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1.
ObjectiveTo develop and assess the efficacy of an ultrasound (US)-guided pericapsular hip desensitization (PHD) technique in dogs.Study designProspective, randomized, anatomical study and a case series.AnimalsA total of 30 healthy dogs, eight canine cadavers and seven dogs with hip osteoarthritis.MethodsAfter studying the US anatomy of the medial aspect of the coxofemoral joint and determining an acoustic window to perform an US-guided PHD in healthy dogs, the US-guided PHD was performed bilaterally in canine cadavers. A low [(LV) 0.1 mL kg–1] and high [(HV) 0.2 mL kg–1] volume of dye was injected per hip on each cadaver. The staining of the pericapsular nerves was assessed by anatomical dissection, and comparison between LV and HV was assessed using Fisher’s exact test. Then, the US-guided PHD was performed using a triamcinolone–bupivacaine solution in dogs with hip osteoarthritis. Dynamic pain response was assessed before and after injection. The canine brief pain inventory (CBPI) questionnaire was used to assess treatment efficacy and duration.ResultsThe US-guided PHD could be performed by inserting the needle between the iliopsoas muscle and the periosteum of the ilium. The articular branches of the femoral and obturator nerves were stained in all cadavers using both volumes. The main femoral nerve was never stained, but the main obturator nerve was stained in 37.5% and 100% of injections using LV and HV, respectively (p = 0.026). Treated animals showed decreased dynamic pain response after the injection. Compared with baseline, CBPI scores were reduced by ≥ 50% for ≥ 12 weeks in all but one dog.Conclusions and clinical significanceThe US-guided PHD with both 0.1 and 0.2 mL kg–1 volumes stained the articular branches of the femoral and obturator nerves in canine cadavers and was associated with clinical improvement in dogs with hip osteoarthritis.  相似文献   

2.
ObjectiveTo describe the gross and microscopic anatomy of the sciatic nerve paraneural sheath and to report an ultrasound (US)-guided subparaneural approach to the sciatic nerve in dogs, comparing two different volumes of injectate.Study designProspective, randomized, anatomical study.AnimalsA group of nine middle-sized adult Mongrel canine cadavers (18 limbs).MethodsThe sciatic nerves of three pelvic limbs of two canine cadavers were identified, exposed and isolated between the greater trochanter and the popliteal fossa for gross anatomical and microscopic examination. An additional three pelvic limbs were surgically dissected on the lateral surface of the limb; the sciatic nerves were isolated, and a 26 gauge over-the-needle catheter was inserted through the paraneural sheath under direct visualization. A methylene blue solution was then slowly injected into the subparaneural compartment through the catheter under US visualization using an 8–13 MHz linear-array transducer. Subsequently, 12 pelvic limbs (six cadavers) were randomly allocated to one of two groups; using US-guided percutaneous subparaneural approach, either 0.1 or 0.05 mL kg–1of a 1:1 solution of methylene blue and 0.5% bupivacaine was injected. The spread of the dye solution and the amount of nerve staining were macroscopically scored. The stained sciatic nerves with their sheaths were then harvested for microscopic examination.ResultsThe paraneural sciatic nerve sheath was easily identified distinct from the nerve trunk both macroscopically and with US visualization, and microscopically. Complete staining was achieved in five of six (83.3%) sciatic nerves in each group; no difference was found in the amount of staining between the two groups. Microscopically, no signs of sciatic nerve intraneural injection were observed.Conclusions and clinical relevanceThe US-guided subparaneural injection of 0.05 mL kg–1 of a dye injectate resulted in satisfactory nerve staining without evidence of sciatic nerve intraneural injection.  相似文献   

