Advertisement

A sonographic investigation for the development of ultrasound-guided paravertebral brachial plexus block in dogs: cadaveric study

Published:September 15, 2017DOI:https://doi.org/10.1016/j.vaa.2017.08.005

      Abstract

      Objective

      To describe a novel in-plane ultrasound (US)-guided approach to the sixth (C6), seventh (C7), eighth (C8) cervical and to the first thoracic (T1) spinal nerves.

      Study design

      Prospective, descriptive, experimental anatomic study.

      Animals

      A total of seven canine Beagle cadavers.

      Methods

      Phase 1: One cadaver was used to define bony landmarks for the C6-T1 spinal nerves using computed tomography (CT) and magnetic resonance imaging. An US transducer was positioned lateral to the C6 vertebra. Methylene blue (0.05 mL kg−1) was injected cranial and caudal to the transverse process of C6. The probe was moved caudally to identify the cranial costal fovea of T1 and 0.1 mL kg−1 of methylene blue was injected. Full cadaver dissection was performed to assess the staining of the spinal nerves.
      Phase 2: The technique was repeated using a 50:50 mixture of iohexol and methylene blue in six dogs. CT verified the proximity of contrast to C6, C7, C8 and T1 nerves. Mediastinal, epidural, intravascular and pleural contamination was recorded. Methylene blue staining of the phrenic nerve was assessed by dissection.

      Results

      Phase1: The identified bony landmarks were the lamina ventralis of C6, the transverse process of C6 and C7, T1 vertebra and the first rib. Phase 2: At all the 12 sites, the C6, C7 and C8 nerves were in contact with contrast material. Contrast was demonstrated in close proximity to the anatomical location of the T1 nerve in 11/12 sites. Mediastinal, epidural and intravascular contamination was observed in six, four and two cadavers, respectively. Pleural contamination was not observed. The phrenic nerve was stained on 2/12 of sides.

      Conclusions and clinical relevance

      In-plane US-guided blockade of the spinal roots is a feasible technique. However, because of the undesirable spreads of contrast, further research is needed to diminish the occurrence of contaminations of noble structures.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adami C.
        • Studer N.
        A case of severe ventricular arrhythmias occurring as a complication of nerve-stimulator guided brachial plexus block.
        Vet Anaesth Analg. 2015; 42: 226-231
        • Bagshaw H.S.
        • Larenza M.P.
        • Seiler G.S.
        A technique for ultrasound-guided paravertebral brachial plexus injections in dog.
        Vet Radiol Ultrasound. 2009; 50: 649-654
        • Bergmann L.
        • Martini S.
        • Kesselmeier M.
        • et al.
        Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection.
        BMC Anesthesiol. 2015; 16: 45
        • Bhalla R.J.
        • Leece E.A.
        Pneumothorax following nerve stimulator-guided axillary brachial plexus block in a dog.
        Vet Anaesth Analg. 2015; 42: 657-661
        • Campoy L.
        • Read M.R.
        The thoracic limb.
        in: Campoy L. Read M.R. Small animal regional anaesthesia and analgesia. 1st edn. Wiley-Blackwell, USA2013: 141-165
        • Chan V.W.
        • Perlas A.
        • McCartney C.J.
        • et al.
        Ultrasound guidance improves success rates of axillary brachial plexus block.
        Can J Anaesth. 2007; 54: 176-182
        • Gücük A.
        • Uyetürk U.
        Usefulness of Hounsfield unit and density in the assessment and treatment of urinary stones.
        World J Neprhol. 2014; 6: 282-286
        • Guilherme L.
        • Benigni L.
        Ultrasonographic anatomy of the brachial plexus and major nerves of the canine thoracic limb.
        Vet Radiol & Ultrasound. 2008; 49: 577-583
        • Hounsfield G.N.
        Nobel lecture, 8 December 1979.
        J Radiol. 1980; 61: 459-468
        • Flores S.
        • Riguzzi C.
        • Herring A.A.
        • et al.
        Horner's syndrome after superficial cervical plexus block.
        West J Emerg Med. 2015; 16: 428-431
        • Lemke K.A.
        • Creighton C.M.
        Paravertebral blockade of the brachial plexus in dogs.
        Vet Clin Small Anim. 2008; 38: 1231-1241
        • Nash L.
        • Nicholson M.D.
        • Zhang M.B.
        Does the investigating layer of the deep cervical fascia exist?.
        Anesthesiology. 2005; 103: 962-968
        • Pandit J.J.
        • Dutta D.
        • Morris J.F.
        Spread of injectate with superficial cervical plexus block in humans: an anatomical study.
        Br J Anaesth. 2003; 91: 733-735
        • Rioja E.
        • Sinclair M.
        • Chalmers H.
        • et al.
        Comparison of three techniques for paravertebral brachial plexus blockade in dogs.
        Vet Analg Anaesth. 2012; 39: 190-220
        • Schreiber J.J.
        • Anderson P.A.
        • Hsu W.K.
        Use of computed tomography for assessing bone mineral density.
        Neurosurg Focus. 2014; 37: E4
        • Stradling J.R.
        • Kozar L.F.
        • Dark J.
        • et al.
        Effect of acute diaphragm paralysis on ventilation in awake and sleeping dogs.
        Am Rev Respir Dis. 1987; 136: 633-637
        • Stundner O.
        • Meissnitzer M.
        • Brummett C.M.
        • et al.
        Comparison of tissue distribution, phrenicnerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trial.
        Br J Anaesth. 2016; 116: 405-412
        • Viscasillas J.
        • Sanchis-Mora S.
        • Hoy C.
        • et al.
        Transient Horner's syndrome after paravertebral brachial plexus blockade in a dog.
        Vet Anaesth Analg. 2013; 40: 104-106