Ultrasound-guided caudal quadratus lumborum block combined with the greater ischiatic notch plane block as motor-protective analgesia for the pelvic limb in dogs.

Abstract

OBJECTIVE: To develop an ultrasound-guided caudal quadratus lumborum block (C-QLB) technique in canine cadavers and to compare sensory and motor blockade resulting from the combination of ultrasound-guided greater ischiatic notch (GIN) plane and C-QLB approaches (GIN-CQLB group) versus a lumbosacral plexus (LSP group) approach [combination of lateral pre-iliac (LPI) and parasacral (PS) techniques] in dogs. STUDY DESIGN: Descriptive anatomical study and prospective randomized, blinded, experimental crossover trial. ANIMALS: A total of six canine cadavers and six adult Beagle dogs. METHODS: Phase I: following ultrasound-guided C-QLB injections of 0.3 mL kgof dye, using the interfascial plane located lateral to the quadratus lumborum muscle at the level of the sixth lumbar vertebra (L6) as injection point, the spread of injectate and nerve staining was evaluated using gross anatomical dissection. PHASE II: sensory and motor blockade achieved with the GIN-CQLB or LSP blocks in Beagle dogs were evaluated and compared. The assigned technique was performed with 2% lidocaine: 0.2 mL kgfor the GIN and PS approaches and 0.3 mL kgfor the C-QLB and LPI approaches. RESULTS: Dissection revealed distribution of dye around the lumbar hypaxial musculature, extending into the paravertebral spaces, with staining of 3 (2-4) [median (interquartile range)] spinal nerves, spanning L3 to L6. The median motor blockade in the GIN-CQLB and LSP groups was 7 (7-8) versus 16 (10-16) (p = 0.026), whereas the median sensory blockade was 5 (4-5) versus 3 (3-3) (p = 0.025), respectively. CONCLUSION AND CLINICAL SIGNIFICANCE: The GIN-CQLB approach desensitized the thigh dermatomes effectively. Compared with the LSP approaches, GIN-CQLB exhibits a motor-protective effect by preserving tonic muscle function.