Evaluation of a Midhumeral Block of the Radial, Ulnar, Musculocutaneous and Median (RUMM Block) Nerves for Analgesia of the Distal Aspect of the Thoracic Limb in Dogs.
Summary of "Evaluation of a Midhumeral Block of the Radial, Ulnar, Musculocutaneous and Median (RUMM Block) Nerves for Analgesia of the Distal Aspect of the Thoracic Limb in Dogs."
Objective: To evaluate a technique for midhumeral peripheral nerve blockade in the dog. Study Design: Cadaveric technique development; in vivo placebo-controlled, prospective crossover study. Animals: Canine cadavers (n=38) and 8 clinically healthy, adult hound dogs. Methods: A technique for peripheral block of the radial, ulnar, musculocutaneous, and median nerves (RUMM block) was evaluated using cadaver limbs. Eight purpose-bred, research dogs were anesthetized; a RUMM block was performed on each thoracic limb. One limb from each dog randomly received 0.5% bupivacaine and the opposite limb was assigned to receive sterile saline solution as a control. After recovery from anesthesia, skin sensation at selected dermatomes was evaluated for 24 hours using a mechanical stimulus. Weight-bearing, conscious proprioception, and withdrawal reflex were also evaluated. One month after initial testing, each dog was reanesthetized and each limb received the opposite treatment. Results: Sensory thresholds were significantly increased over baseline measurements when compared with control limbs for all nerves. Complete sensory block was achieved in radial (15/16), ulnar (3/16), musculocutaneous (8/16), and median (11/16) nerves, using a mechanical stimulus of analgesia. Complete simultaneous block of all nerves was only obtained in 1 of 16 limbs. Conclusion: RUMM block resulted in desensitization of the skin in the associated dermatomes for 4-10 hours. Complete sensory block of the dermatomes supplied by the radial nerve was most consistent. Clinical Relevance: RUMM block may be an effective technique to provide adjunctive analgesia for dogs undergoing surgery of the distal aspect of the thoracic limb.
Affiliation
Comparative Pain and Orthopedic Research Laboratories, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.
Journal Details
This article was published in the following journal.
Name: Veterinary surgery : VS : the official journal of the American College of Veterinary Surgeons
ISSN: 1532-950X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20673276
- DOI: http://dx.doi.org/10.1111/j.1532-950X.2010.00712.x
Medical and Biotech [MESH] Definitions
Brachial Artery
The continuation of the axillary artery; it branches into the radial and ulnar arteries.
Median Neuropathy
Disease involving the median nerve, from its origin at the BRACHIAL PLEXUS to its termination in the hand. Clinical features include weakness of wrist and finger flexion, forearm pronation, thenar abduction, and loss of sensation over the lateral palm, first three fingers, and radial half of the ring finger. Common sites of injury include the elbow, where the nerve passes through the two heads of the pronator teres muscle (pronator syndrome) and in the carpal tunnel (CARPAL TUNNEL SYNDROME).
Musculocutaneous Nerve
A major nerve of the upper extremity. The fibers of the musculocutaneous nerve originate in the lower cervical spinal cord (usually C5 to C7), travel via the lateral cord of the brachial plexus, and supply sensory and motor innervation to the upper arm, elbow, and forearm.
Ulnar Artery
The larger of the two terminal branches of the brachial artery, beginning about one centimeter distal to the bend of the elbow. Like the RADIAL ARTERY, its branches may be divided into three groups corresponding to their locations in the forearm, wrist, and hand.
Ulnar Nerve Compression Syndromes
Ulnar neuropathies caused by mechanical compression of the nerve at any location from its origin at the BRACHIAL PLEXUS to its terminations in the hand. Common sites of compression include the retroepicondylar groove, cubital tunnel at the elbow (CUBITAL TUNNEL SYNDROME), and Guyon's canal at the wrist. Clinical features depend on the site of injury, but may include weakness or paralysis of wrist flexion, finger flexion, and ulnar innervated intrinsic hand muscles, and impaired sensation over the ulnar aspect of the hand, fifth finger, and ulnar half of the ring finger. (Joynt, Clinical Neurology, 1995, Ch51, p43)
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