Bloqueo anestésico de los nervios intercostales T6-T11 en un canino sometido a escisión quirúrgica de masa tumoral ubicada en pared abdominal cráneo-ventral. Reporte de caso

Abstract

The anesthetic management of an 8-year-old Golden Retriever female canine submitted to surgical excision of a malignant tumor located in the wall of the cranio-ventral abdomen was exposed; for which the T6-T11 bilateral intercostal nerves anesthetic block was performed using anatomical surface marks as neurolocalization technique, and using bupivacaine (0.5%) as local anesthetic. This as part of a multimodal anesthetic protocol that also included acepromazine, meloxicam, tramadol, propofol and isoflurane in 100% O2. The values of arterial pressure and heart rate were evaluated intraoperatively; postoperative pain was evaluated applying the composite Glasgow pain scale. Intraoperative evaluated cardiorespiratory variables remained stable throughout the surgical procedure. Postoperative pain assessment showed adequate analgesic coverage. The intercostal block used in this patient as part of a multimodal anesthesia protocol allowed to minimize the consumption of isoflurane, and avoided the use of rescue analgesia in the intraoperative period, and the need to administer supplemental anesthesia in the postoperative period. The blockade of the intercostal nerves T6-T11 by means of the surface anatomical marks technique, added to the multimodal protocol used, allowed to obtain effective analgesic coverage, economical and safe in the evaluated patient. This technique could be considered as an alternative to the epidural block traditionally performed in surgical procedures involving the abdominal wall.

Keywords:

analgesia

bloqueo nervioso

epidural

perros

analgesia

dogs

epidural

nerve block

References

 Aarnes, T.K. Epidurals and spinals. In: Lerche, P.; Aarnes, T.K.; Covey-Crump, G.et al. (Ed). Handbook of small animal regional anesthesia and analgesia techniques. New Jersey: Wiley-Blackwell, 2016. p. 75-82.

 Bruggink, S.M.; Schroeder, K.M.; Baker-Herman, T.L. et al. Weight-based volume of injection influences cranial to caudal spread of local anesthetic solution in ultrasoundguided transversus abdominis plane blocks in canine cadavers. Veterinary Surgery, v.41, n.4, p.455-457, 2012.

 Burns, P. Isoflurane and sevoflurane: application and protocols. Clinician’s Brief, p.83- 87, 2015.

 Cata, J.P.; Hernandez, M.; Lewis, V.O. et al. Can regional anesthesia and analgesia prolong cancer survival after orthopaedic oncologic surgery? Clinical Orthopaedics and Related Research, v.72, n.5, p.1434-1441, 2014.

 De Marzo, C.; Crovace, A.; De Monte, V. et al. Comparison of intra-operative analgesia provided by intravenous regional anesthesia or brachial plexus block for pancarpalarthrodesis in dogs. Research in Veterinary Science, v.93, n.3, p.1493-1497, 2012.

 Drozdzynska, M.; Viscallas, J. Descripción del bloqueo ecoguiado del plano transverso del abdomen con abordaje subcostal en el perro: estudio en cadáveres. In: XI Congreso Nacional de la Sociedad Española de Anestesia y Analgesia Veterinaria, 2015, Madrid, España. Memorias XI Congreso Nacional de la Sociedad Española de Anestesia y Analgesia Veterinaria; 2015, p.82.

 Echeverry, D.F.; Peláez, J.T.; Ospina, D.A. et al. Analgesic effect of a bilateral intercostal nerve block in a dog undergoing surgical excision of an abdominal Wall tumor. In: 12th World Congress of a Veterinary Anaesthesiology, 2015, Kyoto, Japan. Memorias 12th World Congress of a Veterinary Anaesthesiology; 2015, p.181.

 Evans, H.E.; de Lahunta, A.; editores. Miller’s Anatomy of the Dog. 4a ed. Filadelfia, Estados Unidos: Saunders, Elsevier; 2013. 850p.

 Figueiró, M.R.; Soares, J.H.; Ascoli, F.O. 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.

 Finnerty, O.; Carney, J., McDonell, J.G. Trunk blocks for abdominal surgery.Anaesthesia, v.65, p.76-83, 2010 (suppl.1).

 Fox, S.M.; editor. Pain management in small animal medicine. 1a ed. Florida, Estados Unidos: CRC Press Taylor & Francis Group, 2014. 416p.

 Franci, P.; Leece, E.A.; Corletto, F. Thoracic epidural catheter placement using a paramedian approach with cephalad angulation in three dogs. Veterinary Surgery, v.41, n.7. p.884-889,
2012.

