The effect of epidural injection speed on epidural pressure and distribution of solution in anesthetized dogs

ObjectiveTo determine the effect of injection speed on epidural pressure (EP), injection pressure (IP), epidural distribution (ED) of solution, and extent of sensory blockade (SB) during lumbosacral epidural anesthesia in dogs.Study designProspective experimental trial.AnimalsTen healthy adult Beagle dogs weighing 8.7 ± 1.6 kg.MethodsGeneral anesthesia was induced with propofol administered intravenously and maintained with isoflurane. Keeping the dogs in sternal recumbency, two spinal needles connected to electrical pressure transducers were inserted into the L6-L7 and the L7-S1 intervertebral epidural spaces for EP and IP measurements, respectively. Bupivacaine 0.5% diluted in iohexol was administered epidurally to each dog via spinal needle at L7-S1 intervertebral space, at two rates of injection (1 and 2 mL minute^?1 groups), with a 1-week washout period. Epidural distribution was verified with computed tomography, and SB was evaluated after arousal by pinching the skin with a mosquito hemostatic forceps over the vertebral dermatomes. The results were analyzed according to each injection speed, using paired t- and Wilcoxon signed-rank tests.ResultsMean ± SD of baseline EP and IP values were 2.1 ± 6.1 and 2.6 ± 7.1 mmHg, respectively. Significant differences were observed between 1 and 2 mL minute^?1 groups for peak EP (23.1 ± 8.5 and 35.0 ± 14.5 mmHg, p = 0.047) and peak IP (68.5 ± 10.7 and 144.7 ± 32.6 mmHg, p <0.001). However, the median (range) of the ED, 11.5 (4–22) and 12 (5–21) vertebrae, and SB, 3.5 (0–20) and 1 (0–20) dermatomes, values of the two groups were not related to injection speed.Conclusions and clinical relevanceThe EP profile during injection was measured by separating the injection and pressure monitoring lines. The increase in epidural injection speed increased the EP, but not the ED or the SB in dogs.     

Epidural spread of iohexol following the use of air or saline in the 'loss of resistance' test

ObjectiveTo compare, using CT epidurography, the cranial distribution of contrast after epidural injection when saline or air is used for the loss of resistance (LOR) technique in identifying the epidural space.Study designProspective, randomized, cross-over experimental study.AnimalsNine healthy adult Beagle dogs.MethodsUnder general anaesthesia, a spinal needle (22-gauge, 70 mm) was inserted through the lumbosacral space, and the position in the epidural space confirmed using the LOR technique employing either 0.3 mL per dog of saline or of air. Epidurography using CT was performed before and 5, 10 and 20 minutes after epidural injection of 0.2 mL kg^?1 of iohexol. The cranial distribution of iohexol was recorded as the number of vertebral segments reached from the seventh lumbar vertebrae.ResultsThe median values in vertebral segments of the cranial distribution at 5, 10 and 20 minutes after epidural injection were 19.5, 20.5 and 21.0 respectively with the saline treatment, and 12.0, 15.0 and 16.0 respectively in the air treatment. At all time points spread of contrast was significantly less with the air treatment. All dogs after air treatment had some air bubbles in the epidural space, and in seven, the spinal cord was moderately compressed by the air. No neurological complications were observed after recovery.Conclusions and clinical relevanceThe use of air for the LOR technique is associated with significantly less spread, uneven cranial distribution of the contrast medium and compression of the spinal cord. It is recommended that saline, and not air, should be used to identify the epidural space by this method.     

Evaluation of analgesic and physiologic effects of epidural morphine administered at a thoracic or lumbar level in dogs undergoing thoracotomy

