Equis ISSN 2398-2977

Forelimb: perineural analgesia

Contributor(s): Dennis R Gieser, Graham Munroe, Vetstream Ltd, Enzo Vettorato, Laura Quiney

Introduction

  • By removing sensitization to source of pain, lameness is abolished or lessened.
  • Technique is conducted sequentially, working from distal to proximal.

Uses

  • Localization of pain causing lameness or poor performance.
  • Valuable adjunct to lameness diagnostic work-up.
  • Direct diagnostic imaging, diagnosis and prognosis.
  • Peri-operative analgesia Anesthesia: analgesia - overview.

Advantages

  • Systematic procedure.
  • Minimally invasive.
  • Regional localization of source(s) of pain is a valuable adjunct to lameness or poor-performance work-ups.
  • Majority of perineural analgesia techniques are easy to perform.

Disadvantages

  • Local anesthetic solution may diffuse from deposition site and desensitize adjacent structures, eg joints, bursae, tendon sheaths, or more proximal nerves. Perineural analgesia is not as specific as once thought.
  • Accurate technique and choice of volume of local anesthetic solution are essential.
  • Careful interpretation of results often requires experience.
  • Can be time consuming if multiple blocks are to be performed in multiple limbs.
  • Anesthetic solution irritates tissues and can cause low grade inflammation → may sometimes confound scintigraphic imaging techniques for up to 2 weeks.
  • Procedure complicated by fractious horses.
  • There is a risk of introducing bacteria, and therefore infection.

Requirements

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Preparation

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Procedure

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Aftercare

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Pezzanite L, Contino E & Kackak C (2018) Lameness originating from the proximal metacarpus/tarsus: A review of local analgesic techniques and clinical diagnostic findings. Equine Vet Educ (In press) WileyOnline.
  • Paz C F, Magalhaes J F et al (2016) Mechanical nociceptive thresholds of dorsal laminae in horses after local anaesthesia of the palmar digital nerves or dorsal branches of the digital nerve. Vet J 214, 102-108 PubMed.
  • Malton R & Nagy A (2015) Diffusion of radiodense contrast medium after a mid-pastern ring block. Equine Vet Educ 28 (1), 40-46 VetMedResource.
  • Nagy A & Malton R (2015) Diffusion of radiodense contrast medium after perineural injection of the palmar digital nerves. Equine Vet Educ 27 (12), 648-654 VetMedResource.
  • Michou J & Leece E (2012) Sedation and analgesia in the standing horse 2. Local anaesthesia and analgesia techniques. In Pract 34 (10), 578-587 VetMedResource.
  • Nagy A, Bodo G & Dyson S J (2012) Diffusion of contrast medium after four different techniques for analgesia of the proximal metacarpal region: An in vivo and in vitro study. Equine Vet J 44 (6), 668-673 PubMed.
  • Nagy A, Bodo G, Dyson S J, Szabo F & Barr A R S (2009) Diffusion of contrast medium after perineural injection of the palmar nerves: An in vivo and in vitro study. Equine Vet J 41 (4), 379-383 PubMed.
  • Castro F A, Schumacher J S, Pauwels F & Blackford J T (2005) A new approach for perineural injection of the lateral palmar nerve in the horse. Vet Surg 34 (6), 539-542 PubMed.
  • Schumacher J, Schumacher J, Schramme M C, DeGraves F J, Smith R & Coker M (2004) Diagnostic analgesia of the equine forefoot. Equine Vet Educ 16 (3), 159-165 VetMedResource.
  • Lopez-Sanroman F J, Cruz J M, Santos M, Mazzini R A, Tabanera A & Tendillo F J (2003) Evaluation of the local analgesic effect of ketamine in the palmar digital nerve block at the base of the proximal sesamoid (abaxial sesamoid block) in horses. Am J Vet Res 64 (4), 475-478 PubMed.
  • Jones E (2003) The palmar digital nerve block. UK Vet (5), 6-7.
  • McGuigan M P & Wilson A M (2001) The effect of bilateral palmar digital nerve analgesia on the compressive force experienced by the navicular bone in horses with navicular disease. Equine Vet J 33 (2), 166-171 PubMed.
  • Schumacher J et al (2000) Effects of analgesia of the distal interphalangeal joint or palmar digital nerves on lameness caused by solar pain in horses. Vet Surgery 29, 54-58 PubMed.
  • Drevemo S, Johnston C, Roepstorff L & Gustas P (1999) Nerve block and intra-articular anaesthesia of the forelimb in the sound horse. Equine Vet J Suppl 30, 266-269 PubMed .

Other sources of information

  • Moyer W, Schumacher J & Schumacher J (2011) Eds Equine Joint Injection and Regional Anesthesia. In: Academic Veterinary Solutions. Chadds Ford, USA.
  • Redding W R (2006) Critical Evaluation and Review of Local Anaesthetic techniques for the Lower Limb. In: Handbook of Presentations & Free Communications. BEVA Congress 2006. BEVA, UK. pp 28-30.
  • Singer E R (2006) Critical Evaluation and Review of Local Anaesthetic techniques for the Upper Forelimb. In: Handbook of Presentations & Free Communications. BEVA Congress 2006. BEVA, UK. pp 31-32.
  • Bassage L H & Ross M W (2003) Perineural Analgesia in the Forelimb. In: Diagnosis & Management of Lameness in the Horse. Eds: Ross M W & Dyson S J. Saunders, USA. pp 100-107.


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