Veterinary Medicine - March 2009 - (Page 138)

Anesthesia techniques PEER-REVIEWED For a traditional brachial plexus block, when the musculocutaneous nerve is stimulated, the biceps muscle will contract, causing exion of the elbow.25 Injecting local anesthetic should cause the muscle movement to immediately cease.9,14-16,19,25 Refer to Table 1 for drug choices and dosages. The use of a nerve locator for the paravertebral block has been described11; however, the exact muscle movements that should be elicited to achieve a successful block are still being de ned. Various motor movements may be elicited from stimulation of individual nerves within the brachial plexus and range from dorsal displacement of the scapula to extension of the triceps.11 An in-depth review of the paravertebral blockade is provided elsewhere.11 If a hiccupping movement of the diaphragm is elicited, the phrenic nerve has been located, and the needle should be repositioned before injection of local anesthetic. SUMMARY By adopting the above techniques, you can greatly reduce your patients’ pain after surgery or trauma. These techniques do not require expensive equipment or drugs, yet can provide effective analgesia of prolonged duration, reducing the requirements for systemic analgesics to control pain. Look for upcoming articles on maxillary and mandibular nerve blocks and epidural anesthesia and analgesia. ACKNOWLEDGMENT The authors wish to thank Gregory Hirshoren, Instructional Resources, College of Veterinary Medicine, The University of Tennessee, for the photos that accompany this article. REFERENCES 1. Lemke KA. Pain management II: local and regional anaesthetic techniques. In: Seymour C, Duke-Novakovski T, eds. BSAVA manual of canine and feline anaesthesia and analgesia. 2nd ed. Gloucester, UK: British Small Animal Veterinary Association, 2007;104-114. 2. Gaynor JS, Mama KR. Local and regional anesthetic techniques for alleviation of perioperative pain. In: Gaynor J, Muir W, eds. Handbook of veterinary pain management. St Louis, Mo: Mosby, 2002;261-280. 3. Hoelzler MG, Harvey RC, Lidbetter DA, et al. Comparison of perioperative analgesic protocols for dogs undergoing tibial plateau leveling osteotomy. Vet Surg 2005;34(4):337-344. 4. Kapitzke D, Vetter I, Cabot PJ. Endogenous opioid analgesia in peripheral tissues and the clinical implications for pain control. Ther Clin Risk Manag 2005;1(4):279-297. 5. Axelsson K, Gupta A, Johanzon E, et al. Intraarticluar administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study. Anesth Analg 2008;106(1):328-333. 6. McCartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systemic review of the literature. Reg Anesth Pain Med 2007;32(4):330-338. 7. Ansah OB, Pertovaara A. Peripheral suppression of arthritic pain by intraarticular fadolmidine, an alpha 2-adrenoceptor agonist, in the rat. Anesth Analg 2007;105(1):245-50. 8. Thompson SE, Johnson JM. Analgesia in dogs after intercostal thoracotomy. A comparison of morphine, selective intercostal nerve block, and intrapleural regional analgesia with bupivacaine. Vet Surg 1991;20(1):73-77. 9. Scarda RT, Tranquilli WJ. Local and regional anesthetic and analgesic techniques: dogs; Local and regional anesthetic techniques: cats. In: Tranquilli WJ, Thurmon JC, Grimm KA, eds. Lumb and Jones’ veterinary anesthesia and analgesia. 4th ed. Ames, Iowa: Blackwell Publishing, 2007;395-418, 561-604. 10. Stobie D, Caywood DD, Rozanski EA, et al. Evaluation of pulmonary function and analgesia in dogs after intercostal thoracotomy and use of morphine administered intramuscularly or intrapleurally and bupivacaine administered intrapleurally. Am J Vet Res 1995;56(8):1098-1109. 11. Lemke KA, Creighton CM. Paravertebral blockade of the brachial plexus in dogs. Vet Clin North Am Small Anim Pract 2008;38:1231-1241. 12. Katagiri M, Young RN, Platt RS, et al. Respiratory muscle compensation for unilateral or bilateral hemidiaphragm paralysis in awake canines. J Appl Physiol 1994;77:1972-1982. 13. Hofmeister EH, Kent M, Read MR. Paravertebral block for forelimb anesthesia in the dog—an anatomic study. Vet Anaesth Analg 2007;34(2):139-142. 14. Mahler SP, Adogwa AO. Anatomical and experimental studies of brachial plexus, sciatic, and femoral nerve-location using peripheral nerve stimulation in the dog. Vet Anaesth Analg 2008;35(1):80-89. 15. Mahler SP, Reece JLM. Electrical nerve stimulation to facilitate placement of an indwelling catheter for repeated brachial plexus block in a traumatized dog. Vet Anaesth Analg 2007;34(5):365-370. 16. Futema F, Fantoni DT, Auler JOC, et al. A new brachial plexus block technique in dogs. Vet Anaesth Analg 2002;29:133-139. 17. Davies RG, Myles PS, Graham JM. A comparison of the analgesic ef cacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and metaanalysis of randomized trials. Br J Anaesth 2006;96(4):418-426. 18. Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 2008;100(2):154-164. 19. Wenger S. Brachial plexus block using electrolocation for pancarpal arthrodesis in a dog. Vet Anaesth Analg 2004;31(4):272-275. 20. Wenger S, Moens Y, Jäggin N, et al. Evaluation of the analgesic effect of lidocaine and bupivacaine used to provide a brachial plexus block for forelimb surgery in 10 dogs. Vet Rec 2005;156(20):639-642. 21. Portela D, Melanie P, Briganti A, et al. Nerve-stimulator guided paravertebral lumbar plexus anaesthesia in dogs. Vet Res Commun 2008 32(Suppl 1):S307-S310. 22. Wellehan, JFX, Gunkel CI, Kledzik D, et al. Use of a nerve locator to facilitate administration of mandibular nerve blocks in crocodilians. J Zoo Wildl Med 2006;37(3):405-408. 23. Wilson DV, Dhanjal JK, Garcia-Periera F. A comparison of two techniques for brachial plexus blockade in dogs (abst), in Proceedings. Int Vet Emerg Crit Care Soc 2007. 24. Campoy L, Martin-Flores M, Looney A, et al. Distribution of a lidocaine-methylene blue solution staining in brachial plexus, lumbar plexus and sciatic nerve blocks in the dog. Vet Anaesth Analg 2008;35:348-354. 25. Campoy L. Fundamentals of regional anesthesia using nerve stimulation in the dog. In: Gleed RD, Ludders JW, eds. Recent advances in veterinary anesthesia and analgesia: companion animals. Ithaca NY: International Veterinary Information Service, 2006 (www.ivis.org). Accessed Nov. 25, 2008. 138 March 2009 VETERINARY MEDICINE http://www.ivis.org

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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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