ObjectiveTo evaluate the analgesic and physiological effects of epidural morphine administered at the sixth and seventh lumbar or the fifth and sixth thoracic vertebrae in dogs undergoing thoracotomy.Study designProspective, randomized, blinded trial.AnimalsFourteen mixed-breed dogs, weighing 8.6 ± 1.4 kg.MethodsThe animals received acepromazine (0.1 mg kg^?1) IM and anesthesia was induced with propofol (4 mg kg^?1) IV. The lumbosacral space was punctured and an epidural catheter was inserted up to the region between the sixth and seventh lumbar vertebrae (L, n = 6) or up to the fifth or sixth intercostal space (T, n = 8). The dogs were allowed to recover and after radiographic confirmation of correct catheter position, anesthesia was reinduced with propofol IV and maintained with 1.7% isoflurane. Following stabilization of monitored parameters, animals received morphine (0.1 mg kg^?1) diluted in 0.9% NaCl to a final volume of 0.25 mL kg^?1 via the epidural catheter, and after 40 minutes, thoracotomy was initiated. Heart rate and rhythm, systolic, mean and diastolic arterial pressures, respiratory rate, arterial hemoglobin oxygen saturation, partial pressure of expired CO₂ and body temperature were measured immediately before the epidural administration of morphine (0 minute) and every 10 minutes during the anesthetic period. The Melbourne pain scale and the visual analog scale were used to assess post-operative pain. The evaluation began 3 hours after the epidural administration of morphine and occurred each hour until rescue analgesia.ResultsThere were no important variations in the physiological parameters during the anesthetic period. The post-operative analgesic period differed between the groups, being longer in T (9.9 ± 1.6 hours) compared with L (5.8 ± 0.8 hours).ConclusionsThe use of morphine, at a volume of 0.25 mL kg^?1, administered epidurally over the thoracic vertebrae provided longer lasting analgesia than when deposited over the lumbar vertebrae.Clinical relevanceThe deposition of epidural morphine provided longer lasting analgesia when administered near to the innervation of the injured tissue without increasing side effects.     

Distribution of new methylene blue injected into the dorsolumbar epidural space in cows

Objective To describe the effect of injection volume and anatomy on the spread of new methylene blue (NMB) injected into the epidural space between the first and second lumbar vertebrae in cows. Study Design Prospective experimental study. Sample Population Thirteen nonpregnant cows. Methods Cows were randomly assigned to two groups. Group 1 received 5 mL and Group 2 received 10 mL of 0.12% NMB in 0.9% saline. The injection was made into the first interlumbar epidural space using a dorsal approach. The extent of cranial and caudal migration of the dye, as manifested by the staining of the epidural fat and dura mater, was measured. Results Mean ± SEM number (range) of stained vertebrae was significantly greater in the 10‐mL group than in the 5‐mL group, 4.4 ± 0.6 (T11 to L5) and 3.0 ± 0.2 (T12 to L3), respectively (p < 0.05). Linear regression analysis showed that the volume was significantly correlated with the number of stained vertebrae (R² = 0.42, p = 0.016). In the dorsal and lateral aspect of the spinal cord, there were two types of distribution of NMB along the surface of the epidural fat: between the periosteum and epidural fat; and between the epidural fat and dura mater. Migration under the spinal cord occurred along the two longitudinal epidural veins. Conclusions and Clinical Relevance The larger the volume of solution injected into the first interlumbar epidural space, the greater the spread. Intrinsic anatomic factors, such as characteristics of epidural fat and veins, influence the epidural spread of injected solution and, consequently, epidural analgesia.     

Cranial epidural spread of contrast medium and new methylene blue dye in sternally recumbent anaesthetized dogs

ObjectiveTo examine the spread of solution in the epidural space of sternally recumbent dogs.Study designProspective experimental trial.AnimalsTen healthy adult Beagle dogs weighing 7.6 ± 1.1 kg.MethodsDogs were anaesthetized with total intravenous propofol infusion, and placed in sternal recumbency. A volume of 0.2 mL kg^?1 contrast medium (CM) containing 1% new methylene blue (MB) dye was administered into the lumbosacral epidural space. Left to right lateral radiographs using a horizontal beam were taken every 5 minutes for 45 minutes. The perpendicular height (PH) between floor of the epidural canal of the highest vertebra and that of lumbosacral spinal canal was measured on radiographs. The angle of slope from the injection point toward the highest vertebral floor was measured. Immediately after taking the last radiographic image, dogs were euthanized and a laminectomy was performed from the cervical to lumbar vertebrae for visual evaluation of MB spread. The spread of CM and of MB as counted in number of stained vertebra were compared, and each of these data sets were further compared to PH and angle, using linear regression analyses.ResultsThe PH and angle were (mean ± SD) 3.8 ± 0.8 cm and 14.8 ± 2.8° respectively. The most cranial spread of CM was at 12.7 ± 5.7 (range: C6–L3) vertebrae, and at 14.0 ± 5.4 (range: C6–L2) vertebrae for MB staining. There were no significant correlations between PH and spread of CM (R² = 0.08) or MB (R² = 0.13), between angle and spread of CM (R² = 0.05) or MB (R² = 0.02), respectively. CM and MB demonstrated proportional relationship (R² = 0.82, p < 0.001).ConclusionsNo significant inhibitory effect of upward slope on cranial epidural spread of the solution was observed. Other factors may have greater effect on epidural spread in sternally recumbent dogs.     

