Anestesia regional intravenosa (bloqueio de Bier) em urubu-de-cabeça-preta (Coragyps atratus) submetido à amputação de dígito / Regional intravenous anaesthesia (Bier's block) in black-headed vulture (Coragyps atratus) submitted to digit amputation

Background: The Coragyps atratus flies long distances in search of food and has a marked behaviour of food competition. Since they are frequently found in areas of recent human occupation, they are subject to trauma, which may require surgical interventions. Locoregional blocks are used as part of a balanced-anaesthesia protocol and are currently being evaluated in birds, with brachial plexus block being the main technique described in the literature. However, to our knowledge, this is the first description of intravenous regional anaesthesia (Bier's block) in a vulture. Thus, we aim to report the use of Bier's block with 1% lidocaine, in a black-headed vulture submitted to digit amputation. Case: A black-headed vulture (Coragyps atratus), weighing 2 kg, was rescued and referred to the Veterinary Hospital due to its inability to fly. Physical examination revealed a swollen digit in the right pelvic limb. Radiographic examination confirmed the intermediate phalanx fracture of the 4th digit of the right pelvic limb with signs suggestive of advanced osteomyelitis. The animal was referred to surgery for amputation of the affected digit. Before surgery, water and food were withdrawn for 12 h. Pre-anaesthetic medication consisted of 1 mg/kg midazolam and 0.5 mg/kg morphine intramuscularly (IM). Anaesthetic induction was performed through face mask with isoflurane, followed by orotracheal intubation with a 3 mm-endotracheal tube. Anaesthesia was maintained with isoflurane through a non-rebreathing circuit in 100% oxygen. Using a multiparametric monitor, heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2 ), oxyhemoglobin saturation (SpO2 ), electrocardiography (ECG), systolic blood pressure (SBP) and core temperature (CT) were evaluated. Antisepsis of the right pelvic limb was performed and an elastic band was applied around the distal region of the affected tibia to serve as a tourniquet. A scalp vein set was used to access the lateral saphenous vein in the region distal to the tourniquet, and 5 mg/ kg lidocaine 1% was injected intravenously. The patient remained stable during the procedure, with no need for analgesic rescue. The tourniquet was gradually released 40 min past its application, being completely removed after 45 min of surgery. The anaesthetic supply was interrupted, with extubation after 4 min; the patient had satisfactory anaesthetic recovery. Discussion: The present report describes the success in using the technique of intravenous regional anaesthesia with 1% lidocaine for digit amputation performed on a specimen of black-headed vulture. The pre-anaesthetic medication provided analgesia, satisfactory sedation for venoclysis, and anaesthetic induction without complications. Anaesthetic induction and maintenance in birds are preferably performed with inhaled anaesthetics, thus the choice of mask induction. Despite the reduction in RR soon after induction, the patient remained on spontaneous ventilation. Bier's block using 5 mg/kg lidocaine showed to be an easy and safe technique in vultures, but doses up to 6 mg/kg lidocaine are not associated with adverse effects in birds. The intravenous regional anaesthesia technique described in this manuscript promoted adequate analgesia for the digit amputation procedure in black-headed vultures and allowed hemodynamic stability without significant anaesthetic complications. Thus, the present report points to the potential use of this locoregional block in other birds.

Bloqueio do plexo-braquial e peridural lombossacra em um quati (Nasua nasua) / Brachial plexus block and lumbosacral epidural in a South American coati (Nasua nasua)

