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Description of ultrasound-guided quadratus lumborum block technique and evaluation of injectate spread in canine cadavers.
Veterinary Anaesthesia and Analgesia ( IF 1.7 ) Pub Date : 2019-12-31 , DOI: 10.1016/j.vaa.2019.12.005
Marta Garbin 1 , Diego A Portela 1 , Gianluca Bertolizio 2 , Fernando Garcia-Pereira 3 , Aitor Gallastegui 4 , Pablo E Otero 5
Affiliation  

Objective

To describe a quadratus lumborum (QL) block technique in canine cadavers and the spread of injectate.

Study design

Prospective, randomized, descriptive, experimental anatomic study.

Animals

A group of 12 adult canine cadavers.

Methods

Gross and ultrasound anatomy of the sublumbar musculature and the relationship with the spinal nerves was studied in two cadavers. Bilateral ultrasound-guided injections were performed in eight cadavers in the fascial plane between the QL and psoas muscle using a dye–lidocaine solution [low volume (LV) 0.15 mL kg–1 or high volume (HV) 0.3 mL kg–1]. The ultrasound transducer was positioned caudal and parallel to the proximal aspect of the last rib, and an insulated needle was introduced in-plane using a ventrolateral to dorsomedial approach. Dissections were performed to determine the number of spinal nerves successfully stained (>1 cm) and the presence of injectate in the epidural space or abdominal cavity. Additionally, two cadavers were transversally cryosectioned after QL injection.

Results

Ventral branches of the last thoracic and first three lumbar spinal nerves ran between the bundles of the QL muscle and between the QL and psoas muscles. The target fascial plane was ultrasonographically identified and filled with the dye solution following all injections. Ventral branches of the thirteenth thoracic and first, second and third lumbar nerves were stained by 0.0%, 71.4%, 100%, 100%, and 25%, 100%, 100%, 100% using LV and HV, respectively. Multisegmental spread stained the lumbar sympathetic trunk on 0 (0–3) and 3 (0–4) vertebral levels with LV and HV, respectively. No abdominal or epidural spread was identified.

Conclusion and clinical relevance

Although no significant differences were found, HV resulted in a higher percentage of stain on spinal nerves and sympathetic trunk than LV. Further studies are warranted to determine if the QL block provides somatic and visceral abdominal analgesia in dogs.



中文翻译:

超声引导下四头肌腰块阻滞技术的描述以及犬尸体内注射扩散的评估。

目的

为了描述犬尸体中的方形腰(QL)块技术和注射剂的扩散。

学习规划

前瞻性,随机,描述性,实验性解剖学研究。

动物

一组12只成年犬尸体。

方法

在两个尸体中研究了腰下肌的大体和超声解剖以及与脊神经的关系。使用染料-利多卡因溶液[低体积(LV)0.15 mL kg –1或高体积(HV)0.3 mL kg –1,在QL和腰肌之间的筋膜平面中的八个尸体中进行双向超声引导注射]。将超声换能器定位在尾端并平行于最后肋骨的近端,然后使用腹侧到背侧入路将绝缘针头插入平面内。进行解剖以确定成功染色的脊髓神经数量(> 1 cm)以及硬膜外腔或腹腔中是否存在注射剂。此外,QL注射后,将两个尸体横向冷冻切片。

结果

后胸和前三腰椎神经的腹侧分支在QL肌束之间以及QL和腰肌之间。在所有注射后,通过超声检查确定目标筋膜平面并用染料溶液填充。使用LV和HV分别对第13胸椎和第一,第二和第三腰神经的腹分支染色0.0%,71.4%,100%,100%和25%,100%,100%,100%。多节段扩散分别在0(0–3)和3(0–4)椎骨水平上用LV和HV染色了腰交感神经干。未发现腹部或硬膜外扩散。

结论与临床意义

尽管没有发现显着差异,但HV导致脊髓神经和交感神经干的染色百分比高于LV。有必要进行进一步的研究以确定QL阻滞剂是否可为犬提供躯体和内脏的腹部镇痛作用。

更新日期:2019-12-31
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