Use of electrical nerve stimulation to monitor lumbosacral epidural needle placement in cats

ObjectiveTo determine the minimal electrical threshold (MET) necessary to elicit muscle contraction of the pelvic limb or tail when an insulated needle is positioned outside (MET_out) and inside (MET_in) the lumbosacral epidural space in cats.Study designProspective, blinded study.AnimalsTwelve mixed-breed healthy adult cats, scheduled for a therapeutic procedure where lumbosacral epidural administration was indicated.MethodsUnder general anesthesia, an insulated needle was advanced through tissues of the lumbosacral interspace until its tip was thought to be just dorsal to the interarcuate ligament. An increasing electrical current (0.1 ms, 2 Hz) was applied through the stimulating needle in order to determine the MET necessary to obtain a muscle contraction of the pelvic limb or tail (MET_out), and then 0.05 mL kg^?1 of iohexol was injected. The needle was further advanced until its tip was thought to be in the epidural space. The MET was determined again (MET_in) and 0.2 mL kg^?1 of iohexol was injected. The cats were maintained in sternal position. Contrast medium spread was determined through lateral radiographic projections.ResultsThe radiographic study confirmed the correct needle placement dorsal to the interarcuate ligament in all cats. When the needle was placed ventrally to the interarcuate ligament, iohexol was injected epidurally in ten and intrathecally in two cats. The MET_out and MET_in was 1.76 ± 0.34 mA and 0.34 ± 0.07 mA, respectively (p < 0.0001).Conclusion and clinical relevanceNerve stimulation can be employed as a tool to determine penetration of the interarcuate ligament but not the piercing of the dura mater at the lumbosacral space in cats.     

Evaluation of an automatic approach device to the epidural space of Beagle dogs

ObjectiveTo compare the epidural anesthesia device (EPIA), which facilitates an automatic approach to location of the epidural space, with the performance of clinicians using tactile sensation and differences in pressure when inserting an epidural needle into the epidural space of a dog.Study designProspective, crossover experiment.AnimalsA total of 14 Beagle dogs weighing 7.5 ± 2.4 kg (mean ± standard deviation).MethodsEach dog was anesthetized three times at 2 week intervals for three anesthesiologists (two experienced, one novice) to perform 14 epidural injections (seven manual and EPIA device each). The sequence of methods was assigned randomly for each anesthesiologist. The dogs were anesthetized with medetomidine (10 μg kg^–1), alfaxalone (2 mg kg^–1) and isoflurane and positioned in sternal recumbency with the pelvic limbs extended cranially. Epidural puncture in the manual method was determined by pop sensation, hanging drop technique and reduced injection pressure, whereas using the device a sudden decrease in reaction force on the device was detected. A C-arm identified needle placement in the epidural space, and after administration of iohexol (0.3 mL), the needle length in the epidural space was defined as the mean value measured by three radiologists. Normality was tested using the Kolmogorov–Smirnov test, and significant differences between the two methods were analyzed using an independent sample t test.ResultsIn both methods, the success rates of epidural insertion were the same at 95.2%. The length of the needle in the epidural space using the device and manual methods was 1.59 ± 0.50 and 1.68 ± 0.88 mm, respectively, with no significant difference (p = 0.718).Conclusions and clinical relevanceEPIA device was comparable to human tactile sense for an epidural needle insertion in Beagle dogs. Further research should be conducted for application of the device in clinical environments.     

