Is anaesthesia of the deep branch of the lateral plantar nerve specific for the diagnosis of proximal metatarsal pain in the horse?

Hinnigan, G. J.; Milner, Peter; Talbot, Alison; Singer, E. R.

doi:10.3415/vcot-13-12-0146

Cited by 15 publications

(8 citation statements)

References 22 publications

(37 reference statements)

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“…Skin sensation, which was measured prior to and after performing tibial perineural analgesia, was used to determine the onset of nerve blockade following injection of a local anaesthetic agent. As well as being used clinically, loss of skin sensation has been used commonly in research to verify the onset and duration of perineural analgesia (McCracken et al, 2020; Schambourg & Taylor, 2020) and to investigate the diffusion of local anaesthetic agents to nerves in the proximity of injection sites (Hinnigan et al, 2014; Jordana et al, 2014; Miagkoff & Bonilla, 2021). The lateral and medial heel bulbs are autonomous zones (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…ballpoint pen) is often used to assess if perineural analgesia has been adequately performed (Bassage & Ross, 2010;Schumacher & Schramme, 2019). More recently, algometers, instruments that allow measurement of the pressure applied, have been used to test skin sensation in the research setting (Gozalo-Marcilla et al, 2020;Hinnigan et al, 2014;Hoerdemann et al, 2017;Jordana et al, 2014). further aim of this study was to compare horses' tolerance of the procedure and operator safety between US-guided and blind tibial perineural analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided perineural injection of the tibial nerve in the horse versus a ‘blind’ technique

Bellitto

Voûte

Reardon³

et al. 2023

Equine Veterinary Education

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SummaryBackgroundTibial perineural analgesia has often been reported to fail to achieve nerve desensitisation in horses. Ultrasound‐guided (US‐guided) techniques have recently been described to improve tibial perineural desensitisation.ObjectivesTo compare US‐guided and ‘blind’ tibial perineural analgesia techniques in lameness investigation.Study designRandomised clinical trial.MethodsHorses presenting for lameness investigation, which required tibial perineural analgesia, were randomly assigned either to a US‐guided or blind injection group. The efficacy of perineural analgesia was assessed by testing the loss of skin sensation at the medial and lateral heel bulbs. Skin sensation was assessed, prior to injection and then at four intervals post‐injection (10–15, 20–25, 30–35 and 40–45 min) using a hand‐held digital algometer with a 1 mm diameter pin; a value of 25 N was defined as indicative of skin desensitisation. The time taken to perform each injection technique and any adverse reactions were recorded. Summary statistics were performed to examine differences between groups. The frequency of skin desensitisation was compared between groups using a Fisher's exact test and the length of time taken to perform injections was compared using a Mann–Whitney U test.ResultsSixteen US‐guided and 11 blind injections were included in the study. All cases undergoing US‐guided injection lost skin sensation, whereas this occurred in only one case receiving the blind injection. The US‐guided group had a significantly higher probability of skin sensation loss (p < 0.001), although the injection technique took significantly longer to complete compared to the blind group (p < 0.001). No adverse reactions were noted with either perineural injection technique.Main limitationsLimited number of cases for each injection group.ConclusionsThese findings suggest that US‐guided tibial perineural injection is more likely to result in adequate and prompt tibial perineural analgesia compared to the blind injection technique, although it takes longer to complete.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided perineural injection of the tibial nerve in the horse versus a ‘blind’ technique

Bellitto

Voûte

Reardon³

et al. 2023

Equine Veterinary Education

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“…Entire axial skeleton [24,25,27] Thoracic limb [30] Neck [20] Distal forelimb [15,22,36,45,51,57,58] Trunk [23,26,29,33,[38][39][40][41][42][43] Pastern region forelimb [19,34] Pelvis [18,21,33] Pelvic limb [59] Abdomen [31] Tarsal region [32] MNTs have been recorded in both unweighted and weighted limbs [30,33]. Most pharmaceutical studies test MNTs in weighted forelimbs as the horse can stand quietly restrained during the testing procedure, which may help to improve identification of subtle avoidance reactions (e.g., weight-shifting to the non-tested limb) [51].…”

Section: Axial Skeleton Landmarks Appendicular Skeleton Landmarksmentioning

confidence: 99%

Pressure Algometry for the Detection of Mechanical Nociceptive Thresholds in Horses

