Unilateral cervical plexus block for prosthetic laryngoplasty in the standing horse

Abstract

For standing unilateral laryngeal surgery, a cervical plexus block is a viable alternative to tissue infiltration and it improves the surgical field conditions.

Clinical Assessment of an Ipsilateral Cervical Spinal Nerve Block for Prosthetic Laryngoplasty in Anesthetized Horses

“…The risk avoidance of general anesthesia and recovery is cited as a major benefit in the advent of the standing prosthetic laryngoplasty (20). Indeed, standing surgery does not require anesthetic recovery, but standing laryngoplasty is performed under sedation using α2-adrenergic receptor agonists as either intermittent boluses or a constant rate infusion (11,20). A recent study comparing fecal output and postoperative colic in horses undergoing standing or general anesthesia showed that horses with higher cumulative doses of detomidine had a longer time to first fecal passage and reduced overall 24-h fecal output.…”

“…The ventral branch of C2 and the cutaneous branches of C3 do not provide sensory innervation to the deeper laryngeal structures. During standing prosthetic laryngoplasty, a second intraoperative local anesthetic infiltration at the level of the caudal pharyngeal constrictors and cricoarytenoid joint is necessary for antinociception (11). Albeit rare, anecdotal transient contralateral arytenoid paresis/plegia has been observed during standing prosthetic laryngoplasty due to local anesthetic diffusion leading to inadvertent blockade of the contralateral recurrent laryngeal nerve.…”

“…Following clipping and aseptic preparation of the surgical site, the neurovascular bundle associated with the ipsilateral second cervical spinal nerve (C2) was identified sonographically using a technique similar to that previously described (11). Briefly, using a 12-MHz linear array transducer with compatible portable ultrasound machine (MyLab Alpha model 7400; Esaote S.p.A., Genova, Italy) positioned just ventral to the wing of the atlas at the level of parotid tissue, the operator scanned caudally with the probe oriented axially with a slightly dorsal angle (Figure 1) to find the fascial plane between the cleidomastoideus and longus capitis muscles.…”

“…In 2018, Campoy et al described an ultrasound-guided locoregional anesthetic cervical spinal nerve block for use in horses through blockade of the ipsilateral ventral branch of the second cervical spinal nerve (C2) combined with subcutaneous perineural infiltration of the ipsilateral third cervical spinal nerve (C3) cutaneous branches (hence forth referred to as C2-C3) during sedated, standing prosthetic laryngoplasty (11). A conscious, sedated horse will respond to surgical stimuli in the absence of nociceptive blockade; therefore, locoregional anesthesia is essential.…”

Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature

“…Nine publications focused on different loco-regional techniques [272][273][274][275][276][277][278][279][280]. In the last few years, a renaissance of loco-regional techniques on standing horses has occurred with the advent of ultrasound guided technology [469,470]. When general anaesthesia is unavoidable, loco-regional techniques can still be used to provide intra-and postoperative analgesia, reduce surgical stimulations and produce muscle relaxation.…”