一种新型的筋膜外斜角肌下臂丛阻滞:与筋膜内技术相比,可减轻半膈肌轻瘫。

IF 1.9 2区 农林科学 Q2 VETERINARY SCIENCES
Santiago E Fuensalida, Lisa Tarragona, Alfredo Díaz, María Fenranda Sanchez, Ceballos Martin, Pablo A Donati, Andrea S Zaccagnini, Samanta Waxman, Christina Montalbano, Vincenzo Rondelli, Diego A Portela, Pablo E Otero
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引用次数: 0

摘要

目的:评价超声引导下筋膜外斜角肌下入路(Esub)对犬尸体臂丛(BP)的染色液扩散情况,并比较Beagle犬的Esub和筋膜内斜角肌下入路(Isub)半膈肌性瘫的发生率。研究设计:描述性解剖研究(一期)和前瞻性、随机、盲法、实验性交叉试验(二期)。动物:共有6具犬类尸体和7只成年比格犬。方法:第一阶段用6具成年犬尸体对Esub后的染料扩散进行解剖评估。第二阶段采用随机交叉设计,7只健康成年Beagle犬,每只接受Esub和Isub块,洗脱期为14天。两种方法均使用2%利多卡因0.4 mL kg-1。半膈肌轻瘫定义为与术前相比半膈肌偏移减少≥25%,而< 25%归类为无轻瘫。对于半失语性轻瘫(一个二分类变量)的发生率,计算每个比例的精确二项95%置信区间(CIs),并使用McNemar检验进行配对比较。p < 0.05为差异有统计学意义。结果:ⅰ期解剖证实沿BP颈深筋膜外侧层有染色堆积,内脏隔室未见染色;喉返神经、迷走交感干、膈神经及其分支未见染色。在II期,Esub和Isub入路的半膈肌麻痹率分别为0% (95% CI: 0.3-58%)和100% (CI 95%: 59-100%) (p = 0.015)。结论:超声引导下的Esub入路成功地将注射限制在尸体的筋膜外平面,避免了扩散到膈神经。在Beagle犬中,与Isub入路相比,Esub显著降低了半膈肌轻瘫的发生率。有必要在临床人群中进一步研究以证实这些发现并评估长期结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A novel extrafascial subscalene brachial plexus block in dogs: reducing hemidiaphragmatic paresis compared with the intrafascial technique.

Objective: To assess dye solution spread of an ultrasound-guided extrafascial subscalene approach (Esub) to the brachial plexus (BP) in canine cadavers and to compare the incidence of hemidiaphragmatic paresis between the Esub and intrafascial subscalene (Isub) approaches in Beagle dogs.

Study design: Descriptive anatomical study (Phase I) and prospective, randomized, blinded, experimental crossover trial (Phase II).

Animals: A total of six canine cadavers and seven adult Beagle dogs.

Methods: Phase I used six adult canine cadavers for anatomical assessment of dye spread after Esub. Phase II involved seven healthy adult Beagle dogs, each receiving Esub and Isub blocks with a 14 day washout in a randomized, crossover design. Both approaches used 0.4 mL kg-1 of 2% lidocaine. Hemidiaphragmatic paresis was defined as ≥ 25% reduction in hemidiaphragmatic excursion compared with the preprocedural value, while < 25% was classified as no paresis. For the incidence of hemidiaphragmatic paresis (a dichotomous variable), exact binomial 95% confidence intervals (CIs) were calculated for each proportion, and the McNemar test was used for paired comparison. Statistical significance was set at p < 0.05.

Results: In Phase I, dissection confirmed dye accumulation in the lateral layer of the deep cervical fascia along the BP, with no dye in the visceral compartment; the recurrent laryngeal nerve, vagosympathetic trunk, phrenic nerve, and its branches were unstained. In Phase II, the rate of hemidiaphragmatic paresis was 0% (95% CI: 0.3-58%) and 100% (CI 95%: 59-100%) for Esub and Isub approaches, respectively (p = 0.015).

Conclusions: The ultrasound-guided Esub approach successfully confined injectate to the extrafascial plane in cadavers, avoiding spread to the phrenic nerve. In Beagle dogs, Esub significantly reduced the incidence of hemidiaphragmatic paresis compared with the Isub approach. Further studies in clinical populations are warranted to confirm these findings and assess long-term outcomes.

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来源期刊
Veterinary anaesthesia and analgesia
Veterinary anaesthesia and analgesia 农林科学-兽医学
CiteScore
3.10
自引率
17.60%
发文量
91
审稿时长
97 days
期刊介绍: Veterinary Anaesthesia and Analgesia is the official journal of the Association of Veterinary Anaesthetists, the American College of Veterinary Anesthesia and Analgesia and the European College of Veterinary Anaesthesia and Analgesia. Its purpose is the publication of original, peer reviewed articles covering all branches of anaesthesia and the relief of pain in animals. Articles concerned with the following subjects related to anaesthesia and analgesia are also welcome: the basic sciences; pathophysiology of disease as it relates to anaesthetic management equipment intensive care chemical restraint of animals including laboratory animals, wildlife and exotic animals welfare issues associated with pain and distress education in veterinary anaesthesia and analgesia. Review articles, special articles, and historical notes will also be published, along with editorials, case reports in the form of letters to the editor, and book reviews. There is also an active correspondence section.
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