Serra Roger Medina, Jimenez Carolina Palacios, Monticelli Paolo, Plested Mark, Viscasillas Jaime
Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK.
Departament de Medicina y Cirugia Animal, Facultad de Veterinaria, Instituto de Ciencias Biomedicas, Universidad CEU Cardenal Herrera, Valencia, Spain.
Open Vet J. 2019 Oct;9(3):230-237. doi: 10.4314/ovj.v9i3.7. Epub 2019 Aug 16.
The caudal thoracic paravertebral (CTPV) block is a regional anesthesia technique currently used in human medicine to provide analgesia in abdominal surgical procedures.
The objectives of this study are to describe an ultrasound-guided technique to place catheters in CTPV space in canine cadavers and evaluate the distribution of a 50:50 contrast-dye solution administered through them.
Eight thawed adult beagle cadavers (9.2 ± 2.0 kg body total weight) were used. Thirteen catheters were placed. In the first phase, a volume of 0.3 ml kg of the contrast-dye was administered in all cases. After the injections, computed tomography (CT) scans were carried out to assess the distribution of the contrast-dye. In the second phase, an extra 0.2 ml kg of the contrast-dye was administered through eight catheters, followed by a second CT scan. Two cadavers were dissected to assess the distribution of the contrast-dye. The injection site varied between T8-9 and T12-13.
The evaluation of the CT scans showed contrast-dye within the paravertebral space in 92% (12/13) of the injections. The distribution pattern observed after the injections performed within the TPV space was linear and intercostal in all cases. The median (range) linear spread of the contrast was 7 (5-10) spinal nerves and involved 3 (2-8) intercostal spaces. The contrast-dye reached lumbar regions in 42% of the injections (5/12). A larger spread of the contrast-dye was not observed after the administration of a second dose of the injectate. No signs of epidural, intrapleural/intrapulmonary, intravascular, or intraabdominal spread were observed. The dissection of the two cadavers confirmed the spread of the contrast-dye along the sympathetic trunk and intercostal spaces.
The administration of 0.3 ml kg of the contrast-dye in the CTPV space resulted in a distribution compatible with the block of nerves responsible for the innervation of the majority of the abdominal viscera and cranial abdominal wall.
胸段尾侧椎旁(CTPV)阻滞是目前在人类医学中用于腹部外科手术镇痛的一种区域麻醉技术。
本研究的目的是描述一种在犬类尸体的CTPV间隙放置导管的超声引导技术,并评估通过这些导管注入的50:50造影剂与染料混合溶液的分布情况。
使用8只解冻的成年比格犬尸体(总体重9.2±2.0千克)。共放置了13根导管。在第一阶段,所有病例均注入0.3毫升/千克的造影剂与染料混合溶液。注射后,进行计算机断层扫描(CT)以评估造影剂与染料混合溶液的分布情况。在第二阶段,通过8根导管额外注入0.2毫升/千克的造影剂与染料混合溶液,随后进行第二次CT扫描。解剖2只尸体以评估造影剂与染料混合溶液的分布情况。注射部位在T8 - 9和T12 - 13之间变化。
CT扫描评估显示,92%(12/13)的注射在椎旁间隙内有造影剂与染料混合溶液。在TPV间隙内注射后观察到的分布模式在所有病例中均为线性且沿肋间分布。造影剂的线性扩散中位数(范围)为7(5 - 10)条脊神经,涉及3(2 - 8)个肋间间隙。42%的注射(5/12)中造影剂与染料混合溶液到达了腰部区域。在注入第二剂注射液后,未观察到造影剂与染料混合溶液有更大范围的扩散。未观察到硬膜外、胸膜内/肺内、血管内或腹腔内扩散的迹象。对2只尸体的解剖证实了造影剂与染料混合溶液沿交感干和肋间间隙扩散。
在CTPV间隙注入0.3毫升/千克的造影剂与染料混合溶液,其分布与负责大部分腹部内脏和腹部前壁神经支配的神经阻滞相匹配。