The combination of an ultrasound‐guided erector spinae plane (ESP) block and epidural morphine as effective intra‐operative adjuncts to opioid premedication in six dogs undergoing lateral thoracotomy

Abstract

Six dogs were presented to the University College Dublin Veterinary Hospital for either left or right lateral thoracotomy. After opioid premedication and induction of general anaesthesia, ultrasound-guided erector spinae plane (ESP) block with bupivacaine 0.5% (0.5 mL/kg) or bupivacaine 0.25% (1 mL/kg) was performed in all cases before the surgical procedure along with morphine (0.2 mg/kg) administered epidurally. This combination of local techniques was a successful adjunct to systemic analgesia in these six dogs undergoing lateral thoracotomy, reducing considerably the need for systemic opioids intra-and post-operatively. Ultrasound-guided ESP block with bupivacaine and epidurally administered morphine provided good multimodal intra-operative analgesia for dogs undergoing lateral thoracotomy. BACKGROUNDLateral thoracotomy is one of the most painful but commonly performed surgical procedure to manage diseases within the thoracic cavity in small animals. 1,2 In humans it is known that adequate intra-and post-operative analgesia is essential to allow for early mobilization and discharge and also to reduce the incidence of chronic neuropathic pain development. [3][4][5][6] In human and veterinary medicine, both systemic administration of opioids and locoregional anaesthesia have been used to manage intra-and post-operative pain after lateral thoracotomy. 3,7,8 The use of locoregional anaesthesia reduces systemic opioid requirement and provides analgesia without central respiratory depression or sedation, thus improving ventilation and allowing a more accurate clinical assessment of the patient. 9,10 Thoracic epidural catheter is the "gold standard" analgesic technique in humans, 11 and its effectiveness in providing analgesia in lateral thoracotomies has also been reported in veterinary medicine. 12,13 However, the technique itself and the epidural administration of local anaesthetics may have certain complications and contraindications. 12,14,15 In dogs, these can include mechanical or chemical injury of the spinal cord, motor function impairment, and sympathetic blockade leading to hypotension. 12 Vomiting has also beenThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Opioid‐sparing anaesthesia techniques in dog and cat undergoing bilateral thoracotomy

“…However, clinical experience in dogs is limited. The introduction of UG‐ESPB as part of MA approach resulted in a reduction of perioperative opioid consumption in a series of six dogs undergoing thoracotomy 19 . UG‐ESPB catheter insertion has been described to manage post‐surgical thoracic pain in a dog where injection of 0.7 ml/kg of 0.15% levobupivacaine solution through an ESP catheter located at T10 desensitised T6–T12 dermatomes 30…”

“…The introduction of UG-ESPB as part of MA approach resulted in a reduction of perioperative opioid consumption in a series of six dogs undergoing thoracotomy. 19 UG-ESPB catheter insertion has been described to manage post-surgical thoracic pain in a dog where injection of 0.7 ml/kg of 0.15% levobupivacaine solution through an ESP catheter located at T10 desensitised T6-T12 dermatomes. 30 One of the main advantages of these techniques is their simplicity and safety in comparison to the thoracic epidural or paravertebral block.…”

“…UG‐SPB prevented nociception and reduced the intraoperative opioid requirements in four dogs undergoing lateral thoracotomy 18 . Similarly, UG‐ESPB as part of MA provided good intraoperative analgesia in six dogs undergoing lateral thoracotomy 19 . To the authors’ knowledge, neither of these LA techniques has been described yet in cats undergoing thoracic surgery.…”

“…18 Similarly, UG-ESPB as part of MA provided good intraoperative analgesia in six dogs undergoing lateral thoracotomy. 19 To the authors' knowledge, neither of these LA techniques has been described yet in cats undergoing thoracic surgery.…”

A Two-Point Ultrasound-Guided Injection Technique for the Transversus Thoracis Plane Block: A Canine Cadaveric Study

“…In veterinary medicine, thoracic epidural [ 6 ], thoracic paravertebral block [ 7 , 8 , 9 , 10 , 11 ], erector spinae plane block [ 12 , 13 , 14 ], intercostal blocks [ 6 , 15 ], transversus thoracis plane (TTP) block [ 16 , 17 ] and pecto-intercostal block [ 18 ] could be useful, providing analgesia to the ventral chest wall.…”