Diffusion of dye after perineural injection of the palmar/plantar nerves in two different sites in horses: an ex-vivo study

Souza, Anderson Fernando de; Pascual, Carolina Jubran; Maia, Beatriz Tofani; Zoppa, André Luis do Valle de

doi:10.1007/s11259-021-09856-6

Cited by 2 publications

(3 citation statements)

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“…It was important to identify changes that occurred to the structures at the injection point when raising the limb. In a previous study by our group, we could find similar results in the dissection of cadavers compared to those recorded with the animal in support (Souza et al, 2021).…”

Section: Discussionsupporting

confidence: 84%

“…An ex vivo study showed that the position of the medial palmar/plantar nerve at the metacarpal/metatarsal distal third level varies from close to the dorsal edge of the deep digital flexor tendon to a more palmar/plantar position close to the superficial digital flexor tendon (Souza et al, 2021). Generally speaking, this exact position occurs in the live animal.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical position of the palmar/plantar nerves at the metacarpal/metatarsal distal level in horses: An in vivo study by means of ultrasonography

Maia

Vendrusculo

Souza

et al. 2022

Anat Histol Embryol

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The neurovascular bundle of the equine distal cannon can dynamically vary with limb position, and this can affect the performance of low 4‐ or 6‐point block. This study aims to identify and describe the anatomical position and variations of the lateral and medial palmar/plantar nerve at the metacarpal/metatarsal distal level in horses by ultrasonography. Eight mares underwent ultrasound examination on the lateral and medial palmar/plantar sides of the metacarpus/metatarsus. Images were obtained for measurements of the cross‐sectional area of the nerve, distances between the nerve and the skin surface, branch of the suspensory ligament (SL), deep digital flexor tendon (DDFT) and superficial digital flexor tendon (SDFT) with limbs supported and elevated. The distance to the skin for forelimbs was higher on the lateral side when the limb was elevated (p < 0.001). The comparisons between supported and elevated limbs on the same side showed longer distances to the skin with the limb supported on the medial side (p < 0.001). Hindlimbs showed longer distances to the skin with the limb supported on the medial face (p = 0.027). The anatomical position of palmar/plantar nerves was similar between the lateral and medial sides of the limb, generally being in contact with the dorsal edge of DDFT. The strategy of elevating the limb during the injection of the low 4‐ or 6‐point block can lead to a higher risk of puncture of the digital sheath.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Anatomical position of the palmar/plantar nerves at the metacarpal/metatarsal distal level in horses: An in vivo study by means of ultrasonography

Maia

Vendrusculo

Souza

et al. 2022

Anat Histol Embryol

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“…Radiodense contrast medium has been widely used to study potential post-injection distribution characteristics of local anesthetic solution ( 4–8 ). Previous studies have shown inadvertent penetration of synovial structures following perineural injection, such as the carpometacarpal joint after perineural injection of the palmar metacarpal nerves ( 5 ), the digital flexor tendon sheath after perineural injection of the palmar and palmar metacarpal lateral and medial nerves (low 4-point nerve block) ( 4 , 9 , 10 ) and the tarsal sheath and tarsometatarsal joint following perineural injection of the deep branch of the lateral plantar nerve ( 7 , 8 ). In situations with risk of inadvertent synovial penetration, antiseptic preparation prior to performing perineural anesthesia is strongly recommended ( 2 , 3 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic evaluation of the proximity of needles placed for perineural anesthesia of the palmar digital nerves to synovial structures in the foot: an ex vivo study

Gruyaert,

Oosterlinck,

Haspeslagh

et al. 2024

Front. Vet. Sci.

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BackgroundPotential synovial penetration following palmar digital nerve blocks has not been investigated.ObjectivesTo evaluate the proximity of needles placed for palmar digital nerve blocks to nearby synovial structures using computed tomography (CT).Study designDescriptive observational study.MethodsIn 18 cadaver forelimbs, sequential injection of the navicular bursa (NB), distal interphalangeal joint (DIPJ) and digital flexor tendon sheath (DFTS) was performed using 3, 5 and 10 mL diluted radiodense contrast medium, respectively. After each synovial injection, 25 gage needles were placed over the palmar digital nerves at the proximal aspect of the ungular cartilages (distal injections) and 1 cm further proximally (proximal injections), and CT examination was performed. Subsequently, needles were removed, and the synovial structures further distended with the same volume as for the first injection. Perineural needle placement and image acquisition were repeated. The distance between the needle tip and adjacent synovial structures was measured (mm) in reconstructed images. Results were analyzed in separate general linear mixed models, to determine the effect of needle position and synovial distension on the distance from the tip of the needle to the NB, DFTS and DIPJ.ResultsSynovial penetration was confirmed following 12/420 (3%) needle placements (NB n = 5, 1 after proximal and 4 after distal injections; DIPJ n = 2, DFTS n = 2, NB or DIPJ n = 3, all after distal injections). The mean distance from the needle tip to the NB and DIPJ was significantly smaller after the second distension (NB: p = 0.025; DIPJ: p < 0.001) and with the distal needle placements (NB: p < 0.001; DIPJ: p < 0.001). For the DFTS, the distance from the needle tip was significantly smaller with the proximal needle placements (p = 0.001).Main limitationsEx-vivo study.ConclusionThere is a small risk of synovial penetration when performing palmar digital nerve blocks, especially when distension of adjacent synovial structures is present.

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Diffusion of dye after perineural injection of the palmar/plantar nerves in two different sites in horses: an ex-vivo study

Cited by 2 publications

References 10 publications

Anatomical position of the palmar/plantar nerves at the metacarpal/metatarsal distal level in horses: An in vivo study by means of ultrasonography

Anatomical position of the palmar/plantar nerves at the metacarpal/metatarsal distal level in horses: An in vivo study by means of ultrasonography

Computed tomographic evaluation of the proximity of needles placed for perineural anesthesia of the palmar digital nerves to synovial structures in the foot: an ex vivo study

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