Bupivacaine 0.25% and methylene blue spread with epidural anesthesia in dog

ObjectiveTo evaluate the extent sensory and motor blocks produced by the epidural injection of different volumes of 0.25% bupivacaine (Bu) with methylene blue (MB), in dogs.Study designProspective experimental trial.AnimalsTwenty healthy adult mongrel dogs, weighing 9.9 ± 1.9 kg.MethodsDogs were randomly allocated into one of four groups that received 0.2, 0.4, 0.6 or 0.8 mL kg^?1 of an epidural solution containing 0.25% Bu and MB. Sensory block was evaluated against time by pinching the tail, hind limb interdigital web, toenail bases and the skin over the vertebral dermatomes. Motor block was assessed by ataxia, hind limb weight-bearing ability and by loss of muscle tone of the tail and pelvic limbs. Data were collected at 2, 5, 10, 15 and 30 minutes after the end of epidural injection. After the final time point, dogs were euthanatized and laminectomies were conducted to expose the extent of the dural dye staining.ResultsThe volumes 0.2, 0.4, 0.6 and 0.8 mL kg^?1 of 0.25% Bu and MB blocked a mean of 5, 14.2, 20.2 and 21 dermatomes, respectively. The extent of the senory block increased up to a volume of 0.6 mL kg^?1. Motor block was longer-lasting and more intense than sensory block. Complete dyeing of the spinal cord with MB was achieved in some dogs at 0.4 mL kg^?1 and all dogs at 0.6 mL kg^?1.ConclusionsThe volume of anesthetic injected into the epidural space plays an important role in the quality of the epidural anesthesia. At 0.25%, bupivacaine provided an efficient sensory block at 0.6 mL kg^?1.Clinical relevanceRelatively high volumes (0.6 mL kg^?1) of 0.25%, BU and MB were needed to produce an effective sensory and motor block caudal to the umbilicus, but all spinal cord segments were reached by MB at this dose.     

The use of electrical stimulation to guide epidural and intrathecal needle advancement at the L5‐L6 intervertebral space in dogs

ObjectiveTo determine the minimal electrical threshold (MET) necessary to elicit appropriate muscle contraction when the tip of an insulated needle is positioned epidurally or intrathecally at the L_5-6 intervertebral space (phase-I) and to determine whether the application of a fixed electrical current during its advancement could indicate needle entry into the intrathecal space (phase-II) in dogs.Study designProspective, blinded study.AnimalsThirteen (phase-I) and seventeen (phase-II) dogs, scheduled for a surgical procedure where L_5-6 intrathecal administration was indicated.MethodsUnder general anesthesia, an insulated needle was first inserted into the L_5-6 epidural space and secondly into the intrathecal space and the MET necessary to obtain a muscular contraction of the pelvic limb or tail at each site was determined (phase-I). Under similar conditions, in dogs of phase-II an insulated needle was inserted through the L_5-6 intervertebral space guided by the use of a fixed electrical current (0.8 mA) until muscular contraction of the pelvic limb or tail was obtained. Intrathecal needle placement was confirmed by either free flow of cerebrospinal fluid (CSF) or myelography.ResultsThe current required to elicit a motor response was significantly lower (p < 0.0001) when the tip of the needle was in the intrathecal space (0.48 ± 0.10 mA) than when it was located epidurally (2.56 ± 0.57). The use of a fixed electrical stimulation current of 0.8 mA resulted in correct prediction of intrathecal injection, corroborated by either free flow of CSF (n = 12) or iohexol distribution pattern (n = 5), in 100% of the cases.Conclusion and clinical relevanceNerve stimulation may be employed as a tool to distinguish epidural from intrathecal insulated needle position at the L_5-6 intervertebral space in dogs. This study demonstrates the feasibility of using an electrical stimulation test to confirm intrathecal needle position in dogs.     

Distribution of new methylene blue injected into the lumbosacral epidural space in cats

