腰椎竖脊肌平面阻滞：两种超声引导入路在犬尸体中的解剖和染料分布评估。
Lumbar erector spinae plane block: an anatomical and dye distribution evaluation of two ultrasound-guided approaches in canine cadavers.
机构信息
Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK.
Department of Clinical Sciences and Services, The Royal Veterinary College, Hatfield, UK.
出版信息
Vet Anaesth Analg. 2021 Jan;48(1):125-133. doi: 10.1016/j.vaa.2020.07.038. Epub 2020 Nov 11.
OBJECTIVE
To examine the anatomy of the lumbar epaxial region and to describe two different ultrasound-guided approaches for the lumbar erector spinae plane (ESP) block in dogs.
STUDY DESIGN
An anatomical and experimental cadaver study.
ANIMALS
A group of 19 canine cadavers.
METHODS
The anatomy was described following dissection of two cadavers. Bilateral ultrasound-guided ESP injections with 0.4 mL kg of contrast dye were performed in 17 adult Beagle cadavers using either transversal (TVS) or parasagittal (PST) approaches. Computed tomography was performed to measure the total length of the contrast dye column and the epidural, intravascular, hypaxial and intra-abdominal migration. Dissections were performed to assess the spread of the contrast dye and to determine the degree of staining of the dorsal branches of the spinal nerves (DBSN). Mann-Whitney U and chi-square tests were used to compare data between groups.
RESULTS
Using both techniques, the contrast dye was observed within the ESP compartment. There was no difference in the total length of the contrast dye column between TVS and PST approaches (p = 0.056). Using the TVS approach, multisegmental staining of the DBSN was visible with 100% (17/17) of injections, while complete staining of the DBSN was achieved at 94% of the injection sites. Using the PST approach, these values were 29% (5/17) and 23% (4/17), respectively. The TVS approach stained more DBSN than the PST approach (p = 0.001), with a median (range) of 2 (2-3) versus 0 (0-3) DBSN, respectively. Using the TVS approach, epidural and intravascular migration were present in 2/17 (p = 0.485) and 3/17 (p = 0.227) injections, respectively.
CONCLUSIONS AND CLINICAL RELEVANCE
Both ultrasound-guided approaches resulted in a spread of the contrast dye within the ESP compartment. Although there were no differences in the total length of the contrast dye column, the TVS approach was superior to the PST approach in staining DBSN.
目的
研究腰椎脊柱区的解剖结构，并描述两种不同的超声引导下狗腰椎竖脊肌平面（ESP）阻滞方法。
研究设计
解剖学和实验性尸体研究。
动物
一组 19 只犬尸体。
方法
在 2 具尸体解剖后描述解剖结构。在 17 只成年比格犬尸体上，使用横切（TVS）或矢状旁（PST）方法，双侧超声引导 ESP 注射 0.4ml/kg 对比染料。使用 CT 测量对比染料柱的总长度以及硬膜外、血管内、下轴和腹腔内迁移。进行解剖以评估对比染料的扩散，并确定脊神经背支（DBSN）的染色程度。使用曼-惠特尼 U 检验和卡方检验比较组间数据。
结果
两种技术均可见对比染料位于 ESP 隔室内。TVS 和 PST 方法的对比染料柱总长度无差异（p=0.056）。使用 TVS 方法，17 次注射中有 100%（17/17）可见 DBSN 多节段染色，94%（17/17）的注射部位达到完全染色。使用 PST 方法，这些值分别为 29%（5/17）和 23%（4/17）。TVS 方法比 PST 方法染色的 DBSN 更多（p=0.001），分别为中位数（范围）2（2-3）与 0（0-3）个 DBSN。使用 TVS 方法，17 次注射中有 2 次（2/17，p=0.485）和 3 次（3/17，p=0.227）可见硬膜外和血管内迁移。
结论和临床相关性
两种超声引导方法均导致对比染料在 ESP 隔室内扩散。尽管对比染料柱的总长度无差异，但 TVS 方法在 DBSN 染色方面优于 PST 方法。
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