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Use of a perfusion index to confirm the presence of sciatic nerve blockade in dogs

      Abstract

      Objectives

      To evaluate perfusion index (PI) as a determinant of regional nerve block success following sciatic nerve blockade with bupivacaine in dogs undergoing stifle surgery.

      Study design

      Prospective clinical trial.

      Animals

      Ten adult dogs, aged 5.6 ± 2.6 years and weighing 36.9 ± 16.8 kg, undergoing a tibial plateau leveling osteotomy.

      Methods

      Dogs were premedicated with acepromazine (0.03 mg kg−1) and hydromorphone (0.1 mg kg−1) intramuscularly, and anesthetized with propofol (up to 4 mg kg−1) intravenously and isoflurane in oxygen. An ultrasound‐guided femoral and sciatic (F+S) nerve block was performed on the surgical limb with bupivacaine (0.75%), 0.2 mL kg−1 at the femoral site and 0.3 mL kg−1 at the sciatic site, with a maximum volume of 10 mL per site. Physiological variables were recorded every 5 minutes throughout anesthesia. A pulse co‐oximeter probe was placed between the third and fourth digits of both pelvic limbs, and the PI was recorded 5 minutes before infiltration with bupivacaine, immediately afterwards, and every 5 minutes for 30 minutes. Motor nerve conduction velocity (MNCV) of the sciatic nerve was performed on the surgical limb 5 minutes before and 20 minutes after bupivacaine administration to confirm nerve block.

      Results

      The PI of the surgical limb was significantly greater than the contralateral pelvic limb at 10 minutes (p = 0.03) and 15 minutes (p < 0.01) after F+S nerve blockade. The MNCV performed after sciatic nerve blockade revealed a functional motor blockade for all dogs. There were no significant changes in physiological variables.

      Conclusions and clinical relevance

      The PI provided a reliable indication of successful sciatic nerve blockade in the clinical patients in this study. No increase in the PI by 15 minutes after bupivacaine administration around the sciatic nerve could indicate partial or total failure of anesthetic blockade.

