RU2324430C2 - Method of paraaortic blockage of splanchnic and internesenterical nervous in dogs, cats and fur-bearing animals of cage-keeping - Google Patents

Abstract

FIELD: medicine; veterinary.

SUBSTANCE: method consists in injection of anesthetic into the localisation of components of the abdominal aortal plexus, following the large laparotomy in treatment-and-diagnostic surgery of abdominal organs. The operational access to the vegetative conductors is performed by injecting the needle below the parietal peritoneal leaf of the dorsal abdominal wall along the body midline in the area of mesenterial root, at the level of 2-3 lumbar vertebras. Needle is injected at 10-15 degree to the internal surface of the dorsal abdominal wall. Then, the needle is slowly moved in paraaortic fat across the abdominal aorta, towards the cranial and then, caudal directions, and 3-5 ml anesthetic solution is injected in both directions.

EFFECT: method is safe; efficient and allows reducing demand in anesthetic.

Description

The invention relates to veterinary surgery and can be used in veterinary medicine for diagnostic and treatment operations on the abdominal organs for the purpose of pain relief, as well as pathogenetic treatment and prevention of postoperative complications on the organs of the gastrointestinal tract, kidneys, uterus, ovaries and bladder.

A known method of planar jet irrigation of mesentery, mesovarium, major and minor omentum, as well as the abdominal organs in dogs with 5-10% novocaine solutions and 0.1-1% Sovcain solutions, realized after a “wide” laporotomy using syringes connected to polyvinyl chloride or rubber tube. Dose - up to 30 ml of solution per animal. As a result of resorption of anesthetics in the tissue, the nerve elements of these structures are blocked and anesthetized (1).

There is a method of lumbar (perinephral) blockade of the autonomic nerves of the perinephric subfascial loose connective tissue ("fatty capsule of the kidney") in dogs according to I.Ya. Tikhonin (1; 2). The needle is injected at a distance of 3.5 cm from the midline of the lower back. For left-sided blockade, the needle is injected at the level of the end of the transverse costal process of the second lumbar vertebra, and on the right at the level of the first lumbar vertebra. The needle is inserted in a vertical position until it stops at the edge of the corresponding transverse costal process, then the needle is displaced from the bone and immersed to a depth of 0.5-1 cm. A 0.25% novocaine solution is injected at the rate of 3 ml per 1 kg of animal weight.

However, the known methods have the following disadvantages.

The method of plane jet irrigation is unsafe due to the significant risk of drug-toxic poisoning due to the need to introduce a large number of anesthetics in the area of intensive tissue and vascular resorption. Its effect is weakly accented, as a result of which the required analgesic and pathogenetic effect is not achieved.

The perinephral block according to I.Ya. Tikhonin involves the introduction of a solution of novocaine into the perinephric friable connective tissue, which has unstable and individually variable borders. In addition, an unreliable, subjective reference point and needle insertion depth is proposed (3.5 cm lateral midline and 0.5-1 cm deep respectively), which requires mandatory high sensory sensitivity of the doctor’s fingers, as well as an indescribable individual experience of orientation in the tissues . And if for large-sized dog breeds with a pronounced perinephric "fat capsule", the error is 5-7 mm in depth and the point of injection of the needle, which with this technique is likely to play, does not play a role, then for small dogs, cats and fur animals fraught with abdominal injuries. In addition, the perinephral blockade covers only the perinephric vegetative plexus and has a pronounced pathogenetic effect mainly on the kidneys, ureters, ovaries, uterus and bladder. The pathogenetic effect on the organs of the digestive canal is much weaker and there is practically no analgesic effect.

Of the known methods, the closest to the claimed object is a method of suppleural novocaine blockade of the large and small celiac nerves and border sympathetic trunks in dogs, cats and rabbits according to V.V. Mosin (1; 2; 3). The method is as follows: after standard preparation of the surgical field, the needle is pierced at the intersection of the posterior edge of the last rib with the groove between the longest and iliac-rib muscles of the back. The needle is inserted at an angle of 30-35 degrees to the horizontal plane and push it all the way into the body of the last thoracic vertebra. Then the needle is deflected by 5-10 degrees to the sagittal plane, attaching a syringe and evenly pressing on the piston, the needle is gently advanced forward until the 0.5% solution of novocaine freely flows into the suprapleural tissue. The dose of the solution is 3-5 ml. on each side of the body. The solution is localized around the large and small celiac nerves, as a result of which the effect of their pathogenetic blockade is achieved, as well as a partial decrease in the sensitivity of the abdominal organs located in the innervation zone of these autonomous conductors.

