Date Published: July 13, 2020
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Eduardo Cavalcante das Neves, Charles Pelizzari, Romulo Silva de Oliveira, Siham Kassab, Kleber dos Anjos Lucas, Yuri Karaccas de Carvalho.
To develop a 3D anatomical model for teaching canine epidural anesthesia (3DMEA) and to assess its efficacy for teaching and learning prior to the use of live animals.
The creation of 3DMEA was based on 3D optical scanning and 3D printing of canine bone pieces of the fifth to the seventh lumbar vertebrae, sacrum and pelvis. A total of 20 male dogs were scheduled for castration. 20 veterinary students watched a video showing epidural anesthesia in dogs before the clinical attempt and were assigned to control or 3DMEA groups. Students in the 3DMEA group trained in the model after the video. For the clinical trial, the epidural procedure was performed by students under the veterinary supervision. When observed the absence of response to nociceptive stimuli, the epidural was considered successful. Then, all students answered a questionnaire evaluating the main difficulty founded in the technique and its degree of difficulty.
The 3DMEA group reported a lower degree of difficulty to perform the epidural anesthesia technique when compared with the control group (p=0.0037). The 3DMEA reproduced the anatomical structures, allowing the perception of the distance of needle in relation to the iliac prominences during epidural anesthesia. Its mobility allowed simulation of the animal in standing position and sternal recumbency.
The use of 3DMEA demonstrated greater efficacy in the execution of the technique, being effective in the teaching and learning process before the epidural anesthesia in live animals.
The epidural lumbosacral anesthesia is a practical technique that, if performed correctly, can be a very useful complementary method to general anesthesia that promotes pre- and post-operative analgesia. The technique is considered safe and induces minimal cardiovascular and pulmonary changes1,2. The palpation of anatomical references such as the iliac prominences and the spinal process of the last lumbar vertebra (L7) in the dog are indispensable for performing the procedure3. Factors such as obesity and incorrect positioning during the technique make it difficult or impossible to perform it4.
Experimental protocol was approved by the Animal Research Ethics Committee of Universidade Federal do Acre (CEUA-UFAC), protocol number 27/2018.
The image scanning and editing processes performed of the bone pieces allowed a consistent reproduction of the dog’s skeleton lumbosacral region. The 3DMEA ensured accurate visualization of the L7 spinous process and iliac prominences.
None of the 20 animals had any complication or needed analgesic rescue, because everyone received the epidural block before surgery. Although its use in the analgesic rescue was unnecessary, tramadol use in pre-anesthetic medication provided the necessary analgesic support for the procedures. Its use has shown to be successful in the acute pain control, with effective relief of post-surgical discomfort in cases of mild and moderate pain22,23.
The use of 3DMEA before epidural anesthesia by inexperienced students resulted in greater efficiency in the execution of the technique in live dogs subjected to orchiectomy since it facilitated the anatomical identification of the L7 spinous process and iliac prominences, being effective in the teaching and learning process prior to epidural in live animals. Thus, its potential use in teaching was demonstrated. However, further studies with a greater number of animals and students are necessary to validate our findings.