Advertisement

Proximal RUMM block in dogs: preliminary results of cadaveric and clinical studies

Published:January 25, 2019DOI:https://doi.org/10.1016/j.vaa.2018.11.009

      Abstract

      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.

      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 location.
        Vet Anaesth Analg. 2015; 42: 230-231
        • Alemanno F.
        • Bosco M.
        • Barbati A.
        Chapter 10th Axillary Brachial Plexus Block.
        in: Alemanno F. Bosco M. Barbati A. Anesthesia of the Upper Limb - A State of the Art Guide. Springer-Verlag, Italy2014: 185-206
        • Akasaka M.
        • Shimizu M.
        Comparison of ultrasound- and electrostimulation-guided nerve blocks of brachial plexus in dogs.
        Vet Anaesth Analg. 2017; 44: 625-635
        • Ay S.
        • Akinci M.
        • Sayin M.
        • et al.
        The AS and single-injection axillary block.
        Clin. Anat. 2007; 20: 57-63
        • Bhalla R.J.
        • Leece E.A.
        Pneumothorax following nerve stimulator-guided axillary brachial plexus block in a dog.
        Vet Anaesth Analg. 2015; 42: 658-659
        • Barrington M.J.
        • Wong D.M.
        • Slater B.
        • et al.
        Ultra-sound-guided regional anaesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model.
        Reg Anesth Pain Med. 2012; 37: 334-339
        • Bortolami E.
        • Love E.J.
        • Harcourt-Brown T.R.
        • et al.
        Use of mid-humeral block of the radial, ulnar, musculocutaneous and median (RUMM block) nerves for extensor carpi radialis muscle biopsy in a conscious dog with generalized neuro-muscular disease.
        Vet Anaesth Analg. 2012; 39: 446-447
        • Campoy L.
        • Bezuidenhout A.J.
        • Gleed R.D.
        • et al.
        Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve block in dog.
        Vet Anaesth Analg. 2010; 37: 144-153
        • Castiñeiras D.
        • Viscasillas J.
        • Seymour C.
        A modified approach for performing ultrasound-guided radial, ulnar, median and musculocutaneous nerve block in a dog.
        Vet Anaesth Analg. 2015; 42: 659-661
        • De Jong R.
        Axillary block of the brachial plexus.
        Anesthesiology. 1961; 22: 215-225
        • Evans H.E.
        • de Lahunta A.
        Chapter 6th The muscular system.
        in: Evans H.E. de Lahunta A. Miller’s Anatomy of the dog. 4th edn. Saunders, PA, USA2012: 253-254
        • Evans H.E.
        • de Lahunta A.
        Chapter 17th Spinal nerves.
        in: Evans H.E. de Lahunta A. Miller’s Anatomy of the dog. 4th edn. Saunders, PA, USA2012: 611-657
        • Freeman L.M.
        • Becvarova I.
        • et al.
        • WSAVA Nutritional Assessment Guidelines Task Force Members
        WSAVA Nutritional assessment guidelines.
        J Small Anim Pract. 2011; 52: 385-396
        • Guilherme S.
        • Benigni L.
        Ultrasonographic anatomy of the brachial plexus and major nerves of the canine forelimb.
        Vet Radiol Ultrasound. 2008; 49: 577-583
        • Imasogie N.
        • Ganapathy S.
        • Singh S.
        • et al.
        A prospective, randomized, double-blind comparison of ultrasound-guided axillary brachial plexus blocks using 2 versus 4 injections.
        Anesth Analg. 2010; 110: 1222-1226
        • Lemke K.A.
        • Creighton C.M.
        Paravertebral blockade of the brachial plexus in dogs.
        Vet Clin North Am Small Anim Pract. 2008; 38: 1231-1241
        • Marhofer P.
        • Fritsch G.
        Safe performance of peripheral regional anaesthesia: the significance of ultrasound guidance.
        Anaesthesia. 2017; 71: 461-469
        • Mosing M.
        • Reich H.
        • Moens Y.
        Clinical evaluation of the anaesthetic sparing effect of brachial plexus block in cats.
        Vet Anaest Analg. 2010; 37: 154-161
        • Navarrete-Calvo R.
