一种新的超声引导下的犬侧方竖脊肌肌间沟阻滞法：两种入路的比较尸体研究。

A novel ultrasound-guided lateral quadratus lumborum block in dogs: a comparative cadaveric study of two approaches.

机构信息

Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.

出版信息

Vet Anaesth Analg. 2020 Nov;47(6):810-818. doi: 10.1016/j.vaa.2020.08.003. Epub 2020 Aug 13.

DOI:10.1016/j.vaa.2020.08.003

PMID:32981838

Abstract

OBJECTIVE

To describe an ultrasound-guided lateral quadratus lumborum (LQL) block technique and the spread characteristics of lidocaine-dye injected in the LQL plane using a transversal (LQL-T) or a longitudinal (LQL-L) approach.

STUDY DESIGN

Experimental anatomic study.

ANIMALS

A total of eight canine cadavers.

METHODS

Bilateral ultrasound-guided injections in the fascial plane lateral to the quadratus lumborum muscle and medial to the thoracolumbar fascia (LQL plane) with the needle directed at the first lumbar (L1) transverse process were performed using lidocaine-dye (0.3 mL kg). Anatomical dissection determined the dye distribution, sympathetic trunk staining and number of spinal nerves stained circumferentially >1 cm.

RESULTS

The LQL fascial plane was ultrasonographically recognized in all cadavers and filled with lidocaine-dye in all eight cadavers with the LQL-T approach and in six with LQL-L. The injectate spread ventral to the lumbar transverse processes, around the quadratus lumborum muscle and dorsal to the transversalis fascia, affecting the ventral branches of the spinal nerves and the sympathetic trunk. A median (range) of 4 (3-5) and 3 (0-4) ventral branches of the thoracolumbar nerves were dyed with LQL-T and LQL-L approaches, respectively (p = 0.04). The most cranial nerve stained was the twelfth thoracic (T12) with the LQL-T approach and T13 with LQL-L, and the most caudal was L3 with both approaches. The incidence of sympathetic trunk staining was significantly higher using LQL-T (six injections) compared with LQL-L (one injection; p = 0.04). Dye was not observed in the lumbar plexus, epidural space or abdominal cavity.

CONCLUSIONS AND CLINICAL RELEVANCE

Ultrasound-guided LQL-T approach resulted in a more consistent spread toward the spinal nerves and sympathetic trunk compared with LQL-L approach. Further studies are necessary to assess the LQL block effectiveness and success rate in live dogs.

摘要

目的

描述一种超声引导下的侧方竖脊肌（LQL）阻滞技术，以及使用横向（LQL-T）或纵向（LQL-L）入路在 LQL 平面内注射利多卡因-染料的扩散特征。

研究设计

实验解剖学研究。

动物

总共 8 只犬尸体。

方法

在竖脊肌外侧和胸腰筋膜内侧的筋膜平面内进行双侧超声引导下注射（LQL 平面），针尖朝向第 1 腰椎（L1）横突，使用利多卡因-染料（0.3 mL/kg）。解剖确定了染料的分布、交感干染色以及有多少脊神经被染色超过 1 厘米。

结果

在所有尸体中，LQL 筋膜平面均在超声下识别，并在 LQL-T 入路的 8 具尸体和 LQL-L 入路的 6 具尸体中均充满了利多卡因-染料。注射物向腰椎横突的腹侧扩散，环绕竖脊肌，并向腹横筋膜的背侧扩散，影响脊神经的腹侧分支和交感干。LQL-T 和 LQL-L 入路分别染色了 4（3-5）和 3（0-4）条胸腰神经的腹侧分支（p=0.04）。染色的最头脊神经是第 12 胸神经（T12），用 LQL-T 入路，第 13 胸神经（T13）用 LQL-L 入路，最尾脊神经是 L3，两种入路都染色。与 LQL-L 入路（1 次注射）相比，LQL-T 入路的交感干染色发生率明显更高（6 次注射）（p=0.04）。在腰椎丛、硬膜外间隙或腹腔内未观察到染料。