Objective

To describe and evaluate an ultrasound-guided modified subcostal approach for the transversus abdominis plane (TAP) block in horse cadavers in lateral or dorsal recumbency.

Study design

Prospective, experimental cadaveric study.

Animals

Study of one preserved foal and eight fresh adult horse cadavers.

Methods

The lateral and ventral abdominal wall of a preserved cadaver was dissected to identify the muscles and nerves. A unilateral standard TAP block technique was performed (60 mL of methylene blue dye–bupivacaine) on a fresh cadaver in right lateral recumbency. A modified subcostal technique was performed on the opposite side using a linear ultrasound transducer and in-plane approach. Injection points (two 30 mL dye) were at the level of the TAP (between the rectus abdominis and transversus abdominis muscles and ventral to the cutaneous trunci muscle) perpendicular to: 1) the mid-point between the xiphoid cartilage and umbilical scar; and 2) at a point between the caudal and middle thirds of the abdomen measured from the first injection point to the umbilical scar. The modified subcostal approach was performed in seven additional cadavers in both hemiabdomens, with three cadavers in lateral and four cadavers in dorsal recumbency. Ultrasound guidance was used with all injections.

Results

The standard approach stained the sixteenth to eighteenth thoracic nerves (T16–T18). The modified subcostal approach performed in lateral recumbency provided greater spread (T9–T17) than dorsal recumbency (T12–T18) (p = 0.016).

Conclusions and clinical relevance

The modified subcostal TAP approach resulted in extensive staining exceeding the standard approach. The nerves stained are consistent with production of ventral abdominal wall anesthesia in horses. Clinical studies are needed to verify these findings.

中文翻译：

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超声引导下改良腹横肌平面阻滞及卧位对马尸体染料扩散的影响

客观的

描述和评估一种超声引导的改良肋下入路，用于侧卧或背卧位马尸体的腹横肌平面 (TAP) 阻滞。

学习规划

前瞻性、实验性尸体研究。

动物

对一只保存好的小马驹和八具新鲜成年马尸体的研究。

方法

解剖保存的尸体的侧腹壁和腹壁以识别肌肉和神经。在右侧卧位的新鲜尸体上进行了单侧标准 TAP 阻滞技术（60 mL 亚甲蓝染料-布比卡因）。使用线性超声换能器和平面内方法在对侧进行改良的肋下技术。注射点（两个 30 mL 染料）在 TAP 水平（在腹直肌和腹横肌之间以及皮肤躯干肌的腹侧）垂直于：1）剑突软骨和脐带疤痕之间的中点；和 2) 在腹部尾部和中间三分之一之间的点，从第一个注射点到脐带疤痕测量。改良的肋下入路在两个半腹的另外七具尸体上进行，其中三具尸体在侧卧，四具尸体在背卧位。所有注射均使用超声引导。

结果

标准方法染色第十六至第十八胸神经（T16-T18）。与背卧位（T12-T18）相比，在侧卧位进行的改良肋下入路提供了更大的扩散（T9-T17）（p  = 0.016）。

结论和临床相关性

改良的肋下 TAP 方法导致广泛染色超过标准方法。染色的神经与马腹侧腹壁麻醉的产生一致。需要临床研究来验证这些发现。