Erector spinae plane block as part of a multimodal analgesic approach in an anaesthetised horse undergoing dorsal spinous process ostectomy and desmotomy
Abstract:A 14‐year‐old Irish sport horse presented to our institution with a history of right forelimb lameness and left‐sided back pain. Radiography and nuclear scintigraphy were performed under sedation and the horse was diagnosed with overriding dorsal spinous processes, also known as kissing spine syndrome. Surgical treatment consisted of dorsal spinous process ostectomy and desmotomy under general anaesthesia. This case report summarises the perianaesthetic management, which included an erector spinae plane block … Show more
“…Moreover, the clinical application and efficacy of the ESP block also remain under debate, 30 and further research is needed to fully understand the mechanism of action and potential benefits of this technique. In veterinary medicine, this block has recently been investigated in several species, including dogs, 20,21 cats, 22 pigs, 19 horses 23–25 and cows 26 . Epidural spreading has been described in cadaveric studies using the US‐guided ESP block (67%), as well as the blind paravertebral (53%) techniques in cattle 26 .…”
Section: Discussionmentioning
confidence: 99%
“…[16][17][18] This block has been investigated in pigs, 19 dogs, 20,21 cats 22 and recently in horses. [23][24][25] A recent cadaveric study by d' Anselme et al 26 demonstrated the feasibility of an ultrasound-guided erector spinae plane block in cows. Compared to the traditional blind technique, the study found that the ESP block offers several advantages consistent with those reported for other facial plane blocks.…”
Section: Introductionmentioning
confidence: 99%
“…For the proximal paravertebral approach, the erector spinae plane (ESP) block, introduced in humans in 2016 by Forero et al., 15 has been suggested as an equivalent ultrasound‐guided technique 16–18 . This block has been investigated in pigs, 19 dogs, 20,21 cats 22 and recently in horses 23–25 …”
A 5‐year‐old post‐parturient Holstein Friesian cow, with a history of decreased milk production, decreased appetite and metritis, was referred for left abomasal displacement, which was corrected by right paralumbar omentopexy. After aseptic preparation of the right flank, an erector spinae plane block was performed under ultrasound guidance, using 20 mL of lidocaine 2% per point of injection, at the level of the thoracic vertebra 13, and the lumbar vertebrae 1 and 2 to provide flank anaesthesia. The cow reacted to the last 2 cm of the oblique skin incision, that corresponded to the most caudal portion of the flank. After local infiltration of the distal incision with 20 mL lidocaine 2%, the procedure was uneventful, with no anaesthesia‐related complications and no reactions to surgical stimulation. The present report describes the clinical application of the erector spinae plane block to provide flank anaesthesia in a cow undergoing standing laparotomy.
“…Moreover, the clinical application and efficacy of the ESP block also remain under debate, 30 and further research is needed to fully understand the mechanism of action and potential benefits of this technique. In veterinary medicine, this block has recently been investigated in several species, including dogs, 20,21 cats, 22 pigs, 19 horses 23–25 and cows 26 . Epidural spreading has been described in cadaveric studies using the US‐guided ESP block (67%), as well as the blind paravertebral (53%) techniques in cattle 26 .…”
Section: Discussionmentioning
confidence: 99%
“…[16][17][18] This block has been investigated in pigs, 19 dogs, 20,21 cats 22 and recently in horses. [23][24][25] A recent cadaveric study by d' Anselme et al 26 demonstrated the feasibility of an ultrasound-guided erector spinae plane block in cows. Compared to the traditional blind technique, the study found that the ESP block offers several advantages consistent with those reported for other facial plane blocks.…”
Section: Introductionmentioning
confidence: 99%
“…For the proximal paravertebral approach, the erector spinae plane (ESP) block, introduced in humans in 2016 by Forero et al., 15 has been suggested as an equivalent ultrasound‐guided technique 16–18 . This block has been investigated in pigs, 19 dogs, 20,21 cats 22 and recently in horses 23–25 …”
A 5‐year‐old post‐parturient Holstein Friesian cow, with a history of decreased milk production, decreased appetite and metritis, was referred for left abomasal displacement, which was corrected by right paralumbar omentopexy. After aseptic preparation of the right flank, an erector spinae plane block was performed under ultrasound guidance, using 20 mL of lidocaine 2% per point of injection, at the level of the thoracic vertebra 13, and the lumbar vertebrae 1 and 2 to provide flank anaesthesia. The cow reacted to the last 2 cm of the oblique skin incision, that corresponded to the most caudal portion of the flank. After local infiltration of the distal incision with 20 mL lidocaine 2%, the procedure was uneventful, with no anaesthesia‐related complications and no reactions to surgical stimulation. The present report describes the clinical application of the erector spinae plane block to provide flank anaesthesia in a cow undergoing standing laparotomy.
“…This locoregional technique may be useful for desensitising the structures supplied by the dorsal rami of the thoracic and lumbar spinal nerves, specifically to identify and treat conditions affecting the spinous processes of the vertebrae. Recently, three case reports have been published demonstrating the use of ultrasound‐guided ESP (UG‐ESP) block in horses undergoing ostectomy and interspinous ligament desmotomy (Chiavaccini et al., 2022; Perez et al., 2023; Rodriguez et al., 2022). Perez et al.…”
SummaryPerineural anaesthesia is a useful technique in equine surgery, providing pre‐emptive targeted anaesthesia of the surgical site, reducing volatile anaesthetic requirements, improving recovery quality and providing postoperative pain relief. Surgery under standing sedation in horses has increased in popularity, mandating the need for effective locoregional anaesthesia and analgesic techniques. Nerve location techniques offer greater accuracy than blind techniques when placing injectate. These methods can help to avoid structures such as blood vessels and minimise direct nerve damage during needle placement, reducing the risk of procedure‐related complications. This review will discuss the most pertinent research in the veterinary literature where objective methods of nerve location have been used to perform peripheral nerve blocks in horses. The efficacy of using objective methods to perform nerve blocks in equine anaesthesia is discussed by the authors, providing useful information to equine anaesthetists, and potentially improve the quality of anaesthesia and analgesia in horses.
“…27,30 ESP injections have recently been studied in horse cadavers, 15 and there is only one report of its clinical use in horses undergoing dorsal spinous process ostectomy and desmotomy under general anaesthesia. 16 The present case report describes the first ultrasound-guided ESP block in a standing horse as part of an opioid-free neuroleptoanalgesic protocol in a patient undergoing multiple subtotal ostectomy of dorsal spinous processes.…”
Opioid‐free anaesthesia is a growing field in human and veterinary medicine. Several adverse effects have been reported related to the administration of opioids in horses, including the propensity to produce excitement, ataxia and gastrointestinal stasis. However, opioids have traditionally been the mainstay of pain relief in both the human and veterinary field. The feasibility of an opioid‐free anaesthesia protocol in a horse that underwent multiple subtotal spinous process ostectomies is reported here. Instead of traditional opioid therapy, a detomidine continuous‐rate infusion and a bilateral ultrasound‐guided erector spinae block was performed to provide analgesia. The authors concluded that opioid‐free surgical anaesthesia protocols may be feasible in horses undergoing multiple subtotal spinous process ostectomies. Gaining experience with these protocols may be advantageous when the use of opioids is to be avoided.
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