Monticelli Paolo, Fitzgerald Ella, Viscasillas Jaime
Anaesthesia Department Veterinary Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, UK.
Diagnostic Imaging Department, Veterinary Clinical Science, The Royal Veterinary College, Hawkshead Lane, Hatfield, UK.
Vet Anaesth Analg. 2018 Mar;45(2):195-202. doi: 10.1016/j.vaa.2017.08.005. Epub 2017 Sep 15.
To describe a novel in-plane ultrasound (US)-guided approach to the sixth (C6), seventh (C7), eighth (C8) cervical and to the first thoracic (T1) spinal nerves.
Prospective, descriptive, experimental anatomic study.
A total of seven canine Beagle cadavers.
Phase 1: One cadaver was used to define bony landmarks for the C6-T1 spinal nerves using computed tomography (CT) and magnetic resonance imaging. An US transducer was positioned lateral to the C6 vertebra. Methylene blue (0.05 mL kg) was injected cranial and caudal to the transverse process of C6. The probe was moved caudally to identify the cranial costal fovea of T1 and 0.1 mL kg of methylene blue was injected. Full cadaver dissection was performed to assess the staining of the spinal nerves. Phase 2: The technique was repeated using a 50:50 mixture of iohexol and methylene blue in six dogs. CT verified the proximity of contrast to C6, C7, C8 and T1 nerves. Mediastinal, epidural, intravascular and pleural contamination was recorded. Methylene blue staining of the phrenic nerve was assessed by dissection.
Phase1: The identified bony landmarks were the lamina ventralis of C6, the transverse process of C6 and C7, T1 vertebra and the first rib. Phase 2: At all the 12 sites, the C6, C7 and C8 nerves were in contact with contrast material. Contrast was demonstrated in close proximity to the anatomical location of the T1 nerve in 11/12 sites. Mediastinal, epidural and intravascular contamination was observed in six, four and two cadavers, respectively. Pleural contamination was not observed. The phrenic nerve was stained on 2/12 of sides.
In-plane US-guided blockade of the spinal roots is a feasible technique. However, because of the undesirable spreads of contrast, further research is needed to diminish the occurrence of contaminations of noble structures.
描述一种新型的平面内超声引导下针对第六（C6）、第七（C7）、第八（C8）颈神经和第一胸（T1）脊神经的方法。
前瞻性、描述性、实验解剖学研究。
总共7只比格犬尸体。
第一阶段：使用1具尸体，通过计算机断层扫描（CT）和磁共振成像确定C6 - T1脊神经的骨性标志。将超声换能器置于C6椎体外侧。在C6横突的头侧和尾侧注射亚甲蓝（0.05 mL/kg）。探头向尾侧移动以识别T1的肋凹头，并注射0.1 mL/kg的亚甲蓝。进行全尸体解剖以评估脊神经的染色情况。第二阶段：在6只犬中使用碘海醇和亚甲蓝的50:50混合物重复该技术。CT证实造影剂与C6、C7、C8和T1神经的接近程度。记录纵隔、硬膜外、血管内和胸膜污染情况。通过解剖评估膈神经的亚甲蓝染色情况。
第一阶段：确定的骨性标志为C6腹侧椎板、C6和C7横突、T1椎体和第一肋骨。第二阶段：在所有12个部位，C6、C7和C8神经均与造影剂接触。在11/12个部位，造影剂显示靠近T1神经的解剖位置。分别在6只、4只和2只尸体中观察到纵隔、硬膜外和血管内污染。未观察到胸膜污染。在2/12侧观察到膈神经染色。
平面内超声引导下脊神经根阻滞是一种可行的技术。然而，由于造影剂的不良扩散，需要进一步研究以减少对重要结构的污染发生率。