      Keywords

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      References

        • Abdallah FW
        • Brull R
        The definition of block “success” in the contemporary literature: are we speaking the same language?.
        Reg Anesth Pain Med. 2012; 37: 545-553
        • Bergek C
        • Zdolsek JH
        • Hahn RG
        Non-invasive blood haemoglobin and plethysmographic variability index during brachial plexus block.
        Br J Anaesth. 2015; 114: 812-817
        • Brenner DJ
        • Larsen RS
        • Dickinson PJ
        • et al.
        Development of an avian brachial plexus nerve block technique for perioperative analgesia in mallard ducks (Anas platyrhynchos).
        J Avian Med Surg. 2010; 24: 24-34
        • Campoy L
        • Bezuidenhout AJ
        • Gleed RD
        • et al.
        Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs.
        Vet Anaesth Analg. 2010; 37: 144-153
        • Campoy L
        • Martin-Flores M
        • Ludders LW
        • et al.
        Comparison of bupivacaine femoral and sciatic nerve block versus bupivacaine and morphine epidural for stifle surgery in dogs.
        Vet Anaesth Analg. 2012; 39: 91-98
        • Caniglia AM
        • Driessen B
        • Puerto DA
        • et al.
        Intraoperative antinociception and postoperative analgesia following epidural anesthesia versus femoral and sciatic nerve blockade in dogs undergoing stifle joint surgery.
        J Am Vet Med Assoc. 2012; 241: 1605-1612
        • Capdevila X
        • Barthelet Y
        • Biboulet P
        • et al.
        Effects of perioperative analgesic technique on the surgical out-come and duration of rehabilitation after major knee surgery.
        Anesthesiology. 1999; 91: 8-15
        • Costa-Farré C
        • Blanch XS
        • Cruz JI
        • et al.
        Ultrasound guidance for the performance of sciatic and saphenous nerve blocks in dogs.
        Vet J. 2011; 187: 221-224
        • Dalkilic N
        • Bariskaner H
        • Dogan N
        • et al.
        The effect of bupivacaine on compound action potential variables of sciatic nerve fibers.
        Int J Neurosci. 2004; 114: 1-16
        • Davarci I
        • Tuzcu K
        • Karcioglu M
        • et al.
        Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy.
        J Int Med Res. 2013; 41: 1639-1647
        • Dorsch JA
        • Dorsch SE
        Understanding Anesthesia Equipment. 5th edn. Lippincott Williams & Wilkins, USA2008
        • Echeverry DF
        • Gil F
        • Laredo F
        • et al.
        Ultrasound-guided block of the sciatic and femoral nerves in dogs: a descriptive study.
        Vet J. 2010; 186: 210-215
        • Eger II, E
        The pharmacology of isoflurane.
        Br J Anaesth. 1984; 56: 71S-99S
        • Fechner J
        • Ihmsen H
        • Schüttler J
        • Jeleazcov C
        The impact of intra-operative sufentanil dosing on post-operative pain, hyperalgesia and morphine consumption after cardiac surgery.
        Eur J Pain. 2013; 17: 562-570
        • Galvin EM
        • Niehof S
        • Medina HJ
        • et al.
        Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks.
        Anesth Analg. 2006; 102: 598-604
        • Galvin EM
        • Niehof S
        • Verbrugge SJC
        • et al.
        Peripheral flow index is a reliable and early indicator of regional block success.
        Anesth Analg. 2006; 103: 239-243
        • Gamstorp I
        Conduction velocity of peripheral nerves and electromyography in infants and children.
        Psychiatr Neurol Med Psychol Beih. 1970; 13–14: 235-244
        • Ginosar Y
        • Weiniger CF
        • Meroz Y
        • et al.
        Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia.
        Acta Anaesthesiol Scand. 2009; 53: 1018-1026
        • Hashimoto T
        • Iwasaki T
        • Takahashi Y
        • et al.
        Comparison of bupivicaine, ropivacaine, and levobupivacaine in an equal dose and concentration for sympathetic block in dogs.
        Reg Anesth Pain Med. 2010; 35: 409-411
        • Kaya K
        • Babacan A
        • Beyazova M
        • et al.
        Effects of perineural opioids on nerve conduction of N. suralis in man.
        Acta Neurol Scand. 1992; 85: 337-339
        • Kimura J
        Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 3rd edn. Oxford University Press, UK2001
        • Kosel J
        • Bobik P
        • Siemiatkowski A
        The use of regional anesthetic techniques in pain management in patients undergoing primary knee replacement.
        Ortop Traumatol Rehabil. 2012; 14: 315-328
        • Kowalczyk M
        • Fijałkowska A
        • Nestorowicz A
        New generation pulse oximetry in the assessment of peripheral perfusion during general anaesthesia – a comparison between propofol and desflurane.
        Anaesthesiol Intensive Ther. 2013; 45: 138-144
        • Kus A
        • Gurkan Y
        • Gormus SK
        • et al.
        Usefulness of perfusion index to detect the effect of brachial plexus block.
        J Clin Monit Comput. 2013; 27: 325-328
        • Lemke KA
        • Dawson SD
        Local and regional anesthesia.
        Vet Clin North Am Small Anim Pract. 2000; 30: 839-857
        • Li J
        • Karmakar MK
        • Li X
        • et al.
        Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study.
        Reg Anesth Pain Med. 2012; 37: 111-118
        • Lima A
        • Bakker J
        Noninvasive monitoring of peripheral perfusion.
        Intensive Care Med. 2005; 31: 1316-1326
        • Liu Q
        • Chelly JE
        • Williams JP
        • et al.
        Impact of peripheral nerve block with low dose local anesthetics on analgesia and functional outcomes following total knee arthroplasty: a retrospective study.
        Pain Med. 2015; 16: 998-1006
        • Macfarlane AJ
        • Prasad GA
        • Chan VW
        • Brull R
        Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review.
        Br J Anaesth. 2009; 103: 335-345
        • Mahler SP
        • Adogwa AO
        Anatomical and experimental studies of brachial plexus, sciatic, and femoral nerve-location using peripheral nerve stimulation in the dog.
        Vet Anaesth Analg. 2008; 35: 80-89
        • Monteiro ER
        • Teixeira Neto FJ
        • Castro VB
        • Campagnol D
        Effects of acepromazine on the cardiovascular actions of dopamine in anesthetized dogs.
        Vet Anaesth Analg. 2007; 34: 312-321
        • Portela DA
        • Otero PE
        • Tarragona L
        • et al.
        Combined paravertebral plexus block and parasacral sciatic block in healthy dogs.
        Vet Anaesth Analg. 2010; 37: 531-541
        • Sebastiani A
        • Philippi L
        • Boehme S
        • et al.
        Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters.
        Can J Anaesth. 2012; 59: 1095-1101
        • Selander D
        Neurotoxicity of local anesthetics: animal data.
        Reg Anesth. 1993; 18: 461-468
        • Shemesh D
        • Olsha O
        • Orkin D
        • et al.
        Sympathectomy-like effects of brachial plexus block in arteriovenous access surgery.
        Ultrasound Med Biol. 2006; 32: 817-822
        • Smith GB
        • Wilson GR
        • Curry CH
        • et al.
        Predicting successful brachial plexus block using changes in skin electrical resistance.
        Br J Anaesth. 1988; 60: 703-708
        • Sørensen J
        • Bengtsson M
        • Malmqvist EL
        • et al.
        Laser Doppler perfusion imager (LDPI) – for the assessment of skin blood flow changes following sympathetic blocks.
        Acta Anaesthesiol Scand. 1996; 40: 1145-1148
        • Tankisi H
        • Pugdahl K
        • Fuglsang-Frederiksen A
        • et al.
        Pathophysiology inferred from electrodiagnostic nerve tests and classification of polyneuropathies. Suggested guidelines.
        Clin Neurophysiol. 2005; 116: 1571-1580
        • Troncy E
        • Junot S
        • Keroack S
        • et al.
        Results of preemptive epidural administration of morphine with or without bupivacaine in dogs and cats undergoing surgery: 265 cases (1997–1999).
        J Am Vet Med Assoc. 2002; 221: 666-672
        • Vettorato E
        • Bradbrook C
        • Gurney M
        • et al.
        Peripheral nerve blocks of the pelvic limb in dogs: a retrospective clinical study.
        Vet Comp Orthop Traumatol. 2012; 4: 314-320
        • Walker TL
        • Redding RW
        • Braund KG
        Motor nerve conduction velocity and latency in the dog.
        Am J Vet Res. 1979; 40: 1433-1439
        • Wilson DV
        • Evans AT
        • Miller R
        Effects of preanesthetic administration of morphine on gastroesophageal reflux and regurgitation during anesthesia in dogs.
        Am J Vet Res. 2005; 66: 386-390
        • Yamazaki H
        • Nishiyama J
        • Suzuki T
        Use of perfusion index from pulse oximetry to determine efficacy of stellate ganglion block.
        Local Reg Anesth. 2012; 5: 9-14