Authors
Abstract
The brachial plexus block is a loco-regional anaesthetic technique useful to prevent nociceptive discharges in distal canine elbow surgeries. The anesthetic management performed in three canines submitted to ostheosyntesis of the radius is presented. For this purpose, the brachial plexus was blocked by means of a combined ultrasound and electrolocation technique, using an anesthetic mixture of bupivacaine/lidocaine. This was part of a multimodal analgesic protocol that also included acepromazine, morphine, meloxicam, propofol and isoflurane. The intraoperative cardiovascular variables evaluated (heart rate and mean arterial pressure) remained stable throughout the surgical procedure, reason why rescue analgesia was not used in any case. The post-operative pain score, assessed with the Glasgow scale, remained below the indicative limits of low analgesic coverage in all patients. The locoregional blockade employed allowed to minimize the consumption of isoflurane and avoided the use of intra-operative rescue analgesia, as well as the need to use supplementary analgesia in the post-operative period evaluated. Despite the limited ultrasound resolution of the ultrasound equipment used, the analgesic response obtained suggests that the brachial plexus block by means of the combined technique of ultrasound and electrolocation technique was effective to prevent perioperative pain in performing radius-ostheosyntesis in the canines evaluated.
Keywords:
References
Ansón, A. et al. Evaluation of an ultrasound-guided technique for axillary brachial plexus blockade in cats. Journal of Feline Medicine and Surgery, v. 19, n. 2, p. 146- 152, 2017.
Bhalla, R.J.; Leece, E.A. Pneumothorax following nerve stimulator-guided axillary brachial plexus block in a dog. Veterinary Anaesthesia and Analgesia, v. 42, n. 6, p. 658-659, 2015.
Burns, P. Isoflurane and sevoflurane: Application and protocols. Clinician’s Brief, p. 83-87, 2015.
Campoy, L. et al. Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs. Veterinary Anaesthesia and Analgesia, v. 37, n. 2, p. 144-153, 2010.
Campoy, L.; Read, M.R. The Thoracic Limb. En: Campoy, L.; Read, M.R. (Ed). Small Animal Regional Anesthesia and Analgesia. Iowa, USA: Wliey-Blackwell, 2013. p. 141-165.
Cardozo, L.B. et al. Evaluation of the effects of methadone and tramadol on postoperative analgesia and serum interleukin-6 in dogs undergoing orthopaedic surgery. BMC Veterinary Research, v. 10, p. 194, 2014.
Dureja, J. et al. Comparative evaluation of techniques in supraclavicular brachial plexus block: Conventional blind, nerve stimulator guided, and ultrasound guided.International Journal of Scientific Study, v. 3, n. 12, p. 125-128, 2016.
Echeverry, D.F. et al. Ultrasound and neurostimulation-guided brachial plexus block in a dog undergoing radius osteosynthesis. En: Southern European Veterinary Conference, 48 Congreso Nacional AVEPA, 2013, Barcelona, España. Memorias: Southern European Veterinary Conference, 48 Congreso Nacional AVEPA, 2013.
Evans, H.E.; de Lahunta, A. Guide to the dissection of the dog. Filadelfia, USA: Saunders-Elsevier, 2010.
Figueiró, M.R. et al. Isoflurane MAC determination in dogs using three intensities of constant-current electrical stimulation. Veterinary Anaesthesia and Analgesia, v. 43, n. 5, p. 464-471, 2016.
Fossum, T.W. et al. Small Animal Surgery. St. Louis, USA: Elsevier-Mosby, 2013.
Fox, S.M. (Ed). Pain management in small animal medicine. Florida, USA: CRC Press Taylor & Francis Group, 2014.
Frazílio, F. de O. et al. Effects of epidural nalbuphine on intraoperative isoflurane and postoperative analgesic requirements in dogs. Acta Cirúrgica Brasileira, v. 29, n. 1, p. 38-46, 2014.
Futema, F. et al. A new brachial plexus block technique in dogs. Veterinary Anaesthesia and Analgesia, v. 29, n. 3, p. 133-139, 2002.
Höglund, O.V. et al. Comparison of haemodynamic changes during two surgical methods for neutering female dogs. Research in Veterinary Science, v. 91, n. 1, p. 159-163, 2011.