        • Gutiérrez-Bautista A.J.
        • Granados M.M.
        • et al.
        Comparison of the isoflurane concentration of using dexketoprofen or methadone at premedication during orthopedic surgery in dogs.
        Res Vet Sci. 2016; 105: 36-40
        • Nowakowski P.
        • Bierylo A.
        Ultrasound-guided axillary brachial plexus block Part1-basic sonoanatomy.
        Anaesthesiol Intensive Ther. 2015; 47: 409-416
        • Prieto P.F.C.
        • Hernandez M.H.
        • Bonet A.P.
        • et al.
        Endoscopic axillary dissection. Experimental model in dogs.
        Cir Gen. 2007; 29: 32-36
        • Portela D.A.
        • Raschi A.
        • Otero P.E.
        Ultrasound guided mid-humeral block of radial, ulnar, median and musculocutaneous (RUMM block) nerves in a dog with traumatic exposed metacarpal luxation.
        Vet Anaesth Analg. 2013; 40: 552-554
        • Reid J.
        • Nolan A.
        • Hughes J.
        • et al.
        Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score.
        Anim Welfare. 2007; 16: 97-104
        • Romano M.
        • Portela D.A.
        • Breghi G.
        • Otero P.E.
        Stressed-related biomarkers in dogs administered regional anaesthesia or fentanyl for analgesia during stifle surgery.
        Vet Anaesth Analg. 2016; 43: 44-45
        • Schafhalter-Zoppoth I.
        • Gray A.T.
        The musculocutaneous nerve: ultrasound appearance for peripheral nerve block.
        Reg Anesth Pain Med. 2005; 30: 385-390
        • Sehmbi H.
        • Madjdpour C.
        • Shah U.J.
        • Chin K.J.
        Ultrasound guided distal peripheral nerve block of upper limb: a technical review.
        J Anaesthesiol Clic Pharmacol. 2015; 31: 296-307
        • Spence B.C.
        • Sites B.D.
        • Beach M.L.
        Ultrasound-guided musculocutaneous nerve block: descriptions of a novel technique.
        Reg Anesth Pain Med. 2005; 30: 198-201
        • Steffey E.P.
        • Mama K.R.
        • Brosnan R.J.
        Inhalation Anesthetics.
        in: Grimm K.A. Lamont L.A. Tranquilli W.J. Lumb & Jones Veterinary Anesthesia and Analgesia. 5th edn. Blackwell Publishing, IA, USA2015: 311 (Table 16.7A)
        • Thompson G.E.
        • Rorie D.K.
        Functional anatomy of the brachial plexus sheaths.
        Anesthesiology. 1983; 59: 117-122
        • Tran D.Q.
        • Pham K.
        • Dugani S.
        • Finlayson R.J.
        A prospective randomized comparison between double, triple, and quadruple injection ultrasound guided axillary brachial plexus block.
        Reg Anesth Pain Med. 2012; 37: 248-253
        • Trumpatori B.J.
        • Carter J.E.
        • Hash J.
        • et al.
        Evaluation of midhumeral block of the radial, ulnar musculocutaneous and median (RUMM block) nerves for analgesia of the distal aspect of the thoracic limb in dogs.
        Vet Surg. 2010; 39: 785-796
        • Vettorato E.
        • De Gennaro C.
        • Okushima S.
        • Corletto F.
        Retrospective comparison of two peripheral lumbosacral plexus blocks in dogs undergoing pelvic limb orthopaedic surgery.
        J Small Anim Pract. 2013; 54: 630-637
        • Viscasillas J.
        • Sanchis-Mora S.
        • Hoy C.
        • Alibhai H.
        Transient Horner's syndrome after paravertebral brachial plexus blockade in a dog.
        Vet Anaesth Analg. 2013; 40: 104-106
        • Yamamoto K.
        • Tsubokawa T.
        • Ohmura S.
        • Kobayashi T.
        The effect of arm position on central spread of local anesthetics and on quality of the block with axillary brachial plexus block.
        Reg Anesth Pain Med. 1999; 24: 36-42
        • Wenger S.
        • Moens Y.
        • Jaggin N.
        • Schatzmann U.
        Evaluation of the analgesic effect of lidocaine and bupivacaine used to provide a brachial plexus block for forelimb surgery in 10 dogs.
        Vet Record. 2005; 156: 639-642