超声引导下猫竖脊肌间沟阻滞的背腹侧和腹背侧入路比较：尸体研究。
Comparison of dorsoventral and ventrodorsal approaches for ultrasound-guided quadratus lumborum block in cats: a cadaver study.
机构信息
VetOeiras, Veterinary Hospital, Oeiras, Portugal; CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; CECAV, Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; Department of Veterinary Science, University Lusófona, Lisbon, Portugal.
CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal; CECAV, Animal and Veterinary Research Centre UTAD, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.
出版信息
Vet Anaesth Analg. 2022 Sep;49(5):481-489. doi: 10.1016/j.vaa.2022.05.003. Epub 2022 May 26.
OBJECTIVE
To assess the feasibility of an ultrasound (US)-guided quadratus lumborum (QL)-psoas muscle (Pm) interfascial plane injection using a dorsoventral (DV) approach, and to compare needle visualization and distribution pattern between DV and ventrodorsal (VD) approaches.
STUDY DESIGN
Experimental anatomical study.
ANIMALS
A total of 14 cat cadavers.
METHODS
Bilateral in-plane US-guided injections in the QL-Pm plane were performed at the level of the second lumbar (L2) transverse process. A spinal needle was inserted using either a VD or DV approach. A total volume of 0.4 mL kg of a solution of ropivacaine 0.18%, tissue dye and iohexol (350 mg mL), in a proportion of 3:1:1, respectively, was injected bilaterally. Spread of injectate was compared and evaluated using US, computed tomography (CT) scanning and anatomical dissection. Presence of dye on the sympathetic trunk was compared between methods using Kappa (κ) coefficient of agreement.
RESULTS
The QL-Pm plane was visualized, and dye was present in the target plane using both approaches. Needle visualization in the VD approach was enhanced compared with the DV approach (p = 0.0005). Mean distribution along the sympathetic trunk was 4.8 and 4.1 segments in the VD and DV approaches, respectively, showing non-statistical differences. The ventral branches of L1, L2 and L3 were successfully stained in 11/14 and 6/14 using the VD and DV approaches, respectively. Substantial agreement (κ = 0.61) of sympathetic trunk staining was observed between CT scan and anatomical dissection. Dye was observed cranial to the diaphragm in 7/8 cases on CT with both approaches. Epidural and abdominal cavity dye distribution was not observed.
CONCLUSIONS AND CLINICAL RELEVANCE
The DV approach to the QL-Pm plane could be an alternative to the VD approach. Both approaches seem capable of reaching the spinal nerves, the sympathetic trunk and both splanchnic and coeliac nerves in feline cadavers.
目的
评估经背-腹（DV）入路超声（US）引导竖脊肌-腰方肌（QL-Pm）筋膜平面注射的可行性，并比较 DV 和腹-背（VD）入路的针可视化和分布模式。
研究设计
实验解剖研究。
动物
总共 14 只猫尸体。
方法
在第二腰椎（L2）横突水平，双侧行平面内 US 引导的 QL-Pm 平面注射。使用 VD 或 DV 入路插入一根脊椎针。双侧分别注射 0.18%罗哌卡因、组织染料和 iohexol（350mg/ml）的溶液 0.4ml/kg，比例为 3:1:1。使用 US、计算机断层扫描（CT）扫描和解剖学解剖比较和评估注射剂的扩散。使用 Kappa（κ）一致性系数比较两种方法之间染料在交感干上的存在情况。
结果
QL-Pm 平面被可视化，两种方法均在目标平面上存在染料。与 DV 入路相比，VD 入路的针可视化增强（p=0.0005）。VD 和 DV 入路沿交感干的平均分布分别为 4.8 和 4.1 个节段，无统计学差异。11/14 例和 6/14 例成功染色 VD 和 DV 入路的 L1、L2 和 L3 的腹侧分支。CT 扫描和解剖学发现交感干染色具有高度一致性（κ=0.61）。两种入路在 CT 上均有 7/8 例观察到膈顶以上的染料。未观察到硬膜外和腹腔内染料分布。
结论和临床相关性
QL-Pm 平面的 DV 入路可能是 VD 入路的替代方法。两种方法似乎都能够到达猫尸体的脊神经、交感干以及内脏和腹腔神经。
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