3.
Objective: To evaluate a technique for midhumeral peripheral nerve blockade in the dog. Study Design: Cadaveric technique development; in vivo placebo‐controlled, prospective crossover study. Animals: Canine cadavers (n=38) and 8 clinically healthy, adult hound dogs. Methods: A technique for peripheral block of the radial, ulnar, musculocutaneous, and median nerves (RUMM block) was evaluated using cadaver limbs. Eight purpose‐bred, research dogs were anesthetized; a RUMM block was performed on each thoracic limb. One limb from each dog randomly received 0.5% bupivacaine and the opposite limb was assigned to receive sterile saline solution as a control. After recovery from anesthesia, skin sensation at selected dermatomes was evaluated for 24 hours using a mechanical stimulus. Weight‐bearing, conscious proprioception, and withdrawal reflex were also evaluated. One month after initial testing, each dog was reanesthetized and each limb received the opposite treatment. Results: Sensory thresholds were significantly increased over baseline measurements when compared with control limbs for all nerves. Complete sensory block was achieved in radial (15/16), ulnar (3/16), musculocutaneous (8/16), and median (11/16) nerves, using a mechanical stimulus of analgesia. Complete simultaneous block of all nerves was only obtained in 1 of 16 limbs. Conclusion: RUMM block resulted in desensitization of the skin in the associated dermatomes for 4–10 hours. Complete sensory block of the dermatomes supplied by the radial nerve was most consistent. Clinical Relevance: RUMM block may be an effective technique to provide adjunctive analgesia for dogs undergoing surgery of the distal aspect of the thoracic limb.  相似文献   

4.
ObjectiveTo evaluate the dye extent and distribution at the lumbar plexus (LP) of three volumes of local anaesthetic-methylene-blue solution administered close to the femoral nerve (FN) by the use of a ventral ultrasound (US)-guided suprainguinal approach (SIA).Study designProspective experimental trial.AnimalsTwenty mongrel canine cadavers weighing 17.7 ± 3.8 kg (mean ± SD).MethodsThe left and right LP of two cadavers were dissected to identify the FN, obturator nerve (ON) and lateral femoral cutaneous nerve (LFCN). The extent and distribution of dye at the LP of each of three volumes of injectate of 0.2, 0.4 and 0.6 mL kg?1 administered close to the FN by a ventral US-guided SIA then were studied in a further 18 dog cadavers (n = 6 per group). Staining of ≥2 cm along the target nerves was indicative of sufficient spread to produce a nerve block.ResultsThe ventral US-guided SIA allowed the observation of the FN within the iliopsoas muscle (IPM) in a total of 17 cadavers. The assessment of the dye extent and distribution revealed a similar pattern regardless of the injected volume. From the injection site, the spreading of injectate occurred in cranial, lateral and caudal directions. The FN and ON were effectively stained in all the cases. The LFCN was not effectively stained in any case.Conclusions and clinical relevanceA volume of 0.2 mL kg?1 administered close to the FN by a ventral US-guided SIA produced a sufficient distribution of the injectate within the IPM to produce effective staining of the FN and ON. This US-guided technique may be an appropriate alternative to previously reported techniques based on electrolocation to block the FN and ON in the dog.  相似文献   

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ObjectiveTo provide ultrasonographic mapping of the axillary region of dogs to facilitate identification of the major branches of the brachial plexus in relation to the axillary artery.Study designProspective study.AnimalsA total of two dog cadavers and 50 client-owned, healthy dogs weighing >15 kg.MethodsIn Phase 1, anatomical dissections were performed to identify the relation of the major brachial plexus nerves to the axillary artery. In Phase 2, with the dogs in dorsal recumbency with thoracic limbs flexed naturally, the axillary space was scanned using a linear array probe oriented on the parasagittal plane until the axis transverse to nerves was found. Then, the transducer was rotated to a slight lateral angle approximately 30° to midline. The examination aimed to identify the axillary artery and the musculocutaneous, radial, median and ulnar nerves in addition to determining their position and distribution in four predefined sectors.ResultsThe musculocutaneous nerve was observed in all animals cranial to the axillary artery. The radial, ulnar and median nerves were distributed around the axillary artery, with >90% on the caudal aspect of the axillary artery (sectors 1 and 2).Conclusions and clinical relevanceUltrasonography identified the location of the brachial plexus nerves near the studied sectors, providing useful guidance for performing a brachial plexus nerve block.  相似文献   