Background: The South American coatis (Nasua nasua) are capable of adapting to different habitats, which allowed themto exchange between domestic and wild areas, increasing the occurrence of traumas. Procedures performed in this speciesdemand anesthetic protocols that take comorbidities into account and cause minimal cardiorespiratory depression as wellas rapid recovery. It is in such context that locoregional anesthesia has become an essential tool. Thus, we aim to reportthe use of two techniques of locoreginal block: brachial plexus block and lumbosacral epidural block, in a Nasua nasuasubmitted to osteosynthesis of the radius and caudectomy due to trauma.Case: A adult male coati weighing 2.3 kg was referred to the Veterinary Medical Teaching Hospital of the UniversidadeFederal do Paraná (UFPR) - Setor Palotina with a history of trauma. Physical examination showed crackling in the radius and ulnar region, and also abnormal angulation in the distal portion of the tail. After taking x-rays, fractures wereconfirmed in the distal radius and in the distal portion of the tail. The patient was referred for surgery. After 8 h of waterand food withdrawal, the animal was premedicated with a combination of ketamine (10 mg/kg), midazolam (0.3 mg/kg)and methadone (0.2 mg/kg), intramuscularly (IM). Induction of anesthesia was performed with propofol titrated to effect(total dose 4 mg/kg) and anesthesia was maintained with isoflurane in spontaneous ventilation using a non-rebreathingcircuit (Baraka). It was evaluated heart rate (HR), respiratory rate (RF), end-tidal CO2 (EtCO2), expired isoflurane fraction (FE´Iso), oxyhemoglobin saturation (SpO2), electrocardiography (ECG), systolic blood pressure (SBP) and coretemperature (CT) using a multiparametric monitor. After the stabilization period, the animal was positioned in lateral...

Bloqueio do plexo-braquial e peridural lombossacra em um quati (Nasua nasua) / Brachial plexus block and lumbosacral epidural in a South American coati (Nasua nasua)

Background: The South American coatis (Nasua nasua) are capable of adapting to different habitats, which allowed themto exchange between domestic and wild areas, increasing the occurrence of traumas. Procedures performed in this speciesdemand anesthetic protocols that take comorbidities into account and cause minimal cardiorespiratory depression as wellas rapid recovery. It is in such context that locoregional anesthesia has become an essential tool. Thus, we aim to reportthe use of two techniques of locoreginal block: brachial plexus block and lumbosacral epidural block, in a Nasua nasuasubmitted to osteosynthesis of the radius and caudectomy due to trauma.Case: A adult male coati weighing 2.3 kg was referred to the Veterinary Medical Teaching Hospital of the UniversidadeFederal do Paraná (UFPR) - Setor Palotina with a history of trauma. Physical examination showed crackling in the radius and ulnar region, and also abnormal angulation in the distal portion of the tail. After taking x-rays, fractures wereconfirmed in the distal radius and in the distal portion of the tail. The patient was referred for surgery. After 8 h of waterand food withdrawal, the animal was premedicated with a combination of ketamine (10 mg/kg), midazolam (0.3 mg/kg)and methadone (0.2 mg/kg), intramuscularly (IM). Induction of anesthesia was performed with propofol titrated to effect(total dose 4 mg/kg) and anesthesia was maintained with isoflurane in spontaneous ventilation using a non-rebreathingcircuit (Baraka). It was evaluated heart rate (HR), respiratory rate (RF), end-tidal CO2 (EtCO2), expired isoflurane fraction (FE´Iso), oxyhemoglobin saturation (SpO2), electrocardiography (ECG), systolic blood pressure (SBP) and coretemperature (CT) using a multiparametric monitor. After the stabilization period, the animal was positioned in lateral...(AU)

Bloqueio do plexo braquial em jumento - relato de caso / Brachial plexus block in donkey - case report

A anestesia locorregional reduz o requerimento de agentes inalatórios e diminui as respostas autonômicas a estímulos cirúrgicos nocivos. Objetiva-se descrever um bloqueio anestésico do plexo braquial guiado por neuroestimulador em jumento, submetido à amputação do membro anterior direito. Foi realizada medicação pré-anestésica com detomidina 0,01mg.kg-1, indução com diazepam 0,05mg.kg-1 e cetamina 2mg.kg-1, todos pela via intravenosa (IV), e a manutenção da anestesia com isoflurano. O plexo braquial foi bloqueado por acesso subescapular, sendo usado neuroestimulador. Utilizou-se 1mg.kg-1 de bupivacaína 0,5% sem vasoconstritor, associada a 1mg.kg-1 de lidocaína 2% sem vasoconstrictor. Os valores de FC e ƒ durante o procedimento cirúrgico variaram de 62 a 78bpm e de 24 a 32rpm, respectivamente. Foram coletadas quatro amostras de sangue para dosagem de cortisol. Este, antes da aplicação da medicação pré-anestésica, foi de 6,4µg/dL e, 30 minutos após a MPA, foi de 2,8µg/dL. A recuperação anestésica foi rápida e sem complicações. O bloqueio do plexo braquial guiado por neuroestimulador mostrou-se eficaz em jumentos, fornecendo analgesia e anestesia satisfatória.(AU)

