Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
North Downs Specialist Referrals, Bletchingley, UK.
Vet Anaesth Analg. 2022 Nov;49(6):656-663. doi: 10.1016/j.vaa.2022.07.008. Epub 2022 Aug 3.
To investigate the injectate spread and nerve staining of ultrasound-guided erector spinae plane (ESP) injections at the thoracolumbar spine in canine cadavers.
Prospective, randomized, descriptive, anatomic study.
A total of 15 canine cadavers.
The location of the medial and lateral branches of the dorsal branches of the spinal nerves (DBSN) from the tenth thoracic (T10) to the third lumbar vertebra (L3) were identified by dissection of three cadavers. ESP injections of dye (0.5 mL kg) were performed in seven cadavers using as landmarks the T12 transverse process (ESP) on one side and the lateral aspect of the T12 mammillary process (ESP) on the opposite side. Additionally, five cadavers were injected with dye (0.5 mL kg) bilaterally on the lateral aspect of the L2 mammillary process (ESP). Nerve staining effect was analyzed after gross anatomic dissections. The number of stained nerves was analyzed using the Mann-Whitney U test.
Gross anatomic dissections showed that the medial and lateral branches of the DBSN change their path in relation to the epaxial muscles caudal to T11. Approaches ESP and ESP at T12 stained 2 (0-2) and 3 (2-4) medial (p = 0.01) and 3 (3-4) and 2 (0-2) lateral (p = 0.03) branches, respectively. Injection ESP stained 3 (2-4) medial and 2 (0-3) lateral branches. Injections ESP and ESP produced a preferential cranial spread from the injection site. No ventral branches of the spinal nerves were stained with either technique.
These results suggest that the mammillary process should be used as anatomic landmark to perform ultrasound-guided ESP blocks in the thoracolumbar spine caudal to T11 when targeting the medial branches of the DBSN. Injections should be performed one spinal segment caudal to the level intended to desensitize.
在犬尸体中研究超声引导竖脊肌平面（ESP）注射在胸腰椎的注射剂扩散和神经染色。
前瞻性、随机、描述性、解剖学研究。
总共 15 只犬尸体。
通过对三具尸体的解剖，确定了第十胸椎（T10）至第三腰椎（L3）的脊神经背支（DBSN）的内侧和外侧支的位置。在七具尸体中，使用一侧的 T12 横突（ESP）和对侧的 T12 乳突突（ESP）作为标记物，进行了染料（0.5 mL/kg）的 ESP 注射。此外，在五具尸体的 L2 乳突突（ESP）外侧双侧注射了染料（0.5 mL/kg）。大体解剖后分析神经染色效果。使用曼-惠特尼 U 检验分析染色神经的数量。
大体解剖显示，DBSN 的内侧和外侧支在 T11 以下的背阔肌中改变了它们的路径。ESP 和 T12 的 ESP 接近方式分别标记了 2（0-2）和 3（2-4）条内侧（p=0.01）和 3（3-4）和 2（0-2）条外侧（p=0.03）分支。ESP 注射标记了 3（2-4）条内侧和 2（0-3）条外侧分支。ESP 和 ESP 的注射产生了从注射部位优先向头侧扩散的效果。两种技术都没有染色到脊神经的腹侧分支。
这些结果表明，当靶向 DBSN 的内侧支时，应使用乳突突作为解剖学标志，在 T11 以下的胸腰椎进行超声引导的 ESP 阻滞。注射应在计划脱敏的水平下一个脊柱节段进行。
