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1.
Vet Anaesth Analg ; 46(5): 673-681, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31371195

RESUMO

OBJECTIVE: To assess the effects of ultrasound-guided lumbar plexus and sciatic nerve blocks on perianesthetic analgesia and recovery quality in dogs undergoing tibial plateau leveling osteotomy (TPLO). ANIMALS: A group of twenty 20 dogs. STUDY DESIGN: Prospective, randomized, blinded, clinical study. METHODS: Dogs were administered lumbar plexus and sciatic nerve blocks with ropivacaine (1.5 mg kg-1; group RA) or sham blocks with saline (group CON). Dogs were administered hydromorphone (0.2 mg kg-1) and atropine (0.02 mg kg-1) subcutaneously before anesthesia was induced with intravenous propofol and maintained with isoflurane. Variables included duration to perform nerve blocks, intraoperative rescue analgesia, recovery score, postoperative pain scores (modified University of Melbourne, Colorado State University and visual analog pain scales), postoperative rescue analgesia-sedation and complications observed. Two-tailed Student t test, Mann-Whitney test, repeated measures analysis of variance, Friedman test and Fisher exact test were used for comparison. Significance was p < 0.05. RESULTS: Time to perform nerve blocks was [median (range)] 4.3 (2.6-6.1) minutes after aseptic skin preparation. Total fentanyl requirements were 14.2 ± 9 µg kg-1 and 25.4 ± 10 µg kg-1 (p = 0.02) and incidence of hypotension (mean arterial pressure < 60 mmHg) was 40% and 80% (p = 0.16) for groups RA and CON, respectively. Six of eight group CON dogs required more intensive treatment for hypotension than group RA dogs. Recovery scores were 1 (1-4) and 2.5 (1-4) for groups RA and CON, respectively (p = 0.04). RA dogs were less likely to require fentanyl rescue analgesia during the postoperative period (p = 0.04). CONCLUSION AND CLINICAL RELEVANCE: As part of a multimodal analgesia regimen, ultrasound-guided lumbar plexus and sciatic nerve blocks provided greater analgesia and improved recovery quality in dogs during TPLO surgery.


Assuntos
Anestésicos Locais/uso terapêutico , Cães/fisiologia , Bloqueio Nervoso/veterinária , Osteotomia/veterinária , Dor Pós-Operatória/veterinária , Ropivacaina/uso terapêutico , Joelho de Quadrúpedes/cirurgia , Anestésicos Locais/administração & dosagem , Animais , Cães/cirurgia , Feminino , Plexo Lombossacral , Masculino , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ropivacaina/administração & dosagem , Nervo Isquiático , Método Simples-Cego , Ultrassonografia de Intervenção/veterinária
2.
Vet Anaesth Analg ; 46(5): 682-688, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31204254

RESUMO

OBJECTIVE: To determine the anesthesia cost from ultrasound-guided lumbar plexus and sciatic nerve blocks confirmed with electrostimulation for unilateral tibial plateau leveling osteotomy (TPLO) surgery in dogs. STUDY DESIGN: Prospective, randomized, blinded clinical trial. ANIMALS: A group of 20 dogs weighing 33.9 ± 6.0 kg (mean ± standard deviation). METHODS: All dogs were administered hydromorphone and atropine, propofol for induction of anesthesia and isoflurane for maintenance. Hydromorphone and carprofen were administered for recovery. The dogs were randomly assigned to one of two groups, lumbar plexus and sciatic nerve blocks with ropivacaine [regional anesthesia (RA)] or sham blocks with saline [control (CON)]. Fentanyl was administered for rescue analgesia intraoperatively and postoperatively. The cost to manage anesthesia was divided into fixed and variable costs using the micro-costing method. The variable costs were compared using Student's t test or Mann-Whitney U test. RESULTS: The fixed anesthesia costs were equal between groups at US$354.00 per case. The variable anesthesia cost range was US$27.90-100.10 for RA and US$21.00-180.50 for CON. Overall, cost per dog in CON was from -US$6.9 to US$80.4 compared with RA. For 160 TPLO cases per year, hospital cost when RA is performed decreased the cost by $12,864 per year up to increased cost by $1104 per year, depending on the requirements for systemic drugs and incidence/severity of anesthesia complications. The estimated fee charge per case for service necessary to reimburse the cost of a new ultrasound (US$25,000.00) and nerve locator (US$925.00) over their life span of 6 and 10 years, respectively, is US$26.62. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided lumbar plexus and sciatic nerve blocks with electrostimulation confirmation can increase the anesthesia cost through use of specific equipment. However, in most cases, the anesthesia cost decreased as a result of decreased costs for pain management and treatment of complications.


