Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description

Portela, Diego A.; Verdier, Natalí; Otero, Pablo E.

doi:10.1016/j.tvjl.2018.07.003

Cited by 54 publications

(74 citation statements)

References 68 publications

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“…O bloqueio proximal do nervo ciático com ENP realizado através da abordagem lateral, está de acordo com a técnica descrita em cães por Campoy et al [3] e a anestesia do nervo femoral foi realizada pela abordagem inguinal, a qual bloqueia o trecho proximal ao surgimento do seu ramo terminal, o nervo safeno, que é responsável pelo componente sensorial medial da coxa e pelo joelho, permitindo insensibilização completa do membro [11]. Foi utilizado o intervalo de 0,2-0,6 mV de corrente estimuladora, similar ao descrito na literatura, entretanto Mahler e Adogwa [8] ressaltam que a corrente não deve ser o único indicador de contato com o nervo, devendo se atentar também a resistência à injeção.…”

Section: Discussionunclassified

“…A técnica realizada neste caso foi relativamente simples e o uso do neuroestimulador permitiu executar bloqueio com precisão, mesmo se utilizando baixas doses e volumes, reduzindo consideravelmente a possibilidade de ocorrência de intoxicação no paciente ou danos neurológicos iatrogênicos [6,11]. A eletroestimulação contribui para localizar nervos com fibras motoras, por meio das contrações geradas pelos pulsos [8], permitindo deposição do anestésico o mais próximo possível do nervo, atestada pela presença de contrações com frequência mínima de 0,2 mA Desta forma, pode-se afirmar que os bloqueios dos nervos ciático e femoral com ropivacaína a 0,2%, guiados com neuroestimulador, foram de fácil execução, seguros e eficazes para realização de osteossíntese de tíbia em Chinchilla lanigera.…”

Section: Discussionunclassified

“…Os bloqueios locorregionais são relevantes para a anestesia multimodal por conferir segurança, praticidade, analgesia, redução das doses dos outros fármacos empregados e rápida recuperação anestésica [7,14,15]. No que diz respeito à insensibilização do membro pélvico, os bloqueios de nervos periféricos tornaram-se alternativa à anestesia neuroaxial, por promover insensibilidade seletiva na região a ser abordada e reduzir a incidência das intercorrências relacionadas ao bloqueio central [11]. Quando realizados com técnicas de neurolocalização, por meio de estimuladores de nervos periféricos (ENP), aumenta-se a acurácia e possibilita o uso de baixas doses de anestésicos locais, fato de particular relevância em pacientes com baixo peso corporal [11].…”

Section: Introductionunclassified

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Nerve Stimulator-Guided Ciatic and Femoral Nerve Block during Tibial Osteosynthesis in Chinchilla lanigera

Lemos

Vieira

Gusmão

et al. 2019

Acta Scientiae. Vet.

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Background: Nociceptive stimulation in orthopedic surgery requires effective pain management to ensure trans and postoperative patient comfort. Several techniques can be used for this, and multimodal analgesia protocols such as guided locoregional blocks provide a balanced effect, as they enable the use of low-dose anesthetics and offer rapid recovery. The benefits of specific nerve blocks in domestic animals are well known; however, there are few reports that have ascertained their safety in wild species. This report is aimed at describing the successful use of neurolocalizer-guided sciatic and femoral nerve blocks during tibial osteosyntheses in a chinchilla. Case: A 9-month-old chinchilla weighing 0.56 kg was referred for surgery for proximal and mid-diaphyseal tibia fractures resulting from trauma. Following preanesthetic evaluation, the animal received intramuscular dexmedetomidine (15 µg kg -1) as preanesthetic medication. Sedation was apparent after 15 min and was verified by a decreased activity, the animal allowing manipulation, absence of the eyelid and righting reflexes, and limb movement after clamping removal of limb after clamping. After achieving sedation, anesthesia was induced and maintained with sevoflurane (FiO2 = 1.0), supplied through a nasoral mask. Sciatic and femoral nerve blocks were performed with the aid of a neurostimulator. A needle was inserted into the femoral triangle, cranial to the femoral artery, and into the depression between the sciatic tuberosity and the greater femoral trochanter. The neurostimulator was set at a pulse frequency of 1 Hz, pulse duration of 0.1 ms and initial current of 0.6 mA. The needle was advanced toward the nerves until muscle contractions were observed, and the current was gradually reduced until contractions were manifested at a minimum current of 0.2 mA. Ropivacaine 0.2% (1 mg kg -1) was injected at each point. Intraoperative physiological parameters remained stable and within the reference limits while the animal was under light anesthesia. Signs of recovery appeared soon after the inhaled anesthesia was stopped; awakening was gradual and without any signs of excitement or other adverse effects, eliminating the need for additional analgesic medication. Subcutaneous fluid therapy, antibiotics, and anti-inflammatory medications were administered immediately postoperatively. Discussion: This report is groundbreaking in describing neurostimulation-guided sciatic and femoral nerve blocks as an alternative to epidural anesthesia for hind limb surgery; furthermore, it demonstrates the efficacy and safety of ropivacaine in Chinchilla lanigera, which is relevant to the clinical use of the drug as part of a rodent anesthetic protocol. Sevoflurane associated dexmedetomidine use and locoregional anesthesia resulted in cardiorespiratory stability and the absence of behavioral signs of pain in the immediate postoperative period. The technique was easy to apply, and the use of the neurolocalizer increased blockade safety by allowing anesthesia administration as clo...