Locoregional anesthesia reduces the requirement for inhaled agents and reduces the autonomic responses to noxious surgical stimuli. The aim of this study was to describe an anesthetic block of the brachial plexus guided by a neurostimulator in a donkey submitted to right limb amputation. Preanesthetic medication was performed with detomidine 0.01mg.kg-1 induction with diazepam 0.05mg.kg-1 and ketamine 2mg.kg-1 all intravenously, and maintenance of anesthesia with isoflurane. The brachial plexus was blocked by subscapular access, using a neurostimulator. For this purpose, 1mg.kg -1 of bupivacaine 0.5%, without vasoconstrictor, and 1mg.kg- 1 of lidocaine 2%, without vasoconstrictor were used. The values of HR and ƒ during the surgical procedure ranged from 62 to 78bpm, and 24 to 32bpm, respectively. Four blood samples were collected for cortisol dosing. This, prior to the application of the pre-anesthetic medication was 6.4µg/dL and 30 minutes was 2.8µg/dL. Anesthesia recovery was rapid and uncomplicated. Neurostimulator-guided brachial plexus blockade proved to be effective in donkeys, providing satisfactory analgesia and anesthesia.(AU)

Bloqueio do plexo braquial em jumento - relato de caso / Brachial plexus block in donkey - case report

A anestesia locorregional reduz o requerimento de agentes inalatórios e diminui as respostas autonômicas a estímulos cirúrgicos nocivos. Objetiva-se descrever um bloqueio anestésico do plexo braquial guiado por neuroestimulador em jumento, submetido à amputação do membro anterior direito. Foi realizada medicação pré-anestésica com detomidina 0,01mg.kg-1, indução com diazepam 0,05mg.kg-1 e cetamina 2mg.kg-1, todos pela via intravenosa (IV), e a manutenção da anestesia com isoflurano. O plexo braquial foi bloqueado por acesso subescapular, sendo usado neuroestimulador. Utilizou-se 1mg.kg-1 de bupivacaína 0,5% sem vasoconstritor, associada a 1mg.kg-1 de lidocaína 2% sem vasoconstrictor. Os valores de FC e ƒ durante o procedimento cirúrgico variaram de 62 a 78bpm e de 24 a 32rpm, respectivamente. Foram coletadas quatro amostras de sangue para dosagem de cortisol. Este, antes da aplicação da medicação pré-anestésica, foi de 6,4µg/dL e, 30 minutos após a MPA, foi de 2,8µg/dL. A recuperação anestésica foi rápida e sem complicações. O bloqueio do plexo braquial guiado por neuroestimulador mostrou-se eficaz em jumentos, fornecendo analgesia e anestesia satisfatória.(AU)

Locoregional anesthesia reduces the requirement for inhaled agents and reduces the autonomic responses to noxious surgical stimuli. The aim of this study was to describe an anesthetic block of the brachial plexus guided by a neurostimulator in a donkey submitted to right limb amputation. Preanesthetic medication was performed with detomidine 0.01mg.kg-1 induction with diazepam 0.05mg.kg-1 and ketamine 2mg.kg-1 all intravenously, and maintenance of anesthesia with isoflurane. The brachial plexus was blocked by subscapular access, using a neurostimulator. For this purpose, 1mg.kg -1 of bupivacaine 0.5%, without vasoconstrictor, and 1mg.kg- 1 of lidocaine 2%, without vasoconstrictor were used. The values of HR and ƒ during the surgical procedure ranged from 62 to 78bpm, and 24 to 32bpm, respectively. Four blood samples were collected for cortisol dosing. This, prior to the application of the pre-anesthetic medication was 6.4µg/dL and 30 minutes was 2.8µg/dL. Anesthesia recovery was rapid and uncomplicated. Neurostimulator-guided brachial plexus blockade proved to be effective in donkeys, providing satisfactory analgesia and anesthesia.(AU)