The technique developed by V.V. Mosin for suppleural blockade of the celiac nerves and sympathetic trunks involves sticking a needle along the tangent to the body of the last thoracic vertebra (angle of 30-40 degrees), which is easily accomplished only in large-sized animals (for example, "giant" dog breeds), possessing rather pronounced lateral planes of the bodies of the thoracic vertebrae and a relatively fixed, inactive thoracolumbar spine. In small predatory animals (fur-bearing animals, cats, small and medium-sized dog breeds), which have significant mobility and small sizes of the elements of the thoracolumbar skeleton, it is very difficult to conduct a “sliding” injection of a needle precisely into the vertebral body. This is evidenced by another indicator - the ratio of the width of the vertebral body and the thickness of the soft tissues of the back through which the needle must pass before touching it. In small predators, it corresponds to 1: 1.8-1.9, while in most artiodactyls, it corresponds to 1: 1.2-1.3. These morphofunctional features of small predators make it difficult to objectively control the delivery of anesthetic solutions directly to the sympathetic conductors, create conditions for its “failure” in the body cavity or for the most part in the dorsal muscles of the back, and conditions of injury to the aorta and abdominal organs are created, due to the reduced ability to control the depth of administration needles. In addition, the blockade according to V.V. Mosin does not allow the mesenteric nerves to be captured into the zone of distribution of anesthetic solutions, which limits the area of its pathogenetic effect only to the stomach, duodenum and partially jejunum, liver, pancreas and kidneys.

The aim of the invention is perioperative paraaortic blockade of the celiac and mesenteric nerves in canine, feline, and mustine in cases when it is impossible to block these nerves in the preoperative period, in the absence of primary indications, the evidence of which is established during surgery, when it is necessary to safely and with a small dose of anesthetic anesthesia or pathogenetic treatment of all or most of the organs of the abdominal cavity, and also, if necessary, the most reliable manovizualnogo control of the needle position, its direction and depth of the puncture at any time of administration.

This goal is achieved by the fact that paraaortic blockade is carried out perioperatively - after conducting a “wide” laparotomy in the median, paramedian areas, as well as horizontal incisions in the area of proper and soft puffs performed during diagnostic and treatment operations on the abdominal organs. Perioperative para-aortic blockade involves the introduction of solutions of local anesthetics either before or after the implementation of surgical admission (depending on the clinical situation, strategy and tactics of the chosen treatment). The injection technique for its implementation is as follows: with the spatulas or fingers introduced through the incision of the abdominal wall into the cavity, the mesentery and the entire organocomplex of the gastrointestinal tract are displaced by 2-3 centimeters to the right or left, exposing the place of transition of the parietal sheet of the peritoneum to the visceral along the median axis the inner surface of the dorsal abdominal wall in the root zone of the mesentery (at the level of 2-3 lumbar vertebrae). Then a needle 10-12 centimeters in length, the cannula of which is connected to the adapter of the polyvinyl chloride tube (without a syringe), is injected under the parietal sheet of the peritoneum of the dorsal abdominal wall along the median longitudinal axis of the trunk. The angle of injection is 10-15 degrees to the inner surface of the dorsal abdominal wall. The needle is slowly advanced in the paraaortic tissue of the abdominal aorta, parallel to the latter in the cranial and then in the caudal directions. The sequence of directions and the presence of both of them is dictated by clinical necessity (the possibility of a flexible and reasonable choice of a specific object of influence). The polyvinyl chloride tube adapter is connected to a syringe and 3-5 ml of anesthetic solution are injected in both directions. There is no need for injections to the right and left of the median longitudinal axis (respectively, of the abdominal aorta), because when injected from one side, the anesthetic covers the area of the celiac nerves and the entire mesenteric plexus.

Our proposed technique of perioperative para-aortic injection access is safe both from the point of view of injection trauma (absolutely reliable visual and palpation control almost completely eliminates its redundancy), and in terms of the possibility of peridosis (to achieve a clinical effect due to the accuracy of the delivery of the injection to the target, a small amount anesthetic - 5-6 times less than with flat irrigation). The coverage of all elements of the abdominal aortic plexus with a solution of anesthetic (to a greater or lesser extent, if introduced only in the cranial or only in the caudal direction) determines the maximum effectiveness of the technique both when it is used for the pathogenetic effect on the abdominal organs and for anesthesia of these organs . The latter is possible with the introduction of solutions of novocaine and lidocaine in more than 0.25% concentration - for blockade of sensory nerves.

LITERATURE

1. Magda I.I. Local anesthesia. A guide for veterinarians. M .: Selkhozgiz. 1955. - S.375-380.

2. Parshin A.A., Sobolev V.A., Sozinov V.A. Surgical operations in dogs and cats. M .: "Aquarium". 2000. - S.208-212.

3. Mosin VV New in the treatment of non-communicable diseases of farm animals. M .: Rosselkhozizdat. 1975 .-- S.30-32.

Claims (1)

The method of paraaortic blockade of the celiac and mesenteric nerves in dogs, cats and fur-bearing animals of cellular content, comprising introducing an anesthetic solution into the localization area of the elements of the abdominal aortic plexus after conducting a “wide” laparotomy during treatment and diagnostic operations on the abdominal organs, characterized in that there is operative access to vegetative conductors, they are carried out by injecting a needle under the parietal sheet of the peritoneum of the dorsal abdominal wall along the median longitudinal axis of the body in the "root I "mesentery, at the level of 2-3 lumbar vertebrae, an injection angle of 10-15 ° to the inner surface of the dorsal abdominal wall, after which the needle is slowly advanced in the paraaortic fiber of the abdominal aorta parallel to the latter in the cranial and then in the caudal directions, and injected in 3 -5 ml of anesthetic solution in both directions.