OBJECTIVE: To determine the effects of injection volume and vertebral anatomy on the spread of new methylene blue (NMB) injected into the lumbosacral epidural space in cats. STUDY DESIGN: Prospective experimental study. SAMPLE POPULATION: Sixteen cats. METHODS: Cats were randomly assigned to four groups and received from 0.1 to 0.4 mL kg(-1) of 0.12% NMB in 0.9% saline. Injection was made into the lumbosacral epidural space using a dorsal approach with the cats in sternal recumbency. The extent of cranial migration of the dye as indicated by the staining of epidural fat and dura mater was measured. RESULTS: The mean +/- SD (range) number of stained vertebrae in the 0.3 and 0.4 mL kg(-1) groups, were 11.5 +/- 1.5 (T7-T11) and 12.4 +/- 1.8 (T6-T10), respectively. This was significantly greater than the number in the 0.1 and 0.2 mL kg(-1) groups, 4.3 +/- 0.6 (L3-L4) and 6.0 +/- 0.7 (L1-L2) vertebrae, respectively (p < 0.001). Linear regression analysis showed that the volume injected correlated significantly with the number of stained vertebrae (R2 = 0.83, p < 0.001). In the dorsal and lateral aspect of the spinal cord, NMB solution distributed between epidural fat and dura mater. Migration under the spinal cord occurred along the two longitudinal epidural veins. CONCLUSIONS AND CLINICAL RELEVANCE: The larger the volume of solution injected into the lumbosacral epidural space in cats, the greater the spread.     

The use of a nerve stimulation test to confirm sacrococcygeal epidural needle placement in cats

ObjectiveTo determine if a nerve stimulation test (NST) could act as a monitoring technique to confirm sacrococcygeal epidural needle placement in cats.Study designProspective experimental trial in a clinical setting.AnimalsTwenty-four adult cats, scheduled for a therapeutic procedure where epidural anesthesia was indicated.MethodsUnder general anesthesia, an insulated needle was inserted through the S₃-Cd₁ intervertebral space guided by the application of a fixed electrical current (0.7 mA) until a motor response was obtained. The NST was considered positive when the epidural nerve stimulation produced a motor response of the muscles of the tail, whereas it was considered negative when no motor response was evoked. In the NST positive cases, 0.3 mL kg⁻¹ of 0.5% bupivacaine was administrated before needle withdrawal. Ten minutes after injection, epidural blockade was confirmed by the loss of perineal (anal), and pelvic limbs reflexes (patellar and withdrawal).ResultsThe use of a fixed electrical stimulation current of 0.7 mA resulted in correct prediction of sacrococcygeal epidural injection, corroborated by post bupivacaine loss of perineal and pelvic limb reflexes, in 95.8% of the cases.Conclusion and clinical relevanceThis study demonstrates the feasibility of using, in a clinical setting, an electrical stimulation test as an objective and in real-time method to confirm sacrococcygeal epidural needle placement in cats.     

Effect of phentolamine mesylate on regression of lidocaine–epinephrine epidural anaesthesia in sheep

ObjectiveTo determine the impact of epidural phentolamine on the duration of anaesthesia following epidural injection of lidocaine–epinephrine.Study designBlinded randomized experimental study.AnimalsA group of 12 adult ewes weighing 25.7 ± 2.3 kg and aged 8–9 months.MethodsAll sheep were administered epidural lidocaine (approximately 4 mg kg^–1) and epinephrine (5 μg mL^–1). Of these, six sheep were randomized into three epidural treatments, separated by 1 week, administered 30 minutes after lidocaine–epinephrine: SAL: normal saline, PHE1: phentolamine (1 mg) and PHE2: phentolamine (2 mg). The other six sheep were administered only epidural lidocaine–epinephrine: treatment LIDEP. Each injection was corrected to 5 mL using 0.9% saline. Noxious stimuli were pinpricks with a hypodermic needle and skin pinch with haemostatic forceps to determine the onset and duration of sensory and motor block. Heart rate, noninvasive mean arterial pressure (MAP), respiratory rate and rectal temperature were recorded.ResultsThe onset times were not different among treatments. Duration of sensory block was significantly shorter in SAL (57.5 ± 6.2 minutes), PHE1 (60.7 ± 9.0 minutes) and PHE2 (62.0 ± 6.7 minutes) than in LIDEP (81.7 ± 13.4 minutes) (p < 0.05). Duration of motor blockade was significantly shorter in PHE1 (59.4 ± 5.4 minutes) and PHE2 (54.3 ± 4.0 minutes) than in SAL (84.8 ± 7.0 minutes) and LIDEP (91.5 ± 18.2 minutes) (p < 0.01). MAP in PHE2 was decreased at 10 minutes after administration of phentolamine (p < 0.05).Conclusion and clinical relevanceEpidural administration of 5 mL normal saline after epidural injection of lidocaine–epinephrine reduced the duration of sensory but not motor block in sheep. Epidural administration of phentolamine diluted to the final volume of 5 mL diminished both the duration of sensory and motor block in sheep administered epidural lidocaine–epinephrine.     