Assuntos
Cães/fisiologia , Terapia por Estimulação Elétrica/veterinária , Bloqueio Nervoso/veterinária , Osteotomia/veterinária , Dor Pós-Operatória/veterinária , Joelho de Quadrúpedes/cirurgia , Ultrassonografia de Intervenção/veterinária , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Animais , Colorado , Terapia Combinada/economia , Terapia Combinada/veterinária , Análise Custo-Benefício , Cães/cirurgia , Terapia por Estimulação Elétrica/economia , Feminino , Plexo Lombossacral , Masculino , Bloqueio Nervoso/economia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Nervo Isquiático , Método Simples-Cego , Ultrassonografia de Intervenção/economia
3.
Vet Comp Orthop Traumatol ; 32(5): 383-388, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31185504

RESUMO

OBJECTIVES: The aim of this study was to describe an ultrasound-guided injection technique of the lumbosacral disc in horses through the cranial vertebral notch of the sacrum and to evaluate both accuracy and potential complications of the technique on equine cadavers. MATERIALS AND METHODS: Twenty-four injections of the lumbosacral area were performed on 12 equine cadavers shortly after euthanasia under ultrasound guidance with the horse in recumbency using two different dyes (one colour for each side). The lumbosacral area was dissected in each horse and the accuracy of the technique, as well as its potential complications, was evaluated detecting the dyes and the structures that have been coloured. RESULTS: The lumbosacral area was correctly reached in only 11/24 injections. However, this technique allowed a lumbosacral peridiscal injection in 7/12 horses. The main difficulty was reaching the ventral opening of the L6-S1 intervertebral foramen that is partially hidden by the iliac wing on ultrasound. Puncture of the vertebral canal has been observed in 11/24 cases. The L6 spinal nerve roots emerging through the intervertebral foramen could potentially be damaged when inserting the needle. CLINICAL SIGNIFICANCE: The described ultrasound-guided technique allows peridiscal injection in the lumbosacral space in less than 60% of cases with potential sciatic nerve damage. Further investigations are warranted before using this technique in clinical practice in horses suffering from lumbosacral lesions.


Assuntos
Cavalos , Injeções Espinhais/veterinária , Região Lombossacral/diagnóstico por imagem , Ultrassonografia de Intervenção/veterinária , Animais , Cadáver , Feminino , Injeções Espinhais/métodos , Disco Intervertebral , Masculino , Ultrassonografia de Intervenção/métodos
4.
Vet Anaesth Analg ; 46(4): 523-528, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31160170