7.
ObjectiveTo describe the landmarks for localization and to determine the methodology and volume of methylene blue dye to adequately stain the auricular nerves in rabbit cadavers.Study designProspective, randomized, cadaveric study.AnimalsA total of 26 rabbit cadavers (Dutch-Belted and New Zealand White breeds).MethodsPart I: anatomical dissections were performed to identify the sensory auricular nerves and to establish the ideal injection approach and volume of dye required for nerve staining. Part II: a single injection technique using 0.1 mL kg–1 dye was evaluated for staining the greater auricular nerve and two techniques (perpendicular and angled needle approaches) using 0.075 mL kg–1 dye were evaluated for the auriculotemporal nerve. Dye spread was evaluated through cadaveric dissections and nerve staining graded using a 0–2 point scale. Injections were considered successful if the nerve was stained circumferentially. Cadavers were assessed for staining of the mandibular nerve owing to the close proximity to the auriculotemporal nerve. Fisher’s exact test and mixed effects logistic regression model were used for statistical analysis.ResultsThe greater auricular nerve was stained in 24/27 (88.9%) injections. The auriculotemporal nerve was stained in 7/12 injections (58.3%) with the perpendicular needle approach; staining success increased to 80% (12/15 injections) with the angled needle approach; however, this difference was not statistically significant (p = 0.228). Mandibular nerve staining occurred on seven auriculotemporal injections with no statistically significant difference in the incidence of nerve staining between techniques.Conclusions and clinical relevanceResults suggest that the auricular nerves in rabbit cadavers can be successfully located and stained using anatomic landmarks and the described injection techniques.  相似文献   

8.
ObjectiveTo develop an ultrasound-guided interfascial plane technique for injection of the pudendal nerve near its sacral origin in cats.Study designProspective, randomized, anatomical study.AnimalsA group of 12 feline cadavers.MethodsGross and ultrasound anatomy of the ischiorectal fossa, the pudendal nerve relationship with parasacral structures, and the interfascial plane were described. Computed tomography was employed to describe a cranial transgluteal approach to the pudendal nerve. Bilateral ultrasound-guided injections were performed in eight cadavers using low [(LV) 0.1 mL kg–1] or high volume [(HV) 0.2 mL kg–1] of ropivacaine–dye solution. Dissections were performed to determine successful staining of the pudendal nerve (>1 cm) and inadvertent staining of the sciatic nerve, and any rectal, urethral, or intravascular puncture. Pudendal nerve staining in groups LV and HV were compared using Fisher's exact and Wilcoxon rank-sum test as appropriate (p = 0.05).ResultsThe pudendal nerve and its rectal perineal and sensory branches coursed through the ischiorectal fossa, dorsomedial to the ischiatic spine. The pudendal nerve was not identified ultrasonographically, but the target plane was identified between the sacral transverse process, the ischiatic spine, the pelvic fascia and the rectum, and it was filled with dye solution. Both branches of the pudendal nerve were completely stained 75% and 87.5% in groups LV and HV, respectively (p = 1.00). The dorsal aspect of the sciatic nerve was partially stained in 37% of injections in group HV. Rectal or urethral puncture and intravascular injection were not observed.Conclusions and clinical relevanceIn cats, ultrasound-guided cranial transgluteal injection successfully stained the pudendal nerve in at least 75% of attempts, regardless of injectate volume. Group HV had a greater probability of sciatic nerve staining.  相似文献   