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Section: Discussionunclassified

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Nerve Stimulator-Guided Ciatic and Femoral Nerve Block during Tibial Osteosynthesis in Chinchilla lanigera

Lemos

Vieira

Gusmão

et al. 2019

Acta Scientiae. Vet.

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“…Tissues/area desensitized: Used together, these blocks will desensitize structures of the rear limb from the distal femur through the digits. • The description of the block is beyond the scope of this paper but the description and corresponding detailed illustrations can be accessed in Enomoto et al, 2017. BOX 22 Technique for blocking the sciatic and femoral nerves ▪ Although no comparative data are published, a nerve finder or ultrasound guidance is likely to improve block accuracy, especially of the femoral nerve (Campoy & Read, 2013;Otero & Portelo, 2018;Portela et al, 2018a). ▪ The technique described here is used by the author.…”

Section: Other Blocks Of the Pelvic Limbsmentioning

confidence: 99%

Local and regional anaesthesia in dogs and cats: Descriptions of specific local and regional techniques (Part 2)

Grubb

Lobprise

2020

Veterinary Medicine & Sci

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Pain management in veterinary patients is a crucial component of appropriate patient care. Local anaesthetic drugs used in local and regional blockade can completely block the transmission of nociceptive impulses, decreasing both intra-operative nociception and postoperative pain, while decreasing the potential incidence of adverse effects that can be associated with systemic boluses of drugs. For efficacy and safety, this class of drugs is recommended as part of the analgesic protocol in the majority of surgical procedures and traumatic injuries. Numerous local and regional blocks are proven effective in dogs and cats, thus providing the clinician with ample opportunity to include these blocks in practice. This manuscript, Part 2 of a two-part instalment, focuses on brief descriptions of select commonly used local/regional anaesthesia techniques for dogs and cats that cover a multitude of painful surgeries/injuries and that can be implemented in any practice. In Part 1 of this topic, detailed information on local anaesthetic drugs commonly used in small animal practice was reviewed . K E Y W O R D Sanalgesia, bupivacaine, liposome-encapsulated, local anaesthetics, local block This article is linked to "Local and regio nal anaes thesi a in dogs and cats: Overv iew of conce pts and drugs (Part 1)."

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“…Regional anesthesia is well-described and widely used in veterinary medicine in order to control stress response under general anesthesia, improve perioperative analgesia, reduce opioids administration together with their related side effects, and promote earlier recovery from anesthesia (1,2). On the other hand, potential serious complications such as direct trauma to neurovascular structures or ventricular arrhythmias (3,4) are also reported.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Ultrasound Sciatic and Saphenous Nerve Blocks for Tibial Malunion Surgical Correction in a Pediatric African Leopard (Panthera pardus)

et al. 2020

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Little information is available regarding ultrasound-guided locoregional anesthesia in non-domestic species. Locoregional techniques have been shown to reduce intraoperative anesthetic requirements and provide postoperative pain relief. Decreasing dosage of general anesthetics allows more stable cardiopulmonary function during anesthesia and reduces the probability of side effects. An 11-week-old African leopard (Panthera pardus) was referred for treatment of a malunion angular limb deformity secondary to a tibial and fibular fracture. The animal was scheduled to undergo angular correction of the tibia via closing wedge osteotomy and fixation with a locking plate system. Following preanesthetic medication and induction of general anesthesia, a saphenous nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed under ultrasound guidance and a sciatic nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed using ultrasound and a peripheral nerve stimulator. Intraoperative anesthetic plane was considered light, yet no abrupt cardiocirculatory changes were seen, nor was rescue analgesia required. This case report suggests that sciatic and saphenous blockade could therefore be recommended as part of a multimodal plan of analgesia for orthopedic surgeries in pediatric exotic felids.

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Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description

Cited by 54 publications

References 68 publications

Nerve Stimulator-Guided Ciatic and Femoral Nerve Block during Tibial Osteosynthesis in Chinchilla lanigera

Nerve Stimulator-Guided Ciatic and Femoral Nerve Block during Tibial Osteosynthesis in Chinchilla lanigera

Local and regional anaesthesia in dogs and cats: Descriptions of specific local and regional techniques (Part 2)

Case Report: Ultrasound Sciatic and Saphenous Nerve Blocks for Tibial Malunion Surgical Correction in a Pediatric African Leopard (Panthera pardus)

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