ISSN 2398-2977      

Hindlimb: perineural analgesia

pequis

Synonym(s): Nerve block


Introduction

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

Uses

  • Valuable diagnostic tool for localization of pain causing lameness or poor performance.
  • Direct diagnostic imaging, diagnosis and prognosis.
  • Peri-operative analgesia.

Advantages

  • Systematic procedure.
  • Minimally invasive.
  • Good 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 WileyOnline.
  • Malton R & Nagy A (2015) Diffusion of radiodense contrast medium after a mid-pastern ring block. Equine Vet Educ 28 (1), 40-46 WileyOnline.
  • 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 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.
  • Contino E, King M, Valdes-Martinez A & McIlwraith C W (2015) In vivo diffusion characteristics following perineural injection of the deep branch of the lateral plantar nerve with mepivacaine or iohexol in horses. Equine Vet J 47, 230-234 PubMed.
  • 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, 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.
  • Hendrickson D A & Nixon A J (1992) A lateral approach for synovial fluid aspiration and joint injection of the femoropatellar joint of the horse. Equine Vet J 24 (5), 399-401 PubMed.

Other sources of information

  • Bassage L H & Ross M W (2011) Diagnostic Analgesia. In: Diagnosis and Management of Lameness in the Horse. Eds: Ross M W & Dyson S J. Elsevier Saunders, USA. pp 100-135.
  • Moyer W, Schumacher J & Schumacher J (2011) Eds Equine Joint Injection and Regional Anesthesia. Academic Veterinary Solutions, Chadds Ford, USA. 
  • Hughes T K, Eliashar E & Smith R K W (2006) In-vitro Evaluation of a Single Injection technique for Diagnostic Analgesia of the Proximal Suspensory Ligament. In: ECVS Seville, Spain 2006 - Proceedings. Eds: Schramme M, Tremaine H, Walmsley J & Houlton J. ECVS, Zurich. pp 71-73.
  • Dyson S (2006) Critical Evaluation and Review of Local Anaesthetic techniques for the Upper Hindlimb. In: Handbook of Presentations & Free Communications. BEVA Congress 2006. BEVA, UK. pp 33-34.
  • 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.
  • Torre F (2004) How to Perform and Interpret Hind Leg Nerve Blocks in a Fractious Horse. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 39.
  • Stashak T S (2002) Perineural Anesthesia The Hindlimb. In: Adams Lameness in Horses. 5th edn. Lippincott, Williams & Wilkins, USA. pp 165-167.

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