9.
ObjectiveTo evaluate staining of nerve branches after the injection of different volumes during ultrasound-guided transversus abdominis plane (TAP) block in dog cadavers.Study designProspective randomized study.AnimalsA total of 15 frozen/thawed adult dog cadavers.MethodsHemiabdomens were randomly allocated to one of four groups. In groups G0.3, G0.6 and G1.0, ropivacaine–methylene blue solution (0.3, 0.6 and 1.0 mL kg–1 in seven, eight and eight hemiabdomens, respectively) was injected at the midpoint between the iliac crest and the last rib at the height of the shoulder. In group G0.3×2 (seven hemiabdomens), two injections (0.3 mL kg–1) were performed, caudal to the last rib and cranial to the iliac crest at the same height. Total time for injection was recorded; after 30 minutes, cadavers were dissected and spread of dye was evaluated.ResultsAccuracy of injection site was 80% and injection time was 71 (48–120) seconds for all groups together. Craniocaudal spread was 6.4 ± 1.6, 9.1 ± 2.6, 11.4 ± 2.3 and 11.2 ± 3.8 cm for G0.3, G0.6, G1.0 and G0.3×2, respectively [G0.3 to G0.3×2 (p = 0.044) and G1.0 (p = 0.034)]. There was no difference in dorsoventral spread among groups. Number of ventral nerve branches stained was 3 (2–4), 3 (2–4), 3 (3–4) and 3 (2–4) for G0.3, G0.6, G1.0 and G0.3×2, respectively, including nerve branches from twelfth thoracic to third lumbar (L3) in different proportions among groups.Conclusions and clinical relevanceResults suggest that a single-injection TAP block, using 0.3 mL kg–1, stains comparable number of nerve branches as higher volumes or two-point injection. Despite the volume or technique, consistent staining of the innervation of the caudal abdomen (L1–L3) was observed. Additional cadaveric studies are necessary to identify the optimal technique for complete abdominal wall staining.  相似文献   

10.
ObjectiveTo describe the sonoanatomy of the abdominal wall in live cats and to compare the distribution pattern of two versus three ultrasound-guided transversus abdominis plane (TAP) injections using clinically applicable volumes of lidocaine–dye solution in cat cadavers.Study designProspective anatomical study.AnimalsA total of eight client-owned healthy cats and eight cat cadavers.MethodsUltrasound anatomy of the abdominal wall, landmarks and sites for needle access were determined in live cats. Ultrasound-guided TAP injections were performed in eight thawed cat cadavers. Volumes of 0.25 or 0.16 mL kg?1 per point of a lidocaine–dye solution were injected using either two [subcostal and preiliac (SP)] or three [subcostal, retrocostal and preiliac (SRP)] injection points, respectively. Each cadaver was then dissected to determine the injectate distribution and the number of thoracolumbar nerves stained with each approach. The target nerves were defined as the ventromedial branches of the thoracic nerves 10 (T10), T11, T12, T13 and lumbar nerves 1 (L1) and L2.ResultsSonoanatomy was consistent with anatomy upon dissection and the TAP was identified in all cadavers. A total of 16 subcostal, 16 preiliac and nine retrocostal TAP injections were performed. The overall staining success rate of the target nerves was 66.7% and 92.6% for the SP and SPR approaches, respectively (p = 0.02). The ventromedial branches of T10, T11, T12, T13, L1 and L2 were stained in 57.1%, 100.0%, 85.7%, 28.6%, 42.9% and 85.7%, and in 66.7%, 100.0%, 100.0%, 100.0%, 88.9% and 100.0% of the cases with the SP and SRP approaches, respectively.Conclusions and clinical relevanceThe SRP approach allowed a broader distribution around the target nerves, whereas a staining gap was observed at T13 and L1 with the SP approach. Further studies are necessary to investigate the analgesic effect of these approaches in a clinical setting.  相似文献   

11.
ObjectivesTo describe the technique of performing an ultrasound-guided distal parasternal intercostal block and to determine the distribution of two volumes of methylene blue dye solution injected in canine cadavers.Study designProspective cadaver study.AnimalsA group of seven canine cadavers weighing 12–34 kg.MethodsThe space between the transversus thoracic and the internal intercostal muscles is a virtual cavity. Ultrasound-guided injections in the distal (parasternal) intercostal space were performed using dye solution at 0.05 mL kg–1 in each intercostal space from the second to seventh (LV, low volume, six injections per dog) in one hemithorax, and 0.1 mL kg–1 in the third, fifth and seventh intercostal spaces (HV, high volume, three injections in each dog) on the contralateral side. Anatomical dissection was carried out to describe dye spread characteristics and staining of intercostal nerves.ResultsThe ultrasonographic landmarks for injection were identified in each cadaver. In the LV group the solution was found in every intercostal space (36/36), whereas the HV injection stained six intercostal spaces in two dogs, five in two, and in two dogs the solution was found in four and three spaces, respectively, demonstrating multisegmental distribution. Intrapleural staining was observed after two injections.Conclusions and clinical relevanceUltrasound-guided injection of 0.05 mL kg–1 at the distal intercostal space resulted in staining of the intercostal nerve in all dogs when performed in every space and may be an appropriate alternative to previously reported techniques. A single injection of 0.1 mL kg–1 may anaesthetize more than one intercostal nerve, but not consistently. Clinical investigations are warranted to better characterize and to refine this locoregional technique.  相似文献   