Endoscopic anatomy of the cervical vertebral canal in the horse: a cadaver study

Reason for performing study: Localisation of spinal cord compression in horses with cervical vertebral stenotic myelopathy is inexact. Vertebral canal endoscopy has been used in man to localise spinal cord lesions and has the potential to become a useful diagnostic technique in horses. Objective: To establish a surgical approach via the atlanto‐occipital space to the cervical vertebral canal in equine cadavers and describe the endoscopic anatomy of the cervical epidural and subarachnoid spaces. Methods: The cadavers of 25 mature horses were used to assess 3 surgical methods to approach the cervical vertebral canal, including 2 minimally invasive and one open technique. Once the approach had been made, a flexible videoendoscope was inserted into the epidural space (epiduroscopy) or the subarachnoid space (myeloscopy) and advanced caudally until the intervertebral space between C7 and T1 was reached. Results: The epidural and subarachnoid spaces could not be accessed reliably using the minimally invasive techniques. Furthermore, damage to the nervous tissues was a frequent complication with these procedures. The open approach allowed successful insertion of the videoendoscope into the epidural and subarachnoid spaces in all horses and no inadvertent damage was observed. Anatomical structures that could be seen in the epidural space included the dura mater, nerve roots, fat and the ventral internal vertebral venous plexus. In the subarachnoid space, the spinal cord, nerve roots, blood vessels, denticulate ligaments and external branch of the accessory nerve were seen. Conclusions: Using the open approach, epiduroscopy and myeloscopy over the entire length of the cervical vertebral canal are possible in the mature horse. Potential relevance: Cervical vertebral canal endoscopy may become a valuable tool to localise the site of spinal cord injury in horses with cervical vertebral stenotic myelopathy and could aid in the diagnosis of other diseases of the cervical spinal cord.     

Analgesic, hemodynamic and respiratory effects of caudal epidurally administered ropivacaine hydrochloride in mares

Objective To determine the analgesic, hemodynamic and respiratory effects, sedation and ataxia in mares of caudal epidural administration of ropivacaine hydrochloride solution. Study design Prospective, single‐dose trial. Animals Ten healthy mares weighing from 475 to 565 kg. Methods Intravascular catheters and an epidural needle were placed after infiltration of the skin and subcutaneous tissues with 2% lidocaine. Ropivacaine (0.5%, 8 or 9 mL) was then injected epidurally at the fifth sacral or sacrococcygeal vertebrae, respectively. Analgesia was determined by lack of sensory perception to electrical stimulation (> 40 milliamps) and absence of response to needle pricks extending from coccyx to S2 dermatomes. Electrocardiogram, heart and respiratory rates, rectal temperature, arterial blood pressure, arterial acid‐base (pH, standard bicarbonate and base excess), gas tensions (PO₂, PCO₂), PCV, oxyhemoglobin and total solids concentrations, and numerical scores of perineal analgesia, sedation (head drop), and ataxia (position of pelvic limbs) were determined before and during a 5‐hour testing period. Analysis of variance (anova ) with repeated measures was used to detect significant (p < 0.05) differences of mean values from baseline. Results Epidurally administered ropivacaine induced variable analgesia extending bilaterally from coccyx to S2 (three mares), coccyx to S3 (four mares), and coccyx to S4 (three mares), with minimal sedation, ataxia, and cardiovascular and respiratory disturbances of mares. Perineal analgesia was attained at 10 ± 4 minutes and lasted for 196 ±42 minutes (mean ± SD). Five mares demonstrated inadequate perineal analgesia, probably attributable to deviation of the spinal needle from the midline. They were successfully blocked with ropivacaine on another occasion. Epidural ropivacaine significantly reduced repiratory rates of mares and did not change other variables from baseline. Conclusions and clinical relevance Ropivacaine (0.5%, 8 mL 500 kg^?1) can be administered caudal epidurally to produce prolonged (> 2.5 hours) bilateral perineal analgesia with minimal sedation, ataxia, and circulatory and respiratory disturbances in standing mares.     

FEASIBILITY OF ULTRASOUND‐GUIDED EPIDURAL ACCESS AT THE LUMBO‐SACRAL SPACE IN DOGS

Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound‐guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound‐guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid‐shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal–caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound‐guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.     