BLOQUEIO DE PLEXO BRAQUIAL EM GATOS: AVALIAÇÃO DE TÉCNICAS E COMPARAÇÃO DE DIFERENTES CONCENTRAÇÕES DE BUPIVACAÍNA

SOUZA, L.P. 2018. 111p. Bloqueio de plexo braquial em gatos: avaliação de técnicas e comparação de diferentes concentrações de Bupivacaína. Tese (Doutorado em Ciência Animal) Universidade do Estado de Santa Catarina. Programa de Pós-Graduação em Ciência Animal, Lages, 2018. A utilização do bloqueio de nervos periféricos associado a técnicas avançadas tem trazido resultados favoráveis na medicina, entretanto na veterinária há evidente escassez de informações sobre o exposto, por esse motivo, o presente estudo objetivou numa primeira fase avaliar trinta e dois felinos alocados aleatoriamente em quatro grupos correspondentes as técnicas de aplicação ás cegas, guiada por neuroestimulador, guiada por ultrassom e ainda uma associação do neuroestimulador com o ultrassom para bloqueio de plexo braquial via axilar em felinos, a fim de avaliar se há diferença entre as técnicas em relação à eficacia e segurança dos bloqueios. Numa segunda fase objetivou-se analisar a possibilidade de se obter um bloqueio de plexo braquial efetivo e seguro com a menor concentração de bupivacaina possível associado à técnica do estimulador de nervos perifericos guiado por ultrassom. Para isso, foram estudados vinte e quatro felinos alocados aleatoriamente em três grupos que receberam o bloqueio de plexo via axilar com múltiplas injeções de bupivacaína nas concentrações de 0,5%, 0,25% e 0,125%. Em ambas as fases foram avaliados os tempos de latência sensitiva e motora, e tempos de bloqueio sensitivo e motor. Os resultados na primeira fase demonstram que o bloqueio de plexo braquial é efetivo em todos os métodos. Não houve diferença estatística entre os grupos em relação ao tempo de latência sensitiva, já a latência motora demonstrou semelhança entre os grupos AC e US e NE e NE+US. O tempo total de bloqueio sensitivo demonstrou diferença significativa entre os grupos AC e US, sendo que no grupo US a média do tempo total de bloqueio foi de 443,13 minutos em relação a 278,14 minutos do grupo AC. O tempo de latência motora também demonstrou diferença significativa dos grupos que utilizam métodos avançados (Grupo NE= 289,38 minutos, US=325,63 minutos, NE+US= 307,50 minutos) em relação ao grupo AC (175,63 minutos).Foi possível concluir que esse tipo de bloqueio em gatos promove analgesia evidente somente na região da mão e que o método guiado por ultrassom com múltiplas injeções demonstra tempos de bloqueio, em geral, equivalente à técnica guiada por estimulador de nervos periféricos, entretanto com a fundamental vantagem de um procedimento mais seguro com menos ou nenhum efeito adverso. Já na segunda fase o bloqueio foi efetivo em todas as concentrações sendo que tempos de latência sensitiva e motora dos grupos 0,5% e 0,25% foram abaixo da média descrita na literatura (8,13 minutos, 16,88 minutos de latência sensitiva e 15 minutos e 12,5 minutos de latência motora respectivamente), já o grupo 0,125%, apresentou latência sensitiva e motora dentro da média de 25 e 22 minutos respectivamente. Os tempos de duração dos bloqueios no presente estudo apresentaram-se dentro da média considerada normal para o fármcaco utilizado, entretanto, alguns pacientes do grupo 0,125% apresentaram perda sensorial sem bloqueio motor. Pode-se concluir que a associação de técnicas avançadas como a ultrassonografia e o neuroestimulador é viável e proporciona um bloqueio seguro e efetivo com baixa concentração de anestésico local (0,125%) onde o paciente apresenta perda da sensibilidade com disfunção motora mínima.

