Ultrasound-guided parasternal injection in dogs: a cadaver study

Zublena, Francesco; Briganti, Angela; Gennaro, Chiara De; Corletto, Federico

doi:10.1016/j.vaa.2020.12.010

Cited by 8 publications

(28 citation statements)

References 28 publications

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“…Bilateral ultrasound guided t-TTP block could be an alternative or a complementary technique to multiple bilateral intercostal blocks in dogs undergoing median sternotomy, as it might decrease the number of injection points required to provide analgesia and the time of execution as well. As suggested by Zublena et al [22], the TTP approach may produce less ventilatory impairment than that produced by multiple intercostal blocks in patients undergoing medial sternotomy, because the muscles affected by the TTP approach do not play an important role in ventilation.…”

Section: Discussionmentioning

confidence: 95%

“…Although the authors refer to this technique as a parasternal approach, we believe that corresponds to the sagittal TTP approach described in human literature [3,21]. In this study, Zublena et al [22] evaluated the spread of a dye solution along the TTP and the staining of the intercostal nerves when two different volumes (0.05 mL kg −1 and 0.1 mL kg −1 ) were injected. The results suggested its potential utility to desensitize the distal portion of the intercostal nerves, although multiple intercostal injections would be necessary.…”

Section: Discussionmentioning

confidence: 97%

“…Recently, Zublena et al [22] described a sagittal ultrasound-guided parasternal approach to inject a solution between the TT muscle and the internal intercostal muscle. Traditionally in human medicine, parasternal block consists in multiple intercostal blocks just lateral to the sternal border, injecting an anaesthetic solution between the pectoralis profunda and the intercostal muscles [3,16,26].…”

Section: Discussionmentioning

confidence: 99%

“…Sagittal and transverse approaches to TTP block have been reported in human literature [21]. The sagittal approach was recently described in veterinary literature [22]; however, to our knowledge, there are no references to the ultrasound-guided transverse approach to the transversus thoracis plane (t-TTP).…”

Section: Introductionmentioning

confidence: 99%

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Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers

Alaman

González‐Marrón

Lorente

et al. 2021

Animals

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Transversus thoracis plane (TTP) block has demonstrated to produce analgesia in humans undergoing median sternotomy. The objectives of the study were to describe an ultrasound-guided transverse approach to the transversus thoracis plane (t-TTP) and to evaluate the spread of two injectable volumes in canine cadavers. Two cadavers were used to describe relevant gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages. Then, eight cadavers were used to describe the ultrasound-guided injection into the TTP and were dissected to evaluate the injectate spread and the intercostal nerves staining with two different dye-lidocaine volumes: low volume (LV) 0.5 mL kg−1 and high volume (HV) 1 mL kg−1. To compare the spread between both volumes the Fisher’s exact test and Wilcoxon signed-rank test were used. The solution spread along the TTP after all injections, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with LV and HV, respectively (p = 0.014). The injection of HV versus LV increases the number of stained nerves. Ultrasound-guided t-TTP is a feasible technique that provides staining of several intercostal nerves with a single injection site, so it could be useful to provide analgesia to the ventral chest wall.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers

Alaman

González‐Marrón

Lorente

et al. 2021

Animals

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Alaman

Bonastre²,

González‐Marrón³

et al. 2022

Animals

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The transversus thoracis plane (TTP) block desensitizes the intercostal nerves that run through this plane, providing analgesia to the ventral thoracic wall. Two canine cadavers were used to assess the feasibility of the transverse approach for the TTP (t-TTP) under ultrasound guidance to inject a solution at the third and sixth intercostal spaces. Eight cadavers were used to compare the spread and number of intercostal nerves that were stained when a low volume (LV) 0.5 mL kg−1 or a high volume (HV) 1 mL kg−1 of a dye-lidocaine solution was injected into the same hemithorax, injecting the volume equally at these intercostal spaces using the transverse approach. Fisher’s exact test and Wilcoxon signed-rank test were used to contrast the spread of the different volume solutions. The injectate spread along the TTP after all injections, dying a median number (range) of 3 (2–5) and 6 (5–6) nerves with LV and HV, respectively (p = 0.011). The two-point injection of HV, using the t-TTP approach, is a feasible technique that provides a consistent staining from T2 to T7 intercostal nerves. The injection of HV instead of LV increases the spread and enhances the number of stained intercostal nerves.

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Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

Pérez

Martínez

Jiménez

2023

Vet Record Case Reports

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A 12‐year‐old, neutered, male, domestic shorthair cat presented for investigation of acute‐onset respiratory distress and cough. Computed tomography scan showed bilateral pleural effusion and dorsal elevation of the trachea compatible with a mass effect. A median sternotomy was performed. Anaesthetic protocol consisted of premedication with intravenous methadone (0.2 mg/kg), induction with alfaxalone to effect and maintenance with isoflurane in oxygen. Transversus thoracic muscle plane block was performed injecting 0.4 mL/kg of 0.25% bupivacaine per side. Fentanyl (2 μg/kg) was administered as rescue analgesia once during surgery. The Glasgow Composite Pain Scale was assessed postoperatively. Methadone was given as rescue analgesia postoperatively when Glasgow pain score was greater than 5/20. The first administration of methadone was required at 8 hours after the transversus thoracic muscle plane block was performed. This case showed that the ultrasound‐guided transversus thoracic muscle plane block is a feasible technique in feline patients as part of a multimodal analgesia plan in a cat undergoing sternotomy.

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Ultrasound-guided parasternal injection in dogs: a cadaver study

Cited by 8 publications

References 28 publications

Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers

Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers

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

Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

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