RESUMO

OBJECTIVE: To compare two needle insertion techniques in a novel lateral approach to the radial, ulnar, median and musculocutaneous (RUMM) nerve block in cat cadavers. STUDY DESIGN: Prospective, cadaveric experimental study. ANIMALS: A group of 18 feline cadavers. METHODS: Cadavers were divided into two groups. Both thoracic limbs of each cat were 'blocked' using the 'in-plane' (IP) or 'out-of-plane' (OP) ultrasound (US)-guided method. A single operator with limited experience performed all the techniques. Cadavers were placed in lateral recumbency and the uppermost limb was injected before turning to 'block' the contralateral limb in the same manner. The IP method consisted of tracking the triceps brachii muscle until the radial (R) nerve could be identified in the same field of view as the ulnar, median and musculocutaneous (UMM) nerve bundle. A needle was guided by US towards the R nerve and subsequently, methylene blue (0.4 mL) was instilled adjacent to it. The needle was retracted and redirected to the UMM nerve bundle, and another 0.4 mL dye was instilled. For the OP technique, the limb was pronated at a 45° angle. The nerves were then identified with the R nerve directly above UMM nerves. A needle was directed OP deep towards UMM nerves and dye (0.4 mL) was instilled. The needle was retracted superficially and 0.4 mL dye instilled next to the R nerve. After dissection, the nerves were assessed and ≥6 mm of staining was considered a successful technique. RESULTS: A total of 18 RUMM 'blocks' were performed IP and 18 were performed OP. The IP technique was more successful than the OP technique (R nerve p = 0.0339; UMM nerves p = 0.0352). CONCLUSIONS AND CLINICAL RELEVANCE: The lateral approach to the RUMM was achievable in cat cadavers using both needle insertion techniques. The IP technique was significantly more successful than the OP technique.


Assuntos
Gatos , Membro Anterior/inervação , Agulhas , Bloqueio Nervoso/veterinária , Ultrassonografia de Intervenção/veterinária , Animais , Cadáver , Nervo Mediano , Nervo Musculocutâneo , Bloqueio Nervoso/métodos , Nervo Radial , Nervo Ulnar
5.
Vet Anaesth Analg ; 46(4): 516-522, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029460

RESUMO

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.


Assuntos
Corantes/administração & dosagem , Cães , Ultrassonografia de Intervenção/veterinária , Pontos de Referência Anatômicos , Animais , Cadáver , Espaço Epidural , Bloqueio Nervoso/veterinária , Estudos Prospectivos , Vértebras Torácicas , Ultrassonografia de Intervenção/métodos
6.
Vet Clin North Am Exot Anim Pract ; 22(2): 301-314, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961902

RESUMO

Locoregional techniques are used in exotic pets to improve perioperative analgesia as well as decrease the requirement of systemic analgesics during and after invasive surgeries. This article focuses on the techniques that have been described for exotic mammals, birds, and reptiles, focusing on those that rely on ultrasonographic or nerve stimulator guidance.


Assuntos
Anestesia Local/veterinária , Animais Exóticos , Bloqueio Nervoso/veterinária , Animais , Ortopedia , Ultrassonografia de Intervenção/veterinária , Medicina Veterinária
7.
Vet Anaesth Analg ; 46(3): 384-394, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30962041

RESUMO

OBJECTIVE: To design and assess the perioperative analgesic efficacy of an ultrasound (US)-guided radial (R), ulnar (U), median (M) and musculocutaneous (Mc) nerve blocks, performed together in the axillary space by a single, in-plane approach. STUDY DESIGN: Anatomical research and prospective clinical study. ANIMALS: A group of three dog cadavers and 15 client-owned dogs undergoing orthopaedic thoracic limb surgery. METHODS: Phase 1: Anatomical dissection and US study of the axillary space were performed to design the US-guided proximal RUMM block. The technique was considered successful if a total volume of 0.15 mL kg-1 new methylene blue solution completely stained the four nerves in two cadavers for ≥2 cm. Phase 2: In 15 client-owned dogs undergoing orthopaedic thoracic limb surgery, the RUMM block designed in phase 1 was performed to provide analgesia using a total volume of 0.15 mL kg-1 of ropivacaine 0.5%. The block was considered effective if the intraoperative fentanyl requirement was <1.2 mcg kg-1 hour-1 and until the postoperative pain score was [short-form Glasgow Composite Measure Pain Scale (SF-GCMPS)] ≤5/20. RESULTS: Phase1: Detection of the four nerves was always feasible in a single US-window. The axillary artery and Mc nerve were used as landmarks. In-plane needling approach was feasible in both cadavers. All the nerves were completely stained for >2 cm. No intrathoracic dye spread was found. Phase 2: In 14/15 anaesthetized dogs, mean intraoperative fentanyl requirement was 0.25 ± 0.05 mcg kg-1 hour-1. Postoperatively, all dogs had SF-GCMPS ≤5/20 up to 8 hours. CONCLUSIONS AND CLINICAL RELEVANCE: The US-guided proximal RUMM block performed at the axillary level with a single, in-plane needling approach using 0.15 mL kg-1 of ropivacaine 0.5% minimized fentanyl requirement during thoracic limb surgery, contributing to postoperative analgesia up to 8 hours after execution of the peripheral nerve block.


