一种新型超声引导下竖脊肌外侧方阻滞方法的描述：犬尸体研究。

Description of a novel ultrasound-guided approach for a dorsal quadratus lumborum block: a canine cadaver study.

机构信息

Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Hospital Veterinario Anicura Valencia Sur, Silla, Spain.

Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Instituto Universitario de Investigación Mixto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Zaragoza, Spain.

出版信息

Vet Anaesth Analg. 2022 Jan;49(1):118-125. doi: 10.1016/j.vaa.2021.09.002. Epub 2021 Sep 21.

DOI:10.1016/j.vaa.2021.09.002

PMID:34852961

Abstract

OBJECTIVE

To describe an ultrasound-guided approach to the dorsal aspect of the quadratus lumborum muscle (D-QL) and to evaluate the spread of methylene blue dye in canine cadavers.

STUDY DESIGN

Prospective, experimental anatomical study.

ANIMALS

A total of 12 canine cadavers.

METHODS

The ultrasonographic landmarks and injection technique for the D-QL approach were determined in two cadavers. Correct needle tip position was confirmed by computed tomography. Bilateral ultrasound-guided injections were performed in 10 cadavers between the QL muscle, the vertebral body and the ventrocaudal aspect of the transverse process of the first lumbar vertebra (L1) using two volumes of methylene blue: low volume (LV) 0.3 mL kg or high volume (HV) 0.5 mL kg. Staining of the main thoracolumbar trunk, dorsal and ventral branches of the thoracic (T) and lumbar (L) spinal nerves, sympathetic trunk and epidural space were assessed following dissection. Data between groups were compared using Mann-Whitney U test. Data are presented as median (range).

RESULTS

The ventral branches of spinal nerves T12, T13, L1, L2, L3 and L4 were stained in 10%, 70%, 100%, 90%, 60%, 0% and 30%, 100%, 100%, 100%, 50% and 30% after LV and HV injections, respectively. Multisegmental spread of the sympathetic trunk was found on 3 (3-4) and 5 (3-6) vertebral spinal levels following LV and HV injections, respectively (p = 0.005). The T13 segment of the sympathetic trunk was stained after all HV injections. Epidural spread was found in 20% and 30% of LV and HV injections, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

The injection of HV versus LV dye using the D-QL approach provided more consistent staining of the thoracolumbar nerve structures which innervate the abdominal wall and viscera. Clinical studies are required to evaluate the analgesic efficacy of the D-QL block for abdominal procedures in dogs in vivo.

摘要

目的

描述一种经超声引导的腰背阔肌（QL）背侧入路方法，并评估犬 cadaver 中亚甲蓝染料的扩散情况。

研究设计

前瞻性、实验解剖学研究。

动物

共 12 只犬 cadaver。

方法

在 2 只 cadaver 中确定了 D-QL 入路的超声标志和注射技术。通过计算机断层扫描确认了正确的针尖位置。在 10 只 cadaver 中，在 QL 肌肉、椎体和第一腰椎（L1）横突的腹侧之间，使用两种体积的亚甲蓝（低体积 [LV] 0.3 mL/kg 或高体积 [HV] 0.5 mL/kg）进行双侧超声引导注射。注射后，通过解剖评估主要胸腰椎干、胸（T）和腰（L）脊神经的背侧和腹侧分支、交感干和硬膜外间隙的染色情况。使用 Mann-Whitney U 检验比较组间数据。数据以中位数（范围）表示。

结果

LV 和 HV 注射后，T12、T13、L1、L2、L3 和 L4 脊神经的腹侧分支分别染色 10%、70%、100%、90%、60%、0%和 30%、100%、100%、100%、50%和 30%。LV 和 HV 注射后，分别在 3（3-4）和 5（3-6）个椎骨水平发现交感干的多节段扩散（p=0.005）。所有 HV 注射后均染色 T13 节段交感干。硬膜外扩散分别见于 20%和 30%的 LV 和 HV 注射。