Veterinary Medicine - March 2009 - (Page 130)

Anesthesia techniques PEER-REVIEWED Local and regional anesthesia techniques, Part 2: Stifle, intercostal, intrapleural, and forelimb techniques These anesthetic methods, including one recently recommended alternative block, will help you control pain in animals undergoing stiﬂe surgeries, forelimb surgeries, limb amputations, or thoracotomies, as well as in patients with thoracic trauma or cranial abdominal pain. Christine Egger, DVM, MVSc, DACVA, and Lydia Love, DVM I n the January issue of Veterinary Medicine, we presented an overview of the drugs used for local and regional anesthesia and then described ve techniques— in ltration anesthesia, splash blocks, digital nerve blocks, intravenous regional anesthesia, and soakertype catheters —that can greatly enhance the analgesic management of veterinary patients (see “Local and regional anesthesia techniques, Part 1: Overview and ve simple techniques”). In this article, we discuss several more techniques you can begin using immediately in practice to alleviate pain, reduce stress, and optimize recovery in your patients—intraarticular sti e blocks, intercostal nerve blocks, intrapleural analgesia, and various options for forelimb 1. The landmarks for performing an intra-articular analgesia including a recent alterna- stiﬂe block. tive to the traditional brachial plexus nerve block, the paravertebral brachial PREPARATION plexus block. We also discuss electrical For each technique, perform a sterile scrub, nerve stimulation and the use of a nerve wear sterile gloves, and use only sterile locator to improve the success rate of needles, syringes, and catheters. Strict peripheral nerve blocks. adherence to aseptic technique will reduce complications from infection. An overview of each technique is presented in Table 1. The onset of the blockade and duration of Christine Egger, DVM, MVSc, analgesia depend on the local anesthetics DACVA chosen and the use of adjunctive agents. Lydia Love, DVM Department of Small Animal Clinical Sciences College of Veterinary Medicine The University of Tennessee Knoxville, TN 37996 INTRA-ARTICULAR STIFLE BLOCK This block provides analgesia to a joint before (preemptive) or after surgical intervention. It is most commonly used to block the sti e but may be performed in other joints.1-3 To block the sti e joint, ex the joint slightly, and apply digital pressure to the medial side of the patellar ligament. Insert the needle on the lateral side of the patellar ligament midway between the patella and the tibial tuberosity, and direct it medially and toward the intercondylar space of the tibia (Figure 1). After aspirating to ensure correct placement (joint uid is often identi ed), inject the chosen drug or drugs. Lidocaine or bupivacaine are commonly used; morphine or buprenorphine can also be used alone or, more commonly, in combination with a local anesthetic.4,5 Clonidine, an alpha2 agonist, is effective in people as an adjunct to local anesthetics when administered intra-articularly,6 and the alpha2 agonist fadolmidine was shown to suppress peripheral arthritic pain when administered into the sti e joints of rats.7 As outlined in the previous article, adding alpha2 agonists, opioids, or both to a local anesthetic may enhance ef cacy and extend duration of regional anesthetic techniques. Bupivacaine, with or without an opioid or alpha2 agonist, is most commonly used in intraarticular blocks, with onset in about 30 minutes and a duration of action, when given alone, of four to six hours. INTERCOSTAL NERVE BLOCKS Intercostal nerve blocks provide effective analgesia after a lateral thoracotomy or 130 March 2009 VETERINARY MEDICINE

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Veterinary Medicine - March 2009 Contents Letters Correction Author Guidelines Hot Literature Idea Exchange A Challenging Case Local and Regional Anesthesia Techniques The Latest Scoop on Litter Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - March 2009

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