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
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References
- A case of severe ventricular arrhythmias occurring as a complication of nerve-stimulator guided brachial plexus location.Vet Anaesth Analg. 2015; 42: 230-231
- 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
- Comparison of ultrasound- and electrostimulation-guided nerve blocks of brachial plexus in dogs.Vet Anaesth Analg. 2017; 44: 625-635
- The AS and single-injection axillary block.Clin. Anat. 2007; 20: 57-63
- Pneumothorax following nerve stimulator-guided axillary brachial plexus block in a dog.Vet Anaesth Analg. 2015; 42: 658-659
- 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
- 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
- Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve block in dog.Vet Anaesth Analg. 2010; 37: 144-153
- A modified approach for performing ultrasound-guided radial, ulnar, median and musculocutaneous nerve block in a dog.Vet Anaesth Analg. 2015; 42: 659-661
- Axillary block of the brachial plexus.Anesthesiology. 1961; 22: 215-225
- 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
- Chapter 17th Spinal nerves.in: Evans H.E. de Lahunta A. Miller’s Anatomy of the dog. 4th edn. Saunders, PA, USA2012: 611-657
- WSAVA Nutritional assessment guidelines.J Small Anim Pract. 2011; 52: 385-396
- Ultrasonographic anatomy of the brachial plexus and major nerves of the canine forelimb.Vet Radiol Ultrasound. 2008; 49: 577-583
- A prospective, randomized, double-blind comparison of ultrasound-guided axillary brachial plexus blocks using 2 versus 4 injections.Anesth Analg. 2010; 110: 1222-1226
- Paravertebral blockade of the brachial plexus in dogs.Vet Clin North Am Small Anim Pract. 2008; 38: 1231-1241
- Safe performance of peripheral regional anaesthesia: the significance of ultrasound guidance.Anaesthesia. 2017; 71: 461-469
- Clinical evaluation of the anaesthetic sparing effect of brachial plexus block in cats.Vet Anaest Analg. 2010; 37: 154-161
- Comparison of the isoflurane concentration of using dexketoprofen or methadone at premedication during orthopedic surgery in dogs.Res Vet Sci. 2016; 105: 36-40
- Ultrasound-guided axillary brachial plexus block Part1-basic sonoanatomy.Anaesthesiol Intensive Ther. 2015; 47: 409-416
- Endoscopic axillary dissection. Experimental model in dogs.Cir Gen. 2007; 29: 32-36
- 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
- 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
- Stressed-related biomarkers in dogs administered regional anaesthesia or fentanyl for analgesia during stifle surgery.Vet Anaesth Analg. 2016; 43: 44-45
- The musculocutaneous nerve: ultrasound appearance for peripheral nerve block.Reg Anesth Pain Med. 2005; 30: 385-390
- Ultrasound guided distal peripheral nerve block of upper limb: a technical review.J Anaesthesiol Clic Pharmacol. 2015; 31: 296-307
- Ultrasound-guided musculocutaneous nerve block: descriptions of a novel technique.Reg Anesth Pain Med. 2005; 30: 198-201
- 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)
- Functional anatomy of the brachial plexus sheaths.Anesthesiology. 1983; 59: 117-122
- A prospective randomized comparison between double, triple, and quadruple injection ultrasound guided axillary brachial plexus block.Reg Anesth Pain Med. 2012; 37: 248-253
- 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
- Retrospective comparison of two peripheral lumbosacral plexus blocks in dogs undergoing pelvic limb orthopaedic surgery.J Small Anim Pract. 2013; 54: 630-637
- Transient Horner's syndrome after paravertebral brachial plexus blockade in a dog.Vet Anaesth Analg. 2013; 40: 104-106
- 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
- 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
Article info
Publication history
Published online: January 25, 2019
Accepted:
November 21,
2018
Received:
February 25,
2018
Identification
Copyright
© 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