Effect of epidural and intravenous use of the neurokinin-1 (NK-1) receptor antagonist maropitant on the sevoflurane minimum alveolar concentration (MAC) in dogs

ObjectiveTo determine the effect of maropitant, an NK-1 receptor antagonist on the minimum alveolar concentration (MAC) of sevoflurane after intravenous and epidural administration to dogs.Study designProspective experimental study.AnimalsSeven, adult, spayed-female dogs (24.8 ± 1.9 kg).MethodsEach dog was anesthetized twice with sevoflurane in oxygen, with at least 10 days separating the anesthetic events. The minimum alveolar concentration (MAC) of sevoflurane was determined using the tail-clamp technique. During the first anesthetic event, the MAC of sevoflurane was determined initially and again after intravenous administration of maropitant (5 mg kg^?1) and an infusion (150 μg kg^?1 hour^?1). During the second anesthetic event, an epidural catheter was advanced to the 4th lumbar vertebra and MAC was determined after administration of saline and maropitant (1 mg kg^?1) epidurally. All MAC determinations were done in duplicate. The MAC values were adjusted to sea level and compared using student's t-test.ResultsThe baseline MAC for sevoflurane was 2.08 ± 0.25%. Intravenous maropitant decreased (p < 0.05) MAC by 16% (1.74 ± 0.17%). In contrast, epidural administration of either saline or maropitant did not change (p > 0.05) the MAC (2.17 ± 0.34% and 1.92 ± 0.12%, respectively).Conclusion and clinical relevanceMaropitant decreased the MAC of sevoflurane when administered intravenously to dogs but not after epidural administration.     

Comparison of feasibility and safety of epidural catheterization between cranial and caudal lumbar vertebral segments in dogs

To compare the technical difficulty and safety of epidural catheterization between cranial and caudal lumbar region, thirteen dogs were randomly assigned to a cranial lumbar group (group CraL, n=6) or a caudal lumbar group (group CauL, n=6) depending on different epidural sites, and one dog was used as a negative control without catheterization. After general anesthesia, an epidural catheter was advanced 10 cm cranially from the interspace of L1-L2 in group CraL or from lumbosacral space in group CauL. Dogs were euthanized and catheter position and tip location were confirmed by laminectomy. Spinal cord samples were examined by macro- and microscopic observations. Success rate, time taken for epidural space confirmation and catheter insertion were compared, and overall technical difficulty was evaluated subjectively. Epidural catheter was inserted successfully in all dogs. Time needed from needle skin puncture to catheter placement and saline injection was 226 ± 63 and 229 ± 26 sec in groups CraL and CauL without significant differences. Three dogs in group CraL suffered subcutaneous blood, but no spinal cord injuries were found. Subjective evaluation score of the overall technical difficulty was slightly but significantly higher in group CraL than in group CauL (P=0.009). Epidural catheterization in cranial lumbar region could be performed as feasible and safe as that at the caudal lumbar vertebral region in medium or large dogs.     

Cardiovascular effects following epidural injection of romifidine in isoflurane‐anaesthetized dogs