Assuntos
Cães/cirurgia , Bloqueio Nervoso/veterinária , Procedimentos Ortopédicos/veterinária , Ultrassonografia de Intervenção/veterinária , Analgésicos Opioides/uso terapêutico , Animais , Cadáver , Fentanila/uso terapêutico , Membro Anterior/cirurgia , Azul de Metileno/análogos & derivados , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/veterinária , Estudos Prospectivos , Ultrassonografia de Intervenção/métodos
8.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 331-336, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30994963

RESUMO

BACKGROUND: Circumstances such as the inability to pass a retrograde urinary catheter or a lack of surgeon availability may prevent immediate relief of urethral obstruction in dogs. In such situations, a cystostomy tube may be placed with ultrasound guidance to allow urinary diversion until further treatment is possible. KEY FINDINGS: A case of a 5-year-old male neutered Swiss Mountain dog with an obstructive urolith at the level of the os penis is used to describe the technique. Multiple attempts to pass a urinary catheter under sedation were unsuccessful. A pigtail cystostomy tube was placed with ultrasound guidance to allow urinary diversion. The dog was discharged from the hospital within 2 days after scrotal urethrostomy and the dog made a full recovery. Ultrasound-guided placement of a pigtail cystostomy tube was straightforward and without complications. SIGNIFICANCE: Ultrasound-guided placement of a pigtail cystostomy tube may be beneficial as it is not technically challenging, can be performed rapidly, and may avoid the need for general anesthesia. Additionally, ultrasound is readily available and an inexperienced ultrasonographer can easily locate the urinary bladder. This report serves to provide a detailed technique of ultrasound-guided placement of a pigtail cystostomy tube in dogs for emergency urinary diversion.


Assuntos
Cistostomia/veterinária , Doenças do Cão/cirurgia , Obstrução Uretral/veterinária , Urolitíase/veterinária , Animais , Cistostomia/instrumentação , Doenças do Cão/diagnóstico por imagem , Cães , Masculino , Ultrassonografia de Intervenção/veterinária , Obstrução Uretral/cirurgia , Urolitíase/cirurgia
9.
Vet Anaesth Analg ; 46(2): 246-250, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30713055

RESUMO

OBJECTIVE: To describe a novel ultrasound-guided posterior extraconal block in the dog. STUDY DESIGN: Prospective experimental cadaveric study. ANIMALS: A total of 13 Beagle Cross cadaver heads. METHODS: After describing the ultrasound bony landmarks and posterior extraconal local regional technique in one head, 12 heads were used to evaluate the spreading of contrast and evaluate potential complications. A 5-8 MHz microconvex ultrasound probe was positioned caudal to the orbital ligament, with the beam orientated transversely, and then tilted caudally until the orbital fissure was visualized. After identifying the bony structures consistent with the orbital fissure, a needle was advanced using an in-plane technique and 0.5 mL of a 50:50 mixture of iohexol and methylene blue was injected. Computed tomography (CT) and dissection were used to evaluate successful injections and potential complications. The injection was considered successful if radiopaque contrast medium was 5 mm from the orbital fissure. Potential complications were defined as the presence of radiopaque contrast within the globe or the intracalvarial tissues. RESULTS: The CT images confirmed contrast at the target site in 15/24 (63%) of the injections. Only two injections were found in the temporalis muscle; the rest of the injections were located in the extraconal space. No potential complications such as intracranial spreading of contrast, intravascular or intraocular injection were found. CONCLUSIONS AND CLINICAL RELEVANCE: The technique can deliver contrast close to the main nerves which provide sensory and motor innervation to the eye. Further studies are needed to evaluate this technique in clinical cases.