SOUZA,L.P.2018.111p. Brachial plexus block in cats: evaluation of techniques and comparison of different concentrations of Bupivacaine. Thesis (Doctorate in Animal Science) - State University of Santa Catarina. Graduate Program in Animal Science, Lages, 2018. The use of peripheral nerve blocks associated with advanced techniques has brought favorable results in medicine, although in veterinary medicine there is an evident shortage of information about the above. Therefore, the present study aimed to evaluate, in a first phase, thirty two cats randomly allocated in four groups according to ultrasound-guided, "blind" application techniques, as well as an association of the neurostimulator with the ultrasound for axillary brachial plexus block in felines, in order to evaluate if there is a difference between the techniques in relation to the effectiveness and safety of the locks. In a second phase, the objective was to analyze the possibility of obtaining an effective and safe brachial plexus block with the lowest possible bupivacaine concentration associated with the ultrasound guided peripheral nerve stimulator technique. Twenty-four felines were randomly assigned to three groups that received axillary plexus block with multiple bupivacaine injections at concentrations of 0.5%, 0.25% and 0.125%. In both phases, sensory and motor latency times and motor and sensory block times were evaluated. The results in the first phase demonstrate that brachial plexus block is effective in all methods. There was no statistical difference between the groups in relation to the time of sensory latency, whereas the motor latency showed similarity between the AC and US and NE and NE + US groups. The total time of sensory blockade showed a significant difference between the AC and US groups, and in the US group the mean total block time was 443.13 minutes compared to 278.14 minutes in the AC group. The motor latency time also showed a significant difference in the groups using advanced methods (Group NE = 289.38 minutes, US = 325.63 minutes, NE + US = 307.50 minutes) in relation to the AC group (175.63 minutes ). It was possible to conclude that this type of blockade in cats promotes analgesia evident only in the hand region and that the ultrasound guided method with multiple injections demonstrates blocking times, in general, equivalent to the technique guided by peripheral nerve stimulator, however with the fundamental advantage of a safer procedure with less or no adverse effects. In the second phase, the blockade was effective in all concentrations, with sensory and motor latency times of the 0.5% and 0.25% groups were below the mean described in the literature (8.13 minutes, 16.88 minutes of latency sensitive and 15 minutes and 12.5 minutes of motor dormancy respectively), while the 0.125% group presented sensory and motor latency within the mean of 25 and 22 minutes, respectively. The duration of blockade in the present study was within the mean considered normal for the drug used, however, some patients in the 0.125% group presented sensory loss without motor blockade. It can be concluded that the association of advanced techniques such as ultrasonography and the neurostimulator is feasible and provides a safe and effective block with low concentration of local anesthetic (0.125%) where the patient presents with loss of sensitivity with minimal motor dysfunction.

Desenvolvimento de técnica para bloqueio dos nervos medianoulnar e radial em patos (Cairina moschata)

Balthazar, D. A. Desenvolvimento de técnica para bloqueio dos nervos medianoulnar e radial em patos (Cairina moschata). 2016. 44 p. Tese (Doutorado em Medicina Veterinária). Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, 2016. O sucesso das técnicas de bloqueio de nervos periféricos requer conhecimento anatômico preciso da área a ser bloqueada, obtendo-se assim precisão na administração do anestésico local e diminuição na dose de anestésicos. O objetivo do presente estudo foi desenvolver um método de anestesia regional do apêndice locomotor, por meio de bloqueio anestésico dos nervos medianoulnar e radial em pato (Cairina moschata) com lidocaína 2% guiado pelo estimulador de nervo periférico, com base em estudo anatômico, avaliando-se sua efetividade em estudos ex vivo e in vivo. Para confecção do estudo anatômico foram utilizados seis cadáveres de patos e em dois destes cadáveres foi realizado também o exame radiográfico da coluna vertebral. Com base no estudo anatômico foram definidos e descritos dois pontos de acesso para bloqueio do membro torácico, nos quais, em um cadáver de pato, foi injetado azul de metileno com posterior dissecção e observação da coloração dos nervos e das regiões circundantes. Os estudos in vivo foram realizados em espécimes de pato doméstico, constando inicialmente de estudo piloto com dois animais para determinação do regime elétrico para a neurolocalização e posteriormente de avaliação da resposta motora e nociceptiva ao bloqueio dos nervos medianoulnar e radial, em seis exemplares de pato, fêmeas, adultas, peso médio de 1,42kg. Após indução com isoflurano os animais foram submetidos à técnica de neurolocalização, iniciando-se a estimulação do nervo com corrente de 0,7 mA, frequência de 2Hz e duração do pulso de 300 Seg, diminuindo-se gradativamente até obtenção da resposta motora com 0,2 mA e ausência de resposta com correntes de 0,18 mA. Em cada animal uma das asas recebeu injeção de lidocaína 2%, na dose de 6 mg/kg (Grupo Tratado) e a asa oposta solução salina 0,9% (Grupo Controle), em igual volume, em técnica cega, interrompendo-se então o fornecimento de isoflurano. A avaliação das respostas sensitiva e motora foi expressa em escores e teve início três minutos após a extubação, seguida de observação aos cinco, 10, 15 e 20 minutos, prosseguindo no grupo Tratado a cada 10 minutos, até a observação do fim do bloqueio. O exame radiográfico da coluna vertebral e o estudo anatômico revelaram que o pato possui quatro raízes nervosas que se unem em um tronco único e desse originam-se os principais nervos: axilar, radial, medianoulnar e peitoral. Durante o estudo de dispersão de azul de metileno os nervos apresentaram-se pigmentados em uma grande extensão, demonstrando que os pontos de aplicação determinados e o volume de solução aplicada mostraram-se satisfatórios. No estudo in vivo observou-se diferença estatisticamente significante nos escores de relaxamento muscular entre os grupos Tratado e Controle dos tempos 5 a 40 minutos, e de bloqueio sensitivo dos tempos 3 a 50 minutos. A duração do bloqueio sensitivo variou 37 a 77 minutos (média 51,67 + 17,28 minutos). Conclui-se que a técnica de bloqueio dos nervos medianoulnar e radial guiada pelo estimulador de nervos periféricos foi efetiva quando se utilizou dose de 6 mg/kg de lidocaína, promovendo o bloqueio da região distal à articulação úmero-radio-ulnar.

