AVA MeetingBarcelona 2008

EFFICACY OF AN ULTRASOUND-GUIDED TECHNIQUE COMBINED WITH NEUROSTIMULATION FOR THE LOCATION AND ANAESTHETIC BLOCKADE OF THE SCIATIC AND FEMORAL NERVES IN THE DOG.
D. Echeverry1, F. Laredo2, A. Agut2, E. Belda2, M. Soler2, F. Gil2, M.D. Ayala2 1Facultad de Medicina Veterinaria y Zootecnia. Universidad del Tolima, Ibagu (Colombia). 2 Facultad de Veterinaria. Universidad de Murcia (Spain). Introduction: The benefits of ultrasound (US) to achieve peripheral nerve blocks have been confirmed in humans1. This technique is rarely used in dogs. This study evaluated the efficacy of US to locate and block canine sciatic (ScN) and femoral (FN) nerves.

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Figura 1. A: Anatomical dissection of FN 1. Femoral artery 2. Femoral vein 3. Pectineus muscle 4. Femoral nerve 5. Iliopsoas muscle 6. Sartorius muscle. B: Acoustic window for FN. C: US image of FN window 1. Femoral artery 2. Femoral vein 3. Pectineus muscle Arrows: Femoral nerve D: Doppler color image of FN window.

Materials and methods: Three cadavers were used to determine by dissection the ultrasonographic windows to approach the ScN and FN nerves. In 4 other cadavers, the nerves were identified by a 12 MHz linear probe and the accuracy of the location determined by injecting black ink. Four Beagles, sedated with medetomidine (10 g kg-1), were used to locate the ScN and FN by US. A peripheral nerve stimulator (PNS) was employed to confirm the accuracy of their location. Then, lidocaine 1% (0.3 mL kg-1) was injected on each nerve and the occurrence of sensorial and motor block assessed.

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Figura 2. A: Acoustic window No. 1 for ScN ( Gtf : Great trochanter of the femur; It: Ischiatic tuberosity) B: Three acoustic windos for ScN were obtained ( white lines). C:Transversal anatomical section , at the level of the green dotted line from image A. Fb: Femoral biceps muscle Gtf: Great trochanter of the femur Qfm: Quadratus femoris muscle ScN: Sciatic nerve). D: US image of ScN at level of acustic window No. 1 (legends as in C)

Results: Three different ultrasonographic windows were optimal to locate the ScN. This nerve was successfully blocked after US-guided location, confirmed by PNS, in all cases. The FN, approached through a single suboptimal window, was identified in a 62, 5% of cases in cadavers, and in a 50 % of cases in vivo. It was located by the sole use of the PNS in the remaining 50 % of cases. The blockade of the target nerves was achieved in all dogs without complications.
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Figura 3. A: US image of the neurostimulation needle, in the plane technique (arrows) B: Neurostimulation to confirm US location of the nerves. C: Donut Sign. Local anaesthetic (arrows) surrounding the ScN. D: Sensitive and motor bloacked of ScN was achieved.

Conclusions: The US guided technique may improve the accuracy of the nerve location and reduce the risk of nerve/vascular puncture because the progress of the needle and the structures to be avoided can be observed in real time. This technique was easy and reliable to achieve the ScN blockade. However, further studies should be performed to obtain a reliable US approach to the FN of dogs.
1. Marhofer P, Greber M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005; 94:7-17.