Assuntos
Cães/fisiologia , Bloqueio Nervoso/veterinária , Órbita/inervação , Animais , Cadáver , Procedimentos Cirúrgicos Oftalmológicos/veterinária , Estudos Prospectivos , Ultrassonografia de Intervenção/veterinária
10.
Vet Anaesth Analg ; 46(1): 106-115, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30502040

RESUMO

OBJECTIVE: To develop a modified ultrasound-guided parasacral approach to the sciatic nerve and compare the effects of a volume of 0.2 mL kg-1 of 0.5% levobupivacaine with an equivalent volume of 0.9% saline injected near the sciatic nerve. STUDY DESIGN: Cadaveric and experimental, blinded, randomized study. ANIMALS: Seven canine cadavers and seven experimental Beagle dogs. METHODS: Both sciatic nerves of seven cadavers were identified using a modified in-plane ultrasound-guided approach. Methylene blue solution (0.2 mL) was injected perineurally, and success was evaluated through dissection. The same approach was repeated in seven Beagle dogs sedated with dexmedetomidine (50 µg kg-1) injected intramuscularly (IM). After randomization, 0.2 mL kg-1 of 0.5% levobupivacaine (limb L) and 0.2 mL kg-1 of 0.9% saline (limb C) were injected perineurally on either right or left limb. Block success was determined by sensory deficits every hour for 8 hours after an atipamezole injection (0.2 mg kg-1) IM. Reaction to pinprick (binary score) over the course of the sciatic nerve (four locations) and locomotion were assessed. RESULTS: The overall sciatic nerve block success was 93% in cadavers and 86% in sedated dogs. It was impossible to localize the sciatic nerves in one obese sedated dog. Significant differences between limb L and limb C were observed for pinprick at great trochanter, caudal thigh and lateral tarsal joint (p < 0.0001). Reaction to pinprick was absent in all dogs at great trochanter and caudal thigh up to at least 3 hours on limb L. Locomotion was impaired in all but one dog for 60 (30-210) minutes (median; interquartile range). No complications were observed. CONCLUSIONS AND CLINICAL RELEVANCE: A volume of ≥0.2 mL kg-1 and a concentration of 0.5% levobupivacaine can be recommended when using a modified ultrasound-guided parasacral approach to the sciatic nerve in dogs.


Assuntos
Anestésicos Locais/farmacologia , Cães/fisiologia , Levobupivacaína/farmacologia , Bloqueio Nervoso/veterinária , Medição da Dor/veterinária , Nervo Isquiático/diagnóstico por imagem , Anestésicos Locais/administração & dosagem , Animais , Feminino , Levobupivacaína/administração & dosagem , Masculino , Medição da Dor/efeitos dos fármacos , Distribuição Aleatória , Ultrassonografia de Intervenção/veterinária
11.
J Vet Emerg Crit Care (San Antonio) ; 28(6): 579-584, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30294853

