Advertisement

Lumbosacral plexus block using a combination of ultrasound-guided lateral pre-iliac and parasacral approaches in cats

Published:January 22, 2023DOI:https://doi.org/10.1016/j.vaa.2023.01.003

      Abstract

      Objective

      To describe an ultrasound-guided lateral pre-iliac (LPI) and parasacral (PS) approach in feline cadavers (phase I) and compare the perioperative analgesic use and complications in cats administered LPI and PS blocks (group PNB) or epidural anesthesia (group EPI) for pelvic limb surgery (phase II).

      Study design

      Experimental uncontrolled, anatomic and retrospective cohort study.

      Animals

      A group of eight feline cadavers and 52 medical records.

      Methods

      Bilateral LPI and PS approaches with 0.1 mL kg−1 of dye to stain the femoral and obturator nerves and the lumbosacral trunk, respectively, were performed on each cadaver. Nerve staining effect was evaluated upon dissections (phase I). Perioperative analgesics use, and complication rates were retrospectively compared between PNB and EPI groups (phase II). Continuous data were compared using the Mann–Whitney U test and the prevalence of events with Fisher's exact test. Differences were considered significant when p < 0.05.

      Results

      Dissections revealed that the LPI approach stained 94% and 75% of the femoral and obturator nerves, respectively. The PS approach stained 100% of the lumbosacral trunks. Cats enrolled in group PNB (n = 23) were administered lower doses of intraoperative opioids compared with group EPI (n = 25) (p = 0.006). Intraoperative rescue analgesia was required in 60% and 17.4% of cats enrolled in groups EPI and PNB, respectively (p = 0.003). Group PNB required more intraoperative anticholinergics than group EPI (p = 0.02). There were no differences in postoperative pain scores, analgesic use and complication rates.

      Conclusions and clinical relevance

      The ultrasound-guided LPI and PS approach stained the femoral/obturator and the lumbosacral trunk in feline cadavers. Furthermore, PNB was associated with lower intraoperative opioid use and similar postoperative pain and analgesic use compared with epidural anesthesia in a cohort of cats undergoing surgery of the pelvic limb.

      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.
        • Gendron K.
        What is the evidence? The issue of verifying correct needle position during epidural anaesthesia in dogs.
        Vet Anaesth Analg. 2017; 44: 212-218
        • Boscan P.
        • Wennogle S.
        Evaluating femoral-sciatic nerve blocks, epidural analgesia, and no use of regional analgesia in dogs undergoing tibia-plateau-leveling-osteotomy.
        J Am Anim Hosp Assoc. 2016; 52: 102-108
        • Campoy L.
        • Martin-Flores M.
        • Ludders J.W.
        • 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 A.M.
        • Driessen B.
        • Puerto D.A.
        • 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
        • Congdon J.M.
        • Boscan P.
        • Goh C.S.S.
        • Rezende M.
        Psoas compartment and sacral plexus block via electrostimulation for pelvic limb amputation in dogs.
        Vet Anaesth Analg. 2017; 44: 915-924
        • Doi M.
        • Yunoki H.
        • Ikeda K.
        The minimum alveolar concentration of sevoflurane in cats.
        J Anesth. 1988; 2: 113-114
      1. Dyce KM, Sack WO, Wensing CJG (2010) The nervous system. In: Textbook of Veterinary Anatomy (4th edn). Dyce KM, Sack WO, Wensing CJG (eds). Elsevier, USA. pp. 323–325.

        • Floriano D.
        • Sahagian M.J.
        • Chiavaccini L.
        Impact of epidural bupivacaine on perioperative opioid requirements, recovery characteristics, and duration of hospitalization in dogs undergoing cystotomy: a retrospective study of 56 cases.
        Vet Surg. 2019; 48: 1330-1337
      2. Fuensalida SE, Zaccagnini AC, Verdier N at al. (2019) Regional anesthesia in the cat. In: Small Animal Regional Anesthesia (2nd edn). Otero PE, Portela DA (eds). Inter-Medica, Argentina. pp. 377–406.

