 36 hr. No episodes of postoperative urinary retention, pruritus or neurological damage were recorded. The L5-L6 EA decreased significantly iRA but delays the proprioceptive recovery time. Further studies are needed to determine whether a lower bupivacaine dose reduces the duration of the residual block retaining the same incidence of iRA.

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Section: Discussionmentioning

confidence: 99%

Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites

Sarotti¹,

Ala

Franci

2022

J. Vet. Med. Sci.

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“…The use of ultrasound (US)-guided techniques has become increasingly popular in human medicine as well as veterinary medicine. US-guided techniques present several advantages [ 10 , 11 ], including visualisation of the targeted area (fascia plane space or nerves) and a need of smaller volumes of local anaesthetics. Additionally, US-guided techniques may be safer than blind techniques by avoiding the puncture of perineural structures such as vessels, pleura and neuraxis [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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

d'Anselme

Hartnack

Andrade

et al. 2022

Animals

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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.

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POCUS: Nerve Blocks – Neuroaxial

Cited by 2 publications

References 9 publications

Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites

Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites

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

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