 Freire, C.D.; Torres, M.L.; Fantoni, D.T.; Calvancanti, R.L.; Noel-Morgan, J. Bupivacaine 0.25% and methylene blue spread with epidural anesthesia in dog.Veterinary Anaesthesia and Analgesia, v.37, n.1, p.63-69, 2010.

 Hellyer, P.; Rodan, I.; Brunt, J. et al. AAHA/AAFP pain management guidelines for dogs & cats. Journal of American Animal Hospital Association, v.43, n.5, p.235-248, 2007.

 Hermanson, J.W. The muscular system. In: Evans, H.E.; de Lahunta, A. (Ed) Miller’s Anatomy of the Dog. Philadelphia: Saunders, Elsevier, 2013. p. 185–276.

 Höglund, O.V.; Olsson, K.; Hagman, R. 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.

 Lachin, A.; Bufalari, A. Monitoraggio dei gas respirati. In: Bufalari, A.; Lachin, A. (Ed) Anestesia cane, gatto e animalinon convenzionali. Milano: Elsevier, 2012. p. 772- 789.

 López, J.M.; Jiménez, B.M.; Areán, I.et al. Bloqueo transverso abdominal ecoguiado vs. infiltración de herida quirúrgica en cirugía ambulatoria de hernia inguinal. Cirugía Mayor Ambulatoria, v.18, n.1, p.7-11, 2013.



*************************************





 Mangas, M.T.; Lima, J.F.; Abellán, E. et al. Estudio prospectivo sobre el valor predictivo de la monitorización nociceptiva intraoperatoria de los cambios hemodinámicos en perros anestesiados: estudio piloto. In: X Southern European Veterinary Conference, 51 Congreso Nacional AVEPA, 2016, Granada, España. Memorias X Southern European Veterinary Conference, 51 Congreso Nacional AVEPA, 2016.

 Melzack, R.; Wall, P.D.; editores. Textbook of pain. 4a ed. London, England: Churchill Livingstone, 1999. 1588p.

 Otero, P. Epidural anesthesia and analgesia. In: 31st World Small Animal Veterinary Congress, 12th European Congress FECAVA, National Congress CSAVA, 2006, Prague, Czech Republic. Memorias 31st World Small Animal Veterinary Congress, 12th European Congress FECAVA, National Congress CSAVA; 2006, p.199-201.

 Parikh, B.K.; Waghmare, V.T.; Shah, V.R. et al. The analgesic efficacy of ultrasoundguided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: A randomized controlled study. Saudi Journal of Anaesthesia, v.7, n.1, p.43-47, 2013.

 Pawson, P.; Forsyth, S. Anesthetic agents. In: Maddison, J.E.; Page, S.; Church, D. (Ed). Small Animal Clinical Pharmacology. Filadelfia: Saunders, Elsevier, 2008. p. 83- 112.

 Pedroza, S.; Expósito, A.; Aguado, D. et al. Monitorización de la nocicepción intraoperatoria en perros mediante un monitor de tono parasimpático: estudio piloto. In: 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.; Romano, M.; Brignati, A. Retrospective clinical evaluation of ultrasound guided transverse abdominis plane block in dogs undergoing mastectomy. Veterinary Anaesthesia and Analgesia, v.41, n.3, p.319-324, 2014.

 Read, M.R.; Schroeder, C.A. The Trunk. In: Campoy, L.; Read, M.R. (Ed). Small animal regional anesthesia and analgesia. New Jersey: Wiley-Blackwell, 2013. p. 167- 198.

 Sarotti D, Rabozzi R, Franci P. 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.

 Schroeder, C.A.; Snyder, L.B.; Tearney, C.C.et al. Ultrasound-guided transversus abdominis plane block in the dog: an anatomical evaluation. Veterinary Anaesthesia and Analgesia; v.38, n.3, p.267-271, 2011.

 Steffey, E.P.; Mama, K.R.; Brosnan, R.J. Inhalation Anesthetics. In: Grimm, K.A.; Lamont, L.A.; Tranquilli, W.J. et al (Ed). Veterinary Anesthesia and Analgesia The Fifth Edition of Lumb and Jones. Iowa: Wiley-Blackwell, 2015. p. 297-331.

 Takeda, A.; Cunha, L.H.; Hosoi, 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.

 Torske, K.E.; Dyson, D.H. Epidural analgesia and anesthesia. Veterinary Clinics of North America Small Animal Practice, v.30, n.4. p. 859-874, 2000.

 Trębacz, P.; Trębacz, E.; Jurka, P. et al. Comparison of the efficiency of anatomical and ultrasound-guided method for the Th4-Th7 intercostal nerve block in dogs. Bulletin of the Veterinary Institute in Pulawy, v.55, n.3, p.507-511, 2011.

 Voigt, A.M.; Bergfeld, C.; Beyerbach, 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.