RESUMO

OBJECTIVE: To describe a technique for gaining ultrasound-guided access to the femoral artery in an experimental model of acute hemorrhagic shock in anesthetized dogs. CASE SERIES SUMMARY: Five healthy, purpose-bred adult male intact Beagles were enrolled in a respiratory mechanics study under general anesthesia. Upon completion of the primary study a hypovolemic state was induced by blood removal to achieve a mean arterial pressure ≤ 55 mm Hg. Dogs were positioned in dorsal recumbency with the hind limb extended caudally. An ultrasound probe was applied to the medial aspect of the hind limb and positioned in the transverse orientation so that the femoral artery was visualized in its short axis. The artery was identified by lack of compression and presence of visible pulsation. The probe was rotated 90° into the longitudinal orientation such that the artery was visualized in its long axis. Under ultrasound guidance a 19-gauge introducer needle was advanced into the lumen of the femoral artery. Using a modified Seldinger technique the needle was removed and a catheter was placed in the femoral artery. Correct placement of the catheter was verified by observation of the characteristic arterial blood pressure waveform. Upon completion of the study dogs were humanely euthanized. The femoral artery was successfully catheterized in 4/5 dogs and a hematoma was reported in 1/5 dogs. NEW OR UNIQUE INFORMATION PROVIDED: Ultrasound-guided femoral artery catheterization is feasible on anesthetized dogs with concurrent acute hemorrhagic shock.


Assuntos
Doenças do Cão/terapia , Cães/fisiologia , Artéria Femoral/diagnóstico por imagem , Choque Hemorrágico/veterinária , Anestesia Geral/veterinária , Animais , Cateterismo/veterinária , Doenças do Cão/diagnóstico por imagem , Masculino , Choque Hemorrágico/terapia , Ultrassonografia de Intervenção/veterinária
12.
Vet Anaesth Analg ; 45(6): 871-875, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30305232

RESUMO

OBJECTIVE: This study evaluated the spread of a two-point transversus abdominis plane (TAP) injection in canine cadavers. Compared with previous techniques, the two-point TAP injection was developed to increase the consistency of local anaesthetic spread to the nerve segments T11, T12, L1, L2 and L3. STUDY DESIGN: Prospective experimental trial. ANIMALS: Five fresh canine cadavers. METHODS: Two-point TAP injections were performed under ultrasound guidance by a single trained individual in canine cadavers (15.7-43.0 kg). Each hemi-abdomen was infiltrated and evaluated independently for a total of 10 evaluations of the technique. The first injection was performed at the level of the costo-chondral junction of the thirteenth rib, and the second injection was performed cranial to the tuber coxae. Each injection comprised 0.3 mL kg-1 methylene blue solution (0.0015 mg mL-1). Ten minutes after the injections, abdominal wall dissection was performed, and any nerves stained for a minimum of 10 mm along their long axis were identified and recorded. RESULTS: During all injections, separation of the internal oblique and transversus abdominis muscles was observed on ultrasound. On dissection, branches of T12, T13, L1, L2 and L3 were adequately stained in 30%, 100%, 100%, 90% and 90% of injections, respectively. No staining of branches of T11 occurred in any of the cadavers. In one hemi-abdomen, branches of L1 and L3, but not L2, were stained. CONCLUSIONS AND CLINICAL RELEVANCE: This study indicates that the two-point TAP injection delivers consistent dye dispersion to adequately stain branches of T13, L1, L2 and L3, with no coverage of T11 and poor coverage of T12, in fresh canine cadavers. An in vivo study using local anaesthetic should be performed to evaluate the analgesic efficacy of this technique in mid to caudal abdominal surgeries.


Assuntos
Músculos Abdominais , Anestesia Local/veterinária , Injeções Intramusculares/veterinária , Ultrassonografia de Intervenção/veterinária , Anestesia Local/métodos , Animais , Cadáver , Cães , Feminino , Injeções Intramusculares/métodos , Masculino , Projetos Piloto , Estudos Prospectivos , Ultrassonografia de Intervenção/métodos
13.
Vet Anaesth Analg ; 45(6): 811-819, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30254000