Kim, H.Y. et al. A comparison of ultrasound alone vs ultrasound with nerve stimulation guidance for continuous femoral nerve block in patients undergoing total knee arthroplasty. Journal of Clinical Anesthesia, v. 32, p. 274-280, 2016.
Lachin, A. Sistemi respiratori. En: Bufalari, A.; Lachin, A. (Ed). Anestesia Cane, Gatto e Animali non Convenzionali. Milan, Italy: Elsevier, 2012. p. 221-239.
Mangas, M.T. et al. Estudio prospectivo sobre el valor predictivo de la monitorización nociceptiva intraoperatoria de los cambios hemodinámicos en perros anestesiados: estudio piloto. En: X Southern European Veterinary Conference, 51 Congreso Nacional AVEPA, 2016, Granada, España.Memorias: X Southern European Veterinary Conference, 51 Congreso Nacional AVEPA, 2016.
Moore, K.L. et al. Clinically Oriented Anatomy. Filadelfia, USA: Lippincott Williams & Wilkins, 2014.
Mosing, M. et al. Clinical evaluation of the anaesthetic sparing effect of brachial plexus block in cats. Veterinary Anaesthesia and Analgesia, v. 37, n. 2, p. 154-161, 2010.
Pawson, P.; Forsyth, S. Anesthetic agents. En: Maddison, J.E.; Page, S.; Church, D. (Ed). Small Animal Clinical Pharmacology. Filadelfia, USA: Saunders-Elsevier, 2008. p. 83-112.
Pedroza, S. et al. Monitorización de la nocicepción intraoperatoria en perros mediante un monitor de tono parasimpático: estudio piloto. En: XI Congreso nacional Sociedad Española de Anestesia y Analgesia Veterinaria, 2015, Madrid, España. Memorias XI Congreso nacional Sociedad Española de Anestesia y Analgesia Veterinaria, 2015. p.88.
Portela, D.A. et al. Peripheral nerve stimulation under ultrasonographic control to determine the needle-to-nerve relationship. Veterinary Anaesthesia and Analgesia, v. 40, n. 6, p. e91-e99, 2013.
Riccó, C. et al. Different volumes of injectate using electrostimulator and blinded techniques for brachial plexus block in dogs. Veterinary Record, v. 173, n. 24, p. 608, 2013.
Ridge, P. Complication following a brachial plexus block: Analgesia. Veterinary Record, v. 174, n. 24, p. 614, 2014.
Sarotti, D. et al. Comparison of epidural versus intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery. Veterinary Anaesthesia and Analgesia, v. 42, n. 4, p. 405-413, 2015.
Srikumaran, U. et al. Upper-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients. Journal of Bone and Joint Surgery, v. 95, n. 24,p. 1-13, 2013.
Steffey, E.P. et al. Inhalation Anesthetics. En: Grimm, K.A.; Lamont, L.A. et al. Veterinary Anesthesia and Analgesia the Fifth Edition of Lumb and Jones. Iowa, USA: Wiley-Blackwell, 2015. p. 297-331.
Takeda, A. et al. Concentración mínima efectiva de bupivacaína para el bloqueo del plexo braquial vía axilar guiado por ecografía. Revista Brasileira de Anestesiologia, v. 65, n. 3, p. 163-169, 2015.
Voigt, A.M. et al. Effects of isoflurane with and without dexmedetomidine or remifentanil on heart rate variability before and after nociceptive stimulation at different multiples of minimum alveolar concentration in dogs. American Journal of Veterinary Research, v. 74, n. 5, p. 665-671, 2013.
Wenger, S. Brachial plexus block using electrolocation for pancarpal arthrodesis in a dog. Veterinary Anaesthesia and Analgesia, v. 31, n. 4, p. 272-275, 2004.
Wenger, S. et al. Evaluation of the analgesic effect of lidocaine and bupivacaine used to provide a brachial plexus block for forelimb surgery in 10 dogs.Veterinary Record, v. 156, n. 20, p. 639-642, 2005.
Wilson, D.V. et al. A comparison of two techniques for brachial plexus blockade in dogs. Veterinary Anaesthesia and Analgesia, v. 35, n. 6, p. 5-6, 2008.