Haussler

2020

Animals

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The clinical assessment of pain is subjective; therefore, variations exist between practitioners in their ability to identify and localize pain. Due to differing interpretations of the signs or severity of pain equine practitioners may assign varying levels of clinical significance and treatment options. There is a critical need to develop better tools to qualify and quantify pain in horses. Palpation is the most common method to detect local tenderness or sensitivity. To quantify this applied pressure, pressure algometry has been used to gradually apply pressure over specified landmarks until an avoidance response is noted, which is defined as the mechanical nociceptive threshold (MNT). Numerous studies have used pressure algometry in different applications to measure MNTs in horses. There is an acute need to establish normative values within different body regions and to develop standardized methods of testing MNTs to better guide practitioners in the diagnosis and treatment of pain. The aim of this systematic review was to summarize the evidence for the use of pressure algometry in horses. There is good evidence that pressure algometry is a repeatable, semi-objective method that can be used in a wide array of clinical and research applications to assess MNTs in horses.

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“…[4][5][6] The diagnosis of PSD is generally based on regional analgesia and diagnostic imaging including ultrasonography and radiography. 5,7,8 It has, however, been shown that the majority of ultrasonographic measurements are not very precise and radiographic changes do not reliably predict the presence or severity of PSD. 6,9 High-field MRI is currently considered the most accurate imaging modality for the evaluation of the proximal suspensory ligament (PSL), but the technique is only available in a small number of referral centers.…”

Section: Introductionmentioning

confidence: 99%

“…The pathology is characterized by a varying combination of osseous changes at the proximoplantar metatarsus III (MTIII), enthesopathy, and desmopathy of the suspensory origin that may cause local nerve compression 4–6 . The diagnosis of PSD is generally based on regional analgesia and diagnostic imaging including ultrasonography and radiography 5,7,8 . It has, however, been shown that the majority of ultrasonographic measurements are not very precise and radiographic changes do not reliably predict the presence or severity of PSD 6,9 .…”

Section: Introductionmentioning

confidence: 99%

Findings consistent with equine proximal suspensory desmitis can be reliably detected using computed tomography and differ between affected horses and controls

Müller,

Vanderperren,

Merle

et al. 2023

Vet Radiology Ultrasound

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The objective of this retrospective, observational, controlled study was to evaluate bone and soft tissue window CT images of the proximoplantar metatarsus III region in twenty horses with pain localized to the proximal suspensory ligament (PSL) and 20 horses with findings nonrelated to tarsal pain. All horses underwent CT and radiographic examination. Images were reviewed by three independent observers who graded the severity and localization of findings. Bone‐related categories as well as soft tissue‐related categories were evaluated. For the comparison of imaging findings in horses with and without proximal suspensory desmitis (PSD), mixed linear regression was performed. The intraclass correlation coefficient (ICC) was calculated to assess intraobserver agreement, and kappa statistics were employed to evaluate interobserver agreement. CT examination identified significantly more abnormalities in the diseased group. The scores for osseous exostosis (p = .015) and PSL enlargement (p = .004) were notably higher in PSD horses compared to controls. Intraobserver agreement was overall high (ICC .82–1.0), and interobserver agreement was substantial for the detection of mineralization (kappa = .61) and moderate for sclerosis (kappa = .43), exostosis (kappa = .43), and PSL enlargement (kappa = .48/.51). Measurements in the soft tissue window were significantly smaller than those in the bone window. Findings concurrent with PSD including osseous proliferation and sclerosis as well as soft tissue enlargement, mineralization, and avulsion can be reliably detected using CT. Findings from the current study supported the use of CT for evaluating horses with suspected PSD where high‐field MRI is not available.

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Is anaesthesia of the deep branch of the lateral plantar nerve specific for the diagnosis of proximal metatarsal pain in the horse?

Abstract: Concurrent anaesthesia of the LPN is likely to occur when DB-LPN anaesthesia is performed using a single injection technique.

Cited by 15 publications

References 22 publications

Ultrasound‐guided perineural injection of the tibial nerve in the horse versus a ‘blind’ technique

Ultrasound‐guided perineural injection of the tibial nerve in the horse versus a ‘blind’ technique

Pressure Algometry for the Detection of Mechanical Nociceptive Thresholds in Horses

Findings consistent with equine proximal suspensory desmitis can be reliably detected using computed tomography and differ between affected horses and controls

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