1887

Pain management II: local and regional anaesthetic techniques

image of Pain management II: local and regional anaesthetic techniques
GBP
Online Access: GBP25.00 + VAT
BSAVA Library Pass Buy a pass

Abstract

The provision of local anaesthetic blocks prior to surgery, postoperatively or for critically ill or injured patients is a powerful tool for improving the quality of pain control. When performed correctly, there are observable benefits, such as anaesthetic-sparing properties and improved patient comfort. This chapter looks at the history of pain management, pharmacology and pharmacokinetics and local anaesthetic techniques.

Loading full text...

Full text loading...

/content/chapter/10.22233/9781910443231.chap11

Figures

Image of 11.1
11.1 Diagram of a nerve axon, showing an expanded view of a sodium channel in the open and closed state.
Image of 11.2
11.2 Chemical structures of local anaesthetics from the ester group. Red circles indicate the ester linkage.
Image of 11.3
11.3 Chemical structures of three commonly used amide local anaesthetic drugs. Red circles indicate the amide linkage.
Image of 11.7
11.7 A ‘splash’ block being applied on the surgical incision following closure of the linea alba in a dog.
Image of 11.8
11.8 (a) A diffusion wound catheter placed within the incision used for a hindlimb amputation in a dog. (b) Bupivacaine with bicarbonate was injected through the injection port (arrowed) attached to the catheter for postoperative pain control.
Image of 11.9
11.9 (a–b) Use of a nerve stimulator and an insulated needle to perform accurate deposition of local anaesthetic around nerve bundles. These images show a RUMM block being performed with an older unit. New units have electrical current scales which are easier to use and proprietary insulated needles. (c) New model nerve stimulator (Stimpod, Mila International).
Image of 11.10
11.10 (a) Diagram illustrating the needle positions to perform the auricular block in a dog. The positions are identical for the cat. (b) Auricular block for a dog undergoing a vertical ear canal ablation. (a, © Juliane Deubner, University of Saskatchewan, Canada; b, Courtesy of Marieke de Vries, Davies Veterinary Specialists, Higham Gobion, UK)
Image of 11.11
11.11 Cervical paravertebral block being performed using the cranial–caudal approach in a dog about to undergo a humeral fracture repair.
Image of 11.12
11.12 Approaches to the paravertebral block. The green needle indicates the direction for the dorsal–ventral approach and the blue needles indicate the direction for the cranial–caudal approach. C = cervical; T = thoracic. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.13
11.13 (a) Diagram illustrating the direction of the needle to perform the brachial plexus block in a dog. The landmarks are the same for the cat. (b) This dog had a fractured radius/ulna and was difficult to handle. Following opioid administration and a brachial plexus block, the dog became friendly and appeared pain-free ( ). C = cervical; T = thoracic. (a, © Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.14
11.14 Diagrams showing the needle positions for performing the RUMM block. (a) The radial nerve is blocked proximal to the elbow on the lateral surface. (b) The musculocutaneous, medial and ulnar nerves are blocked on the medial surface proximal to the elbow. The positions are identical for the cat. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.15
11.15 (a) The radial nerve in a cat is blocked on the cranial surface of the forelimb, and (b) the median and ulnar nerves are blocked on the palmar surface of the forelimb. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.16
11.16 The femoral nerve is blocked within the groin area as it crosses the femoral triangle. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.17
11.17 The sciatic nerve is blocked between the cranial and middle third of a line connecting the greater trochanter and the ischiatic tuberosity. The tibial nerve is blocked deep to the gastrocnemius muscle and the common peroneal nerve is blocked as it passes caudal to the head of the fibula. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.18
11.18 (a) Cross-section of the spinal cord area depicting the divisions between the epidural and subarachnoid spaces. (b) Sagittal section of the lumbosacral area illustrating needle placement into the epidural space. L = lumbar; S = sacral. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.20
11.20 Diagram illustrating the site for lumbosacral injection, indicated by the red circle. The horizontal blue dashed line illustrates the imaginary line joining the iliac crests, and the yellow dashed line marks the vertebral column. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.21
11.21 An air bubble is introduced into the syringe to aid in detecting loss of resistance to injection into the epidural space.
Image of 11.22
11.22 A loss of resistance syringe for assessing placement of a spinal needle into the epidural space.
Image of 11.23
11.23 A hanging drop of sterile saline or injectate can be placed on the hub of the needle; aspiration of the liquid indicates entry of the distal end of the needle into the epidural space. (Courtesy of Marieke de Vries, Davies Veterinary Specialists, Higham Gobion, UK)
Image of 11.24
11.24 (a) An epidural catheter and Tuohy needle. (b) The needle has a specially designed end to allow the cranial movement of the catheter. (c) Special patches with clips are available to fix the catheter to the skin.
Image of 11.25
11.25 Diagrams illustrating the needle positions for digital nerve blocks for (a) a cat and (b) a dog. The needle is inserted at the point of bifurcation of the nerves. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.26
11.26 (a) Placement of a catheter into a superficial vein and application of a tourniquet (not visible in this image) to perform an intravenous regional block in the hindpaw region of an anaesthetized dog for digit removal. (b) The leg is held above heart level for 5 minutes and the tourniquet is tightened until there is loss of a peripheral pulse distal to the tourniquet. Lidocaine is then injected through the pre-placed catheter.
Image of 11.27
11.27 (a) Placement of an intercostal nerve block in a dog undergoing a lateral thoracotomy. (b) Use of a diluted solution of bupivacaine to allow multiple injections around the intercostal nerves in a cat undergoing a median sternotomy.
Image of 11.28
11.28 Diagram illustrating the areas (red circles) where an intercostal block can be performed for a lateral thoracotomy incision (dashed line) or for chest drain placement. (© Juliane Deubner, University of Saskatchewan, Canada)
Image of 11.29
11.29 Injection of bupivacaine through a pre-placed interpleural catheter for administration of an interpleural block in a dog after lateral thoracotomy. The incision is on the left side of the dog.

More like this

/content/chapter/10.22233/9781910443231.chap11
dcterms_title,dcterms_description
-contentType:Journal
5
5
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error