Stauffer Stephanie, Cordner Beckie, Dixon Jonathon, Witte Thomas
Tierklinik Schönbühl AG, Schönbühl, Switzerland.
Equine Referral Hospital, Clinical Science and Services, Royal Veterinary College, London, UK.
Vet Anaesth Analg. 2017 Jul;44(4):951-958. doi: 10.1016/j.vaa.2016.09.005. Epub 2017 Apr 6.
The aim of this preliminary proof-of-concept study was to evaluate and compare the success and complication rate of infiltration of the maxillary nerve of cadaver heads using previously described surface landmarks, standard ultrasound and a novel needle guidance positioning ultrasound system (SonixGPS).
Prospective, anatomical, method-comparison study.
Thirty-eight equine cadaver heads.
Twenty-six veterinary students performed the three methods consecutively on cadaver heads using an 18 gauge, 8.9 cm spinal needle and 0.5 mL iodinated contrast medium. Computed tomography was used to quantify success (deposition of contrast in contact with the maxillary nerve) and complication rate (contrast identified within surrounding vasculature or periorbital structures) associated with each method.
Perineural injection of the maxillary nerve was attempted 76 times, with an overall success rate of 65.8% (50/76) and complication rate of 53.9% (41/76). Success rates were 50% (13/26) with surface landmark, 65.4% (17/26) with standard ultrasound guidance and 83.3% (20/24) with SonixGPS guidance approaches (Fisher's exact test, p=0.046). No significant difference in complication rate was found between the three methods.
Ultrasound-guided maxillary nerve blocks were significantly more successful than surface landmark approaches when performed by inexperienced operators, and the highest success rate was achieved with guidance positioning system (GPS) needle guidance.
Local anaesthesia of the equine maxillary nerve in the fossa pterygopalatina is frequently used for diagnostic and surgical procedures in the standing sedated horse. Due to vague superficial landmarks with various approaches and the need for experience via ultrasound guidance, this block remains challenging. GPS guidance may improve reliability of maxillary and other nerve blocks, and allow a smaller volume of local anaesthetic solution to be used, thereby improving specificity and reducing the potential for side effects.
本初步概念验证研究的目的是评估和比较使用先前描述的体表标志、标准超声和新型针引导定位超声系统（SonixGPS）对上颌神经进行尸体头部浸润麻醉的成功率和并发症发生率。
前瞻性、解剖学、方法比较研究。
38个马尸体头部。
26名兽医专业学生使用18号、8.9厘米的脊椎穿刺针和0.5毫升碘化造影剂，在尸体头部连续进行三种方法的操作。使用计算机断层扫描来量化每种方法的成功率（造影剂沉积与上颌神经接触）和并发症发生率（在周围血管或眶周结构内发现造影剂）。
共尝试对上颌神经进行神经周围注射76次，总体成功率为65.8%（50/76），并发症发生率为53.9%（41/76）。体表标志法的成功率为50%（13/26），标准超声引导法为65.4%（17/26），SonixGPS引导法为83.3%（20/24）（Fisher精确检验，p = 0.046）。三种方法之间并发症发生率无显著差异。
在由经验不足的操作者进行操作时，超声引导的上颌神经阻滞比体表标志法明显更成功，并且使用引导定位系统（GPS）针引导时成功率最高。
翼腭窝内马的上颌神经局部麻醉常用于站立镇静马匹的诊断和外科手术。由于各种方法的体表标志不明确，且需要超声引导经验，这种阻滞仍然具有挑战性。GPS引导可能会提高上颌神经和其他神经阻滞的可靠性，并允许使用较小体积的局部麻醉溶液，从而提高特异性并降低副作用的可能性。
