Veterinary Medicine - March 2009 - (Page 134) Anesthesia techniques PEER-REVIEWED 4. For a paravertebral brachial plexus block, nerves C6-C8 and T1 are blocked as close to the intervertebral foramina as possible, providing analgesia to the entire forelimb. may facilitate local anesthetic pooling over the incision and blocking of the adjacent intercostal nerves.9 This position may be uncomfortable for the patient, so it is best performed after systemic administration of an analgesic, such as an opioid, to improve patient tolerance. FORELIMB NERVE BLOCKS Intraoperative brachial plexus block Blocking the nerves of the brachial plexus can be performed intraoperatively by depositing lidocaine onto the visualized nerve or by injecting directly into the perineurium, the connective tissue sheath that surrounds a bundle of nerve bers, three to ve minutes before transection. This technique can provide excellent postoperative analgesia after forelimb amputation. The duration can be extended by adding bupivacaine and other adjunctive drugs such as opioids and alpha2 agonists. A similar blockade of the lumbar plexus nerves can be performed for hindlimb amputation. Paravertebral and traditional brachial plexus blocks For regional forelimb blockade when the nerves will not be visualized during the surgical procedure, a paravertebral 134 March 2009 VETERINARY MEDICINE http://www.intervetusa.com http://www.intervetusa.com
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