Balthazar, D. A. Development of median ulnar and radial nerves block technique in ducks (Cairina moschata) 2016. 44 p. Thesis (Doctor of Veterinary Medicine). Veterinary Institute, Rural Federal University of Rio de Janeiro, Seropédica, RJ, 2016. The success of peripheral nerve blocking techniques requires precise knowledge of the anatomical area to be blocked, thus yielding accurate local anesthetic administration and a reduction on the anesthetic dosage. The aim of this study was to develop a regional anesthesia method for locomotor appendage. We performed anesthetic block of median ulnar and radial nerves in muscovy duck (Cairina moschata) with 2% lidocaine guided by peripheral nerve stimulator, followed by evaluation of effectiveness in ex vivo and in vivo studies. For anatomical study we used six cadaver ducks and in two of these was also performed the radiographic examination of the spine. Based on the anatomical study we defined and described two access points to block the forelimb. In a muscovy duck body methylene blue was injected with subsequent dissection and observation of the nerve and the surrounding regions colors. In vivo studies were performed in domestic duck specimens, consisting of an initial pilot study with two animals to determine the electric system for neurolocalization and later evaluation of the motor and nociceptive response to blockage of medianoulnar and radial nerve in six duck specimens, female, adult, middle weight 1,42kg. After induction with isoflurane, animals underwent neurolocalization technique by starting the nerve stimulation with a current of 0.7 mA, frequency of 2 Hz and pulse duration of 300 Seg. We gradually decreased the current to 0.2 mA to induce a motor response, and 0.18 mA to induce no response. Each animal had one wing injected with lidocaine 2% (6 mg/kg), being the Treated Group, and a wing injected with the same volume of saline 0.9%, being the Control Group, in blind technique. Isoflurane was then interrupted. The evaluation of sensory and motor response was expressed as scores and started 3 minutes after extubation, followed by observation at 5, 10, 15 and 20 minutes, and then every 10 minutes untill the end of the block. Radiographic examination of the spine and the anatomical study revealed that the duck has four roots that unite into a single trunk and then originate the major nerves: axillary, radial, medianoulnar and breastplate. During the methylene blue dispersion study, nerves were presented pigmented to a large extent, demonstrating that the application points and the volume of anesthetic applied were satisfactory. The in vivo study showed a statistically significant difference in scores of muscle relaxation between the treated and control groups in times 5-40 minutes and sensory block in times 3-50 minutes. The duration of sensory block ranged between 37-77 minutes (mean 51.67 + 17.28 minutes). We concluded that the medianoulnar and radial nerve block technique guided by peripheral nerve stimulator was effective when using 6 mg/kg of lidocaine, with successful blockade distal to the humerus-radio-ulnar joint.