RESUMO

OBJECTIVES: To describe an ultrasound-guided thoracic paravertebral block and determine the distribution after injection of two volumes of methylene blue in dog cadavers. STUDY DESIGN: Prospective experimental cadaveric study. ANIMALS: Twelve dog cadavers weighing 11 ± 3 kg. METHODS: Ultrasound-guided injections aimed at the fifth thoracic (T5) paravertebral space were performed in randomized order using 0.1 or 0.3 mL kg-1 dye solution (six dogs for each volume). Anatomic dissections determined dye spread characteristics, including the presence and degree of staining of spinal nerves, and the presence of intercostal and sympathetic trunk spread. Staining of mediastinum, epidural, intrapleural and contralateral thoracic paravertebral space was recorded. RESULTS: There was no significant difference in dye distribution between groups. The use of anatomic landmarks resulted in the inaccurate identification of the T5 paravertebral space. The T4, T5 and T6 paravertebral spaces were injected in four, five and three of 12 dogs, respectively. Complete staining of the spinal nerve of the thoracic paravertebral space injected was observed in 11 of 12 dogs, and partial staining in one dog in the low-volume group. Multisegmental distribution was demonstrated with staining of contiguous spinal nerves in one dog in the high-volume group, and multiple segments of intercostal (three dogs) and sympathetic trunk (four dogs) spread in both groups. No mediastinal, epidural, intrapleural or contralateral thoracic paravertebral space staining was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasound-guided injection at the thoracic paravertebral space resulted in staining of the spinal nerve in all dogs. However, T5 paravertebral space was not accurately identified using anatomic landmarks. Dye distribution was not significantly different between the two groups; therefore, the use of the lower-volume and multiple-site injections would be potentially necessary in clinical cases to achieve ipsilateral blockade of the thoracic wall.


Assuntos
Cães/cirurgia , Azul de Metileno/metabolismo , Bloqueio Nervoso/veterinária , Vértebras Torácicas , Ultrassonografia de Intervenção/veterinária , Animais , Cadáver , Feminino , Masculino , Bloqueio Nervoso/métodos , Estudos Prospectivos , Cirurgia Assistida por Computador/veterinária , Vértebras Torácicas/metabolismo
16.
Vet Clin North Am Small Anim Pract ; 48(5): 797-817, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29914694

RESUMO

There remain areas of uncertainty in optimal technique, preferred candidates, and expected outcome for small animal patients undergoing cardiac intervention. This article highlights issues within interventional cardiology that are in need of study and offers the author's opinion and experience on topics such as variants of pulmonary valve anatomy and alternatives to conventional balloon dilation for pulmonary valve stenosis, patient selection for cutting or high-pressure balloon dilation of aortic valvar or subaortic stenosis, occlusion of patent ductus arteriosus in very small dogs, ductal stenting in conditions with reduced pulmonary blood flow, and alternative considerations for vascular access and closure.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/veterinária , Medicina Veterinária/métodos , Animais , Procedimentos Cirúrgicos Cardiovasculares/métodos , Cateterismo/métodos , Cateterismo/veterinária , Permeabilidade do Canal Arterial/cirurgia , Permeabilidade do Canal Arterial/veterinária , Ecocardiografia/veterinária , Fluoroscopia/veterinária , Animais de Estimação , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção/veterinária
17.
Vet Anaesth Analg ; 45(5): 703-706, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29908716

RESUMO

OBJECTIVE: To investigate the utility of identifying the superficial circumflex iliac artery (SCIA) via ultrasound as an anatomical landmark for ultrasound-guided femoral nerve block. STUDY DESIGN: Observational study. ANIMALS: A group of six canine cadavers weighing >20 kg. METHODS: Pelvic limbs from six canine cadavers were examined to study the relationship between the SCIA and the femoral nerve. Ultrasonographic imaging of the SCIA in each limb was obtained with the transducer placed transversely in the medial aspect of the pelvic limb at the inguinal area. Subsequently, a needle was inserted in close proximity to the femoral nerve using an in-plane technique based on the anatomical relationship between the SCIA and femoral nerve. A total of 0.1 mL of colored latex was then injected at the location where the femoral nerve was expected to be in relationship to the SCIA. Gross dissection of the inguinal region in each pelvic limb was performed after injection. Positive nerve location was defined when the colored latex was in contact with the femoral nerve. RESULTS: A total of eleven pelvic limbs were injected because the SCIA could not be successfully visualized in one limb. Upon dissection, colored latex was found to be in direct contact with the femoral nerve in all 11 injected limbs. CONCLUSIONS AND CLINICAL RELEVANCE: We concluded that the ultrasonographic visualization of the SCIA assisted in the accurate deposition of dye in proximity to the femoral nerve of canine cadavers. Further investigation will determine the efficacy of this technique for performing femoral nerve blocks.


