Use of an ultrasound‐guided sciatic and saphenous nerve block as a part of the multimodal analgesic management in a cria for the stabilisation of a left tibial eminence avulsion fracture

Abstract

A 5-month-old female cria with body mass of 30 kg was referred to the Langford Vet farm animal practice for management of a left tibial eminence avulsion fracture. Preanaesthetic medication consisted of xylazine 0.3 mg/kg and butorphanol 0.2 mg/kg intravenously, followed by induction of anaesthesia with ketamine 4 mg/kg intravenously. Anaesthesia was maintained with isoflurane vaporised in oxygen. A multimodal analgesic approach consisting of an ultrasound-guided sciatic and saphenous nerve block using a combination of 2 mg/kg of lidocaine and 10 μg/kg of detomidine and a continuous infusion of ketamine 25 μg/kg/minute were used. Total anaesthetic time was 375 minutes. The cria received paracetamol 5 mg/kg and flunixin meglumine 2 mg/kg intravenously in the postoperative period. The cria was weight bearing on the operated hind limb 3 hours post-extubation. Intravenous meloxicam (0.5 mg/kg/day) was administered 24 hours postoperatively for 4 days. Amoxicillin 15 mg/kg intramuscularly every 48 hours was continued until discharge.

Ultrasound‐guided sciatic nerve block in two alpacas (Vicugna pacos) as part of an anaesthesia plan for hindlimb fractures

“…The end volumes were 0.07 ml/kg (Case 1) and 0.09 ml/kg (Case 2) of bupivacaine 0.5%, which provided satisfactory antinociception during surgery. Volumes administered in both patients were lower than the volumes used in previously published case reports (0.1 ml/kg) 17,18 and remained between the recommended doses (0.05–0.1 ml/kg) for ultrasound‐guided sciatic nerve block in small animals 21 . The concentration of bupivacaine (0.5%) is the same as that recommended by Otero and Portela 21 .…”

“…Recently, a second case report  of  about ultrasound-guided femoral and sciatic nerve block for a tibial eminence avulsion fracture was published. 18 Even considering the economic impact of buying an ultrasound machine, it has been proven that, overall, the anaesthesia costs decreased due to decreased costs related to pain management and complications associated with further treatments. 33 Alternatives to PNBs are neuraxial blocks, such as epidural anaesthesia.…”

“…Bupivacaine blockade duration in ruminants can last up to 360 minutes, although it was not specified whether this was motor blockade, sensory blockade or both. 37 In dogs, ultrasound-guided sciatic nerve block with 0.15 ml/kg of bupivacaine 0.5% showed a motor blockade of 12 hours [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and a sensory blockade of 10 hours. [4][5][6][7][8][9][10][11][12]38 Alpacas are not considered food-producing animals in Belgium, and both were client-owned companion animals; therefore, the use of bupivacaine could be justified by the duration of the surgical procedure.…”

“…17 Recently, an ultrasound-guided saphenous and sciatic nerve block was described as part of a multimodal approach for a tibial eminence avulsion fracture in an alpaca. 18 In the present case report, two alpacas were presented at different times for surgical repair of pelvic limb fractures (one metatarsal and one tibial). A recent review about locoregional anaesthesia in human lower extremity surgeries showed that the sciatic nerve block is used in surgeries of the forefoot, the midfoot and the plantar and lateral ankle.…”

“…Another case report describes ultrasound‐guided psoas compartment and proximal sciatic nerve blocks for pain management of hindlimb surgical procedures in the alpaca 17 . Recently, an ultrasound‐guided saphenous and sciatic nerve block was described as part of a multimodal approach for a tibial eminence avulsion fracture in an alpaca 18 …”