        • Haro P.
        • Gil F.
        • Laredo F.
        • et al.
        Ultrasonographic study of the feline sciatic nerve.
        J Feline Med Surg. 2011; 13: 259-265
        • Haro P.
        • Laredo F.
        • Gil F.
        • et al.
        Ultrasound-guided block of the feline sciatic nerve.
        J Feline Med Surg. 2012; 14: 545-552
        • Kwon Y.
        • Hwang S.M.
        • Lee J.J.
        • Kim J.H.
        The effect of dexmedetomidine as an adjuvant to ropivacaine on the bispectral index for supraclavicular brachial plexus block.
        Korean J Anesthesiol. 2015; 68: 32-36
        • Marolf V.
        • Rohrbach H.
        • Bolen G.
        • et al.
        Sciatic nerve block in dogs: description and evaluation of a modified ultrasound-guided parasacral approach.
        Vet Anaesth Analg. 2018; 46: 106-115
        • Mogicato G.
        • Layssol-Lamour C.
        • Mahler S.
        • et al.
        Anatomical and ultrasonographic study of the femoral nerve within the iliopsoas muscle in beagle dogs and cats.
        Vet Anaesth Analg. 2015; 42: 425-432
        • Mosing M.
        • Reich H.
        • Moens Y.
        Clinical evaluation of the anaesthetic sparing effect of brachial plexus block in cats.
        Vet Anaesth Analg. 2010; 37: 154-161
      3. Otero P, Campoy L (2013) Epidural and spinal anesthesia. In: Small Animal Regional Anesthesia and Analgesia. Campoy L, Read M (eds). Wiley-Blackwell, USA. pp. 227–259.

        • Portela D.A.
        • Verdier N.
        • Otero P.E.
        Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: a review of the literature and technique description.
        Vet J. 2018; 238: 27-40
        • Portela D.A.
        • Otero P.E.
        • Tarragona L.
        • et al.
        Combined paravertebral plexus block and parasacral sciatic block in healthy dogs.
        Vet Anaesth Analg. 2010; 37: 531-541
        • Portela D.A.
        • Otero P.E.
        • Briganti A.
        • et al.
        Femoral nerve block: a novel psoas compartment lateral pre-iliac approach in dogs.
        Vet Anaesth Analg. 2013; 40: 194-204
        • Portela D.A.
        • Romano M.
        • Zamora G.A.
        • et al.
        The effect of erector spinae plane block on perioperative analgesic consumption and complications in dogs undergoing hemilaminectomy surgery: a retrospective cohort study.
        Vet Anaesth Analg. 2021; 48: 116-124
        • Rodrigo-Mocholi D.
        • Martinez-Taboada F.
        Novel ultrasound-guided lateral approach for femoral nerve block in cats: a pilot study.
        J Feline Med Surg. 2019; 22: 339-343
        • Rondelli V.
        • Otero P.E.
        • Romano R.
        • et al.
        Incidence of dural sac puncture during neuraxial anesthesia in cats: an observational, retrospective study.
        J Feline Med Surg. 2022; 24: 398-401
        • Santoro F.
        • Castineiras D.
        • Kaartinen J.
        Intra- and postoperative opioid-sparing analgesia in a cat undergoing pelvic limb amputation.
        J Feline Med Surg. 2022; 820551169221116868
        • Shilo Y.
        • Pascoe P.J.
        • Cissell D.
        • et al.
        Ultrasound-guided nerve blocks of the pelvic limb in dogs.
        Vet Anaesth Analg. 2010; 37: 460-470
        • Steffey E.P.
        • Howland Jr., D.
        Isoflurane potency in the dog and cat.
        Am J Vet Res. 1977; 38: 1833-1836
        • Tayari H.
        • Tazioli G.
        • Breghi G.
        • Briganti A.
        Ultrasound-guided femoral and obturator nerves block in the psoas compartment in dogs: anatomical and randomized clinical study.
        Vet Anaesth Analg. 2017; 44: 1216-1226
        • Thomson A.C.S.
        • Portela D.A.
        • Romano M.
        • Otero P.E.
        Evaluation of the effect of ultrasound guidance on the accuracy of intercostal nerve injection: a canine cadaveric study.
        Vet Anaesth Analg. 2021; 48: 256-263
        • Tomaszewski K.A.
        • Henry B.M.
        • Kumar Ramakrishnan P.
        • et al.
        Development of the anatomical quality assurance (AQUA) checklist: guidelines for reporting original anatomical studies.
        Clin Anat. 2017; 30: 14-20
        • Trujanovic R.
        • Otero P.E.
        • Larenza Menzies M.P.
        Combined ultrasound/electrostimulation-guided block of the lumbosacral plexus in a cat undergoing pelvic limb amputation.
        Vet Rec Case Rep. 2020; 8e000977
        • 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