Assuntos
Cães/anatomia & histologia , Nervo Femoral/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Bloqueio Nervoso/veterinária , Ultrassonografia de Intervenção/veterinária , Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/diagnóstico por imagem , Animais , Nervo Femoral/anatomia & histologia , Artéria Ilíaca/anatomia & histologia , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos
18.
Vet Anaesth Analg ; 45(4): 566-574, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29793780

RESUMO

OBJECTIVE: To evaluate an ultrasound-guided technique for adductor canal (AC) block by describing the distribution of methylene blue around the AC, popliteal fossa, saphenous, tibial and common fibular nerves in dog cadavers. STUDY DESIGN: Prospective experimental trial. ANIMALS: Ten mixed breed canine cadavers weighing 28.55 ± 3.94 kg. METHODS: Ultrasound scans of the AC were performed bilaterally in 10 canine cadavers. A high-frequency linear transducer was placed on the long axis of the pectineus muscle and using an in-plane technique, an insulated needle was introduced at a proximal to distal direction into the AC. Methylene blue 0.1% (0.3 mL kg-1) was administered followed by dissection. The presence of dye over the target nerves for ≥2 cm was considered successful distribution. Three of 10 cadavers were submitted to computed tomography (CT) and one of them to magnetic resonance (MR) evaluation. RESULTS: Methylene blue reached the AC in 20 (100%) and the popliteal fossa in 17 (85%) pelvic limbs. Staining was successful in the saphenous nerve (4.0 ± 1.57 cm) in 11 (55%) limbs, tibial nerve (2.65 ± 0.8 cm) in six (30%) and common fibular nerve (2.7 ± 0.9 cm) in four (20%). There was no evidence of staining around the motor branches of the femoral nerve. No intraneural or intravascular dye spread was found during dissections. Contrast distribution to the popliteal fossa was observed in three limbs (50%) in CT and in one (50%) MR image. CONCLUSIONS AND CLINICAL RELEVANCE: Although the tibial and common fibular nerves were not stained as often as the saphenous nerve, dye was encountered throughout the popliteal fossa near the nerves. The AC block may be useful for intra and postoperative analgesia in stifle surgery with minimal femoral motor dysfunction. However, further study is required to confirm its efficacy and safety in vivo.


Assuntos
Bloqueio Nervoso/veterinária , Ultrassonografia de Intervenção/veterinária , Animais , Cães , Feminino , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/inervação , Masculino , Bloqueio Nervoso/métodos , Nervo Fibular/diagnóstico por imagem , Nervo Tibial/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos
19.
Vet Anaesth Analg ; 45(3): 374-383, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29627201

RESUMO

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.


Assuntos
Analgesia/veterinária , Anestésicos Combinados/administração & dosagem , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Gatos/cirurgia , Lidocaína/administração & dosagem , Bloqueio Nervoso/veterinária , Ovariectomia/veterinária , Ultrassonografia de Intervenção/veterinária , Músculos Abdominais/efeitos dos fármacos , Analgesia/métodos , Animais , Feminino , Bloqueio Nervoso/métodos , Período Perioperatório/veterinária
20.
Vet Anaesth Analg ; 45(3): 384-391, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29625919

RESUMO

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.


Assuntos
Bloqueio Nervoso/veterinária , Ultrassonografia de Intervenção/veterinária , Músculos Abdominais , Anestesia Local/métodos , Anestesia Local/veterinária , Animais , Bovinos , Feminino , Injeções Intramusculares/métodos , Injeções Intramusculares/veterinária , Masculino , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos
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