Veterinary Medicine - March 2009 - (Page 131)

TABLE 1 Indications and Drug Dosages for Local and Regional Anesthesia Techniques Technique Indications Drugs, Dosages,* Equipment (use lower dose range in cats) • 2–5 mg/kg 2% lidocaine or 2 mg/kg 0.5% bupivacaine • +/- morphine 0.1 mg/kg or buprenorphine 0.01 mg/kg • Sterile 22- to 25-ga, 1-in hypodermic needle and syringe Notes Intra-articular stiﬂe block Stiﬂe surgery • Joint infection is a potential complication. • Follow aseptic technique. Intercostal nerve blocks Lateral thoracotomy, rib fractures, thoracic trauma • 1–4 mg/kg (dogs); 1–2 mg/kg (cats) 0.5% bupivacaine • +/- morphine 0.1 mg/kg or buprenorphine 0.01 mg/kg • Sterile 22- to 25-ga, 1-in needle and syringe • Avoid IV or intra-arterial injection. • Block three intercostal nerves in front of the incision (or fractured ribs) and three caudal to it, in addition to the site of interest. Intrapleural analgesia Post-thoracotomy, rib fractures, thoracic trauma, cranial abdominal pain • Inﬁltrate 0.2–0.5 mL 0.2% lidocaine at the site of needle penetration • 1–2 mg/kg of 0.5% bupivacaine through a chest tube or butterﬂy or IV catheter, stopcock, and syringe • 1–2 mg/kg of 2% lidocaine and/or 0.5% bupivacaine dripped onto the exposed nerve or injected into the perineurium of each nerve 3 to 5 minutes before transection • +/- morphine 0.1 mg/kg or buprenorphine 0.01 mg/kg • Sterile 22- to 25-ga, 1-in hypodermic needle and syringe • 1–4 mg/kg (dogs); 1–2 mg/kg (cats) 0.5% bupivacaine • +/- morphine 0.1 mg/kg or buprenorphine 0.01 mg/kg • Sterile 22- to 25-ga, 1-in hypodermic needle and syringe • 2–5 mg/kg 2% lidocaine and/or 2 mg/kg 0.5% bupivacaine (can increase volume by dilution up to 50% with sterile saline solution) • +/- morphine 0.1 mg/kg or buprenorphine 0.01 mg/kg • Sterile 7.5-cm, 20- or 22-ga spinal needle and syringe • 2–5 mg/kg 2% lidocaine and/or 2 mg/kg 0.5% bupivacaine • +/- morphine 0.1 mg/kg or buprenorphine 0.01 mg/kg • Sterile 22- to 25-ga, 1-in needle and syringe • Lung laceration and pneumothorax are potential complications. • If using a chest tube, follow with injection of 3 to 5 ml sterile saline solution to ﬂush the tube. Intraoperative (direct) brachial plexus block Forelimb amputation • Neuroma formation is a potential complication with injection into the nerve. Paravertebral brachial plexus block Forelimb amputation, analgesia of the entire forelimb • Avoid IV, intra-arterial, or intrathoracic injection. • Pneumothorax, phrenic nerve blockade, and injection into the dural sheath are potential complications resulting in high sympathetic blockade, hypotension, and respiratory depression. • Avoid IV, intra-arterial, or intrathoracic injection. • Pneumothorax and phrenic nerve blockade are potential complications. Traditional brachial plexus block Radial, ulnar, carpal, metacarpal, and digital fracture repair; wound repair; biopsy Radial, median, musculocutaneous, and ulnar nerve blocks Analgesia of the elbow and antebrachium • Avoid IV or intra-arterial injection. • Avoid direct injection into the nerve to avoid nerve damage. * Dosages represent total maximum dose that is then divided among all injection sites. VETERINARY MEDICINE March 2009 131

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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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