12.
ObjectiveTo evaluate the anatomy of the serratus plane in dogs to establish the optimal landmarks for a superficial serratus plane (SSP) block and evaluate ropivacaine–methylene blue solution dispersion with three volumes of injection.Study designProspective experimental cadaveric study.AnimalsA formaldehyde solution-preserved dog cadaver and 15 frozen/thawed adult dog cadavers.MethodsThe thoracic wall of the formaldehyde-preserved cadaver was dissected. An SSP injection was performed on each hemithorax of the cadavers, with the ultrasound transducer placed over the fourth and fifth ribs, at the level of the shoulder joint. A needle was inserted in-plane in a caudocranial direction until it could be visualized between the serratus ventralis thoracis and latissimus dorsi muscles. Dog cadavers were injected with a ropivacaine–methylene blue solution at 0.3, 0.6 and 1.0 mL kg–1 and were dissected to determine the spread of the dye.ResultsThe thoracic wall muscles identified in the formalinized cadaver were the cutaneous trunci, latissimus dorsi, external abdominal oblique, serratus ventralis thoracis, scalenus, serratus dorsalis cranialis and external intercostal. The nerves identified in the SSP included the lateral cutaneous branches of intercostal nerves, intercostobrachial nerves and long thoracic nerve. The solution was successfully injected at the SSP in 26 of 29 (89.7%) attempts. Dermatomal dye spread, median (range), was 4 (3–6), 4 (2–5) and 5 (4–8) for 0.3, 0.6 and 1.0 mL kg–1, respectively, with no significant difference among them.Conclusions and clinical relevanceInjections for an SSP block were easily performed under ultrasound guidance, using the fourth and fifth ribs at the level of the shoulder joint as reference landmarks. An injected volume of 0.3 mL kg–1 may be sufficient for hemithorax analgesia in dogs. Further studies in dogs are required to determine the utility of this technique.  相似文献   

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Knowing the structure and variations of the plexus brachialis is important in neck and shoulder surgery. The knowledge of the brachial plexus reduces the injury rate of the nerves in surgical interventions to the axillary region. The major nerve trunks of the thoracic limb were the suprascapular, subscapular, axillary, radial, musculocutaneous, median and ulnar nerves. In Van cats, the brachial plexus was formed by the ventral branches of the spinal nerves, C6-C7-C8 and T1. The 7th cervical nerve was quite thick compared to the others. The subscapular nerve was the thinnest (on the right side, the average length was 6.55 ± 0.60 mm and on the left side was 6.50 ± 0.60 mm), and the radial nerve was the thickest (the average length on the right side was 28.48 ± 0.44 mm and on the left side was 29.11 ± 0.55 mm). The suprascapular nerve was formed by the ventral branch of the 6th cervical nerve. The subscapular nerves were formed by a branch originating from the 6th cervical nerve and the two medial and caudal branches originating from the 7th cervical nerve. No communicating branch between the ulnar nerve and the median nerve was observed in the palmar region. The axillary nerve was formed by the ventral branches of the 7th nerve, the musculocutaneous nerve was formed by ventral branches of the 6th and 7th cervical nerves, and the ulnar nerve was formed by ventral branches of the 8th cervical and the 1st thoracic nerves. The radial nerve was the thickest branch in the brachial plexus. In Van cats, the origin and distribution of nerves were similar to those reported in the literature for other species of cats, with the exception of the suprascapular, subscapular and axillary nerves.  相似文献   