ObjectiveTo investigate the cardiovascular effects of epidural romifidine in isoflurane-anaesthetized dogs.Study designProspective, randomized, blinded experiment.AnimalsA total of six healthy adult female Beagles aged 1.25 ± 0.08 years and weighing 12.46 ± 1.48 (10.25–14.50) kg.MethodsAnaesthesia was induced with propofol (6–9 mg kg^?1) and maintained with 1.8–1.9% end-tidal isoflurane in oxygen. End-tidal CO₂ was kept between 35 and 45 mmHg (4.7–6.0 kPa) using intermittent positive pressure ventilation. Heart rate (HR), arterial blood pressure and cardiac output (CO) were monitored. Cardiac output was determined using a LiDCO monitor and the derived parameters were calculated. After baseline measurements, either 10 μg kg^?1 romifidine or saline (total volume 1 mL 4.5 kg^?1) was injected into the lumbosacral epidural space. Data were recorded for 1 hour after epidural injection. A minimum of 1 week elapsed between treatments.ResultsAfter epidural injection, the overall means (± standard deviation, SD) of HR (95 ± 20 bpm), mean arterial blood pressure (MAP) (81 ± 19 mmHg), CO (1.63 ± 0.66 L minute^?1), cardiac index (CI) (2.97 ± 1.1 L minute^?1 m^?2) and stroke volume index (SI) (1.38 ± 0.21 mL beat^?1 kg^?1) were significantly lower in the romifidine treatment compared with the overall means in the saline treatment [HR (129 ± 24 bpm), MAP (89 ± 17 mmHg), CO (3.35 ± 0.86 L minute^?1), CI (6.17 ± 1.4 L minute^?1 m^?2) and SI (2.21 ± 0.21 mL beat^?1 kg^?1)]. The overall mean of systemic vascular resistance index (SVRI) (7202 ± 2656 dynes seconds cm^?5 m^?2) after epidural romifidine injection was significantly higher than the overall mean of SVRI (3315 ± 1167 dynes seconds cm^?5 m^?2) after epidural saline injection.ConclusionEpidural romifidine in isoflurane-anaesthetized dogs caused significant cardiovascular effects similar to those reportedly produced by systemic romifidine administration.Clinical relevanceSimilar cardiovascular monitoring is required after epidural and systemically administered romifidine. Further studies are required to evaluate the analgesic effects of epidural romifidine.     

IMAGING DIAGNOSIS—SPINAL EPIDURAL HEMANGIOSARCOMA IN A DOG

An 8‐year‐old, male Boxer was examined for an acute onset of ambulatory paraparesis. Neurologic examination was consistent with a T3‐L3 myelopathy. Myelography revealed an extradural spinal cord compression in the region of the T10‐T13 vertebrae. On magnetic resonance (MR) imaging, a well‐defined epidural mass lesion was detected. The mass was mildly hyperintense on T1‐weighted, hyperintense on T2‐weighted and STIR images compared to normal spinal cord and enhanced strongly and homogenously. Postmortem examination confirmed a primary epidural hemangiosarcoma. Findings indicated that the MRI characteristics of spinal epidural hemangiosarcoma may mimic other lesions including meningioma and epidural hemorrhages/hematomas of non‐neoplastic etiology.     

The volume effect of lidocaine on thoracic epidural anesthesia in conscious Beagle dogs

ObjectiveTo evaluate the volume effect of local anesthetic solution on thoracic epidural analgesia in dogs.Study designProspective, experimental trial.AnimalsFive healthy adult Beagle dogs weighing 9.7 ± 1.3 kg.MethodsA catheter was inserted into the seventh thoracic epidural space using a lumbosacral approach, and secured with suture under total intravenous (IV) anesthesia with propofol. Each dog was administered four volume treatments (0.05, 0.10, 0.15 and 0.20 mL kg⁻¹) of 2% lidocaine via the catheter at 12 hour intervals. In every treatment, dogs were re-anesthetized with propofol (6 mg kg⁻¹, IV) and isoflurane, and received iohexol at each volume to visualize the epidural distribution (ED) through computed tomography. Three hours after epidurography, when dogs had recovered from anesthesia, the appropriate volume of lidocaine was injected through the catheter, and sensory blockade (SB) in dermatomes was evaluated by pinching with a mosquito forceps. Results were presented as median (range), and the volume effect on ED and SB was analyzed with one-way Kruskal–Wallis anova.ResultsIn proportion to volumes (0.05, 0.10, 0.15 and 0.20 mL kg⁻¹), there were significant increases in the extent of ED from 7.4 (5.5–9.0) to 10.4 (8.0–12.0), 13.2 (12.5–13.0), and 15.2 (13.0–18.0) vertebrae, respectively, p < 0.001, and in SB from 2.7 (1.0–5.0) to 6.8 (4.5–10.5), 9.9 (6.5–13.0), and 13.1 (11.0–15.0) dermatomes, respectively, p < 0.001. Unilateral ED and SB were observed in all treatments with various grades, and this distribution was more frequent in the low volume treatments. In the high volume treatments, temporary complications including Horner's syndrome, ataxia, paraplegia, depression, stupor, and intermittent cough occurred often.Conclusions and clinical relevanceThe increase in volume of local anesthetic solution improved SB by resulting in more consistent bilateral dermatome blockade as well as an extended blockade. However, caution should be exerted, as higher volume injections of lidocaine caused side effects in all dogs.