Description of an Ultrasound-Guided Erector Spinae Plane Block and Comparison to a Blind Proximal Paravertebral Nerve Block in Cows: A Cadaveric Study

SIMPLE SUMMARY: One of the most common surgical procedures performed in cattle is abdominal surgery, and this procedure is routinely performed in the standing adult animal. This procedure is performed using local anaesthetic techniques in order to eliminate pain and reduce the need for chemical and physical restraints. One of the most common locoregional anaesthetic techniques is the proximal paravertebral nerve block, in which a local anaesthetic is used to desensitize the nerves providing sensation to the flank region. The use of ultrasound-guided techniques has been demonstrated in multiple species, including humans, to be more accurate, safe and efficacious than traditional blind techniques. The aim of this paper was to develop an ultrasound-guided block that would target the nerves desensitized in the paravertebral nerve block of the flank. Additionally, our study aimed to evaluate the two techniques (blind and ultrasound-guided) in cow cadavers. The use of ultrasound guidance resulted in an apparent improvement in accuracy, and the blind technique remains a reliable approach. Further studies are warranted to develop and to evaluate the ultrasound-guided technique in live animals. ABSTRACT: The proximal paravertebral nerve block is commonly used to provide anaesthesia to the flank during standing surgical procedures in adult cattle. It has been reported that additional anaesthetic infiltration may be necessary to provide complete anaesthesia. In humans as well as animal species, another technique—the ultrasound (US)-guided erector spinae plane block (ESPB)—has been described. The goal of the present study was to develop and investigate an US-guided ESPB in comparison to a blind proximal paravertebral nerve block (PPNB) in cow cadavers. In 10 cadaver specimens, injections of methylene blue-lidocaine (1:1) were performed at the level of T13, L1 and L2 vertebras, on one side doing an ESPB block and, on the other side, a PPNB. Five cadavers were injected with high (40 mL per injection for PPNB and 20 mL for ESPB) and five with low (20 and 15 mL, respectively) volumes of injectate. For the ESPB, the ultrasound probe was oriented craniocaudally, and the ventral-cranial aspect of the articular processes (T13, L1 and L2) was targeted for injection. The dye spreading was evaluated by dissection. The landmarks for US-guided injection were easily visualized; however, injections were accidentally performed at T12, T13 and L1. Nevertheless, L2 was stained in 60% of ESPBs. Epidural spreading was observed with both techniques and all volumes. Viscera puncture was reported in two PPNBs. The ESPB resulted in similar nerve staining compared to the PPNB while using a lower volume of injectate. Even better staining is expected with a T13-L2 instead of a T12-L1 ESPB approach. Further studies are warranted to evaluate the clinical efficacy.