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ObjectiveTo investigate the distribution and nerve staining of two volumes of lidocaine–dye solution after ultrasound-guided erector spinae plane (ESP) injections in canine cadavers.Study designExperimental cadaveric study.AnimalsA total of nine canine cadavers.MethodsESP injections were performed between the longissimus thoracis muscle and the dorsolateral edge of the ninth thoracic transverse process. Two cadavers were transversally cryosectioned after unilateral ESP injections [0.6 mL kg–1; high volume (HV)]. In seven cadavers, bilateral ESP injections with HV or low volume (0.3 mL kg–1; LV) were performed. Gadodiamide was added to the injectate for two cadavers and magnetic resonance imaging (MRI) was performed pre- and post-injection. Injectate distribution and nerve staining of the branches of the spinal nerves were recorded after gross anatomical dissection. The thoracic paravertebral and epidural spaces were examined for dye solution.ResultsCryosections, MRI and gross dissections showed that the injectate spread dorsally to the transverse processes, over the ventromedial aspect of the longissimus thoracis muscle where the medial and lateral branches of the dorsal branches of the spinal nerves are located. LV and HV stained a median (range) of 4 (2–7) and 4 (3–8) medial branches, respectively (p = 0.52). LV and HV stained 4 (2–5) and 5 (4–7) lateral branches (p = 0.26), respectively. Ventral branches were not stained, and dye was not identified in the epidural or paravertebral spaces.Conclusionsand clinical relevance Medial and lateral branches were consistently stained over several spinal segments. The number of nerves stained was not different with HV or LV, and the ventral branches of the spinal nerves were not stained in any cadaver. ESP block may find a clinical application to desensitize structures innervated by the medial and lateral branches of the dorsal branches of the thoracic spinal nerves.  相似文献   

19.
ObjectiveTo develop an ultrasound-guided dorsal approach to the brachial plexus and to investigate the nerve distribution and staining of a dyed injectate in common kestrel (Falco tinnunculus) cadavers.Study designProspective, cadaver study.AnimalsA group of three common kestrel cadavers (six wings).MethodsAll cadavers were fresh-frozen at –20 °C and thawed for 10 hours at room temperature before the study. The cadavers were placed in sternal recumbency and their wings were abducted. A 8–13 MHz linear-array transducer was placed over the scapulohumeral joint, at the centre of a triangle formed by the scapula and the humerus. The brachial plexus was identified between the scapulohumeralis muscle and the pectoralis major muscle, as hypoechoic structures lying just cranially to the axillary vessels. After ultrasound-guided brachial plexus identification, a 22 gauge, 50 mm insulated needle was advanced in-plane using ultrasound visualization. A volume of 0.5 mL kg–1 of a 3:1 (2% lidocaine:methylene blue) solution was injected. Following cadaver dissection, the pattern of the spread was assessed, and the extent of nerve staining was measured with a calliper and deemed adequate if more than 0.6 cm of the nerve staining was achieved.ResultsThe brachial plexus was clearly identified in all wings with the dorsal approach. After dye injection, all the branches of the brachial plexus defined as nerves 1–5 (N1, N2, N3, N4 and N5) were completely stained in five (83%) and partially stained in one (17%) of the six wings.Conclusions and clinical relevanceThe ultrasound-guided dorsal approach allows a clear visualization of the brachial plexus structure. The injection of 0.5 mL kg–1of a lidocaine/dye solution produced complete nerve staining in most cases. Further in vivo studies are mandatory to confirm the clinical efficacy of this locoregional anaesthesia technique in common kestrels (Falco tinnunculus).  相似文献   

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The nerves that innervate the fingertips and wing membrane from the upper arm of the bent-winged bat Miniopterus fuliginosus were examined under a stereomicroscope. The radial, median, ulnar and musculocutaneous nerves were formed by the brachial plexus, which ran to the wing membrane. The two suspected axillary nerves ran to the wing membrane. The radial nerve ran to the end of the first digit, while the median nerve ran along the forearm and subsequently branched-off to run along the second to fifth digits up to the end of the phalanges. The ulnar nerve ran to the plagiopatagium on the extensor side of the elbow joint. Finally, the musculocutaneous nerve passed through the ventral side of the humerus and branched out at the elbow joint to run radially to the propatagium area. In this study, the visible nerves that were distributed from the upper arm to the fingertips of Miniopterus fuliginosus were formed by C6–T1.  相似文献   

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