Accuracy of two ventral approaches to block the femoral nerve in the Dog

Echeverry DF1, Laredo F2, Belda E2, Soler M2, Gil F2, Agut A2
Faculty of Veterinary Medicine and Zootechnic. Tolima University (Colombia)1 Veterinary Faculty. Murcia University (Spain)2

1. Objective:
To evaluate the accuracy of 2 ultrasound-guided approaches to locate the femoral nerve (FN) in the dog

The femoral triangle approach (Fta) The suprainguinal approach (SIa)

The ultrasonographic characteristics of the FN were also evaluated

2. Materials & Methods:

The accuracy of the nerve location was confirmad by nerve stimulation

N=5

Fta: Position of the transducer (linear 13 MHz) and the needle.

Once the FN was located

*
Sedation: medetomidine (10g/kg) & butorphanol (0.25 mg/kg) IM

0.2 mL kg-1 of saline was injected around the nerve To evaluate The injectate distribution pattern

0.5 mA;2Hz;0.1 ms Positive response Extension of the stifle

SIa: Position of the transducer (linear 13 MHz) and the needle. *resting period beetwen treatments 8 days
A
2

3. Results:

ventral

ventral
2

3 3 1 3

lateral

lateral

Figure 1. (A) ultrasonographic image correspondig to the ventral FTa. (B) Ultrasonographic image after the blocks. 1. femoral nerve; 2. femoral artery; 3. local anaesthetic.
ventral
2 1 3 2 4 4 5 1 5 5 2

ventral

lateral

lateral

Figure 2. (A) ultrasonographic image correspondig to the SIa. (B) Ultrasonographic image after the blocks. 1. femoral nerve; 2. iliopsoas muscle; 3. ilion; 4. needle. 5. local anaesthetic surronding the FN. Table1. Comparative study of the ultrasonographycal features beetwen the femoral triangle and suprainguinal approaches

Features Size of the Acoustic window Visualization of the nerve during the blocks Visualization of the needle during procedure Distribution pattern of the injectate (saline) Technical difficulty to perform the blocks Proximity to vascular structures Ultrasonographic appearence of the FN
Accuracy of the approach to locate the femoral nerve Use of the neurolocation to locate the target nerve

Femoral triangle approach Small Scarce Scarce Irregular (in several planes under the femoral artery) High Close to the femoral artery Hyperechoic triangular structure 60% 40%

Suprainguinal approach Wide Adequate (permanent) Adequate (permenent) Around of the femoral nerve (donnut sign) Low Far from vascular structures Hypoechoic oval to rounded structure 100% 0%

3. Conclussion:
The SIa seems to be an easier and more efficient technique to locate the FN in comparison to the FTa. The use of nervestimulation as a complementary technique of nerve location appears to be essential when locating the FN by a FTa.
References:
1. Campoy L, Bezuidenhout AJ, Gleed RD, et al: Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs. Vet Anaesth Analg 2010; 37(2):144-53. 2. Echeverry DF, Gil F, Laredo F, et al: Ultrasound-guided block of the sciatic and femoral nerves in dogs: a descriptive study. Vet J 2010; 186(2):210-5.