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Y4 EQ - Orthopaedics > Diagnostic analgesia > Flashcards

Diagnostic analgesia Flashcards

1
Q

Why is diagnostic analgesia important in equine veterinary?

A

Integral part of the lameness examination

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2
Q

What do you need to be able to perform diagnostic analgesia?

A
  • Lame horse: not always obvious!
  • Good handler: safety!
  • Good technique: precision/accuracy!
  • Logical step-wise approach
  • Ability to recognise improvement: try and avoid bias!
  • Understand structures desensitised
  • Plenty of time: not always available in busy equine practice!
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3
Q

How do local anaesthetics work?

A

Act by blocking sodium channels and preventing depolarisation

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4
Q

Which local anaesthetics are most commonly used in equine practice?

A

Mepivicaine
Bupivivcaine

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5
Q

Compare the onset time and duration of mepivicaine and bupivicaine

A

Mepivicaine: 1-2min onset/45-60min duration
Bupivicaine: 4-5 min onset/1-2hr duration

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6
Q

List the 3 contraindications for using diagnostic analgesia

A
  • Suspect fracture - Don’t find out the hard way!
  • Cellulitis
  • Uncooperative horse
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7
Q

Why is diagnostic analgesia not indicated in cellulitis cases?

A

Risk of iatrogenic sepsis
Local anaesthetics don’t work well in acidic conditions

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8
Q

What complications can occur when using diagnostic analgesia

A
  • Broken needles: small needles, bent needles, horse moves suddenly
  • Severe lameness after block
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9
Q

What are the possible reasons for severe lameness following a nerve block?

A

“Flare” - Usually occurs soon after block (e.g. 30-60 mins)
Synovial sepsis - Usually occurs 12-24hrs after block

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10
Q

List the possible reasons for a poor response to local anaesthesia

A
  • Severe pain e.g. P3 fractures and subsolar abscessation
  • Poor technique/inadequate volume
  • Subchondral bone pain
  • Pain originating more proximal e.g. neck pain
  • Neurological/ mechanical
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11
Q

List the options for forelimb nerve blocks

A

Perineural:
- Palmar digital nerve block
- Abaxial sesamoid nerve block
- Low 4-point nerve block
- High 4-point; subcarpal; lateral palmar nerve block
- Median/ulnar
Synovial:
- DIPJ; NB; PIPJ; DFTS; MCPJ; carpal joints; carpal sheath; elbow; shoulder; bicipital bursa

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12
Q

List the options for hindlimb nerve blocks

A

Perineural:
- (Plantar digital nerve block)
- Abaxial sesamoid nerve block
- Low 6-point nerve block
- High 6-point; subtarsal; deep branch lateral plantar nerve block
- Tibial/peroneal
Synovial:
- DIPJ; NB; PIPJ; DFTS; MTPJ; tarsal joints; calcaneal bursa; tarsal sheath; stifle; hip;

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13
Q

What is the injection site for a palmar digital nerve block?

A

Just proximal to collateral cartilage, abaxial to edge of DDFT

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14
Q

Describe the technique used for the palmar digital nerve block

A
  • Limb non‐weightbearing
  • Palpate neurovascular bundle with thumb
  • Place needle angled distal and over bundle
  • Needle: 23/25G 5/8”
  • Volume: 1.5‐2ml
  • Wait 5-10 mins then test by checking skin sensation to the heel bulbs
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15
Q

Which structures are desensitised by the palmar digital nerve block?

A

Localises lameness to palmar aspect (navicular bone) of the foot
In reality:
- Navicular bone, navicular bursa, collateral sensory ligaments, distal sesamoidean impar ligament
- DDFT, insertion of SDFT
- Digital cushion
- Palmar processes of the pedal bone; collateral cartilages; +/- collateral ligaments of DIP joint

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16
Q

Where is the site of injection for the abaxial sesamoid nerve block?

A

Immediately palmar to neurovascular bundle at the abaxial surface of the base of the proximal sesamoid bone

17
Q

Describe the technique to perform the abaxial sesamoid nerve block

A
  • Limb non-weightbearing
  • Palpate neurovascular bundle with thumb
  • Needle inserted distal and parallel to bundle
  • Needle: 23/25G 5/8”
  • Volume: 2ml
  • Wait 5-10 mins then test by checking skin sensation to the dorsal coronary band
18
Q

List the structures desensitised by the abaxial sesamoid nerve block

A

The same structures as the palmar digital nerve block plus:
- Rest of P3/P2 and palmar P1
- Collateral ligaments of the DIP and PIP joints; DIP and PIP joints
- Distal sesamoidean ligaments
- Lamellar corium and coronary band
- Distal digital extensor tendons
- Dorsal extension branch of the suspensory ligament).

19
Q

Where is the injection site to block the distal interphalangeal joint?

A

Dorsal approach

20
Q

Describe the technique to block the distal interphalangeal joint

A
  • Weight‐bearing; midline
  • Palpate depression just proximal to coronary band (1‐2cm) on dorsal aspect of pastern
  • Insert needle vertically through skin and extensor tendon
  • Can also be done via dorsolateral or dorsal inclined approach
  • Needle: 20G 1.5” (smaller needle)
  • Volume: ~6ml (larger volume)
21
Q

Which structures are desensitised in the distal interphalangeal block?

A
  • DIP joint
  • +/– Collateral ligaments of DIP joint
  • Navicular bone/bursa
  • Toe region of sole (not heel)
22
Q

Where is the injection site to block the navicular bursa?

A

Palmar approach between bulb of heels

23
Q

Describe the technique to block the navicular bursa

A
  • Weight‐bearing (horizontal midline) or flexed, both approaches through DDFT
  • Skin bleb bulb of heels
  • Use radiographic control (+ contrast) – difficult!
  • Needle: 18G spinal
  • Volume: 2‐4ml
  • Desensitises navicular region and toe only
24
Q

List the structures desensitised by the navicular bursa block

A

Desensitises navicular region and toe only

25
Q

Describe the low 4 or 6 nerve block

A

Low 4 in the forelimb and low 6 in the hind limb
Reason? – extra supply to dorsal fetlock by lateral and medial dorsal metatarsal nerves

26
Q

Which area is desensitised by the low 4 or 6 block?

A

Desensitise fetlock region

27
Q

Describe how to perform the low 4 block in the forelimb

A

2-3ml per site; 23G
- Lateral and medial palmar nerves (just below palpable button of the splints)
- Lateral and medial palmar metacarpal nerves (dorsal to DDFT laterally and between DDFT/SDFT medially)

28
Q

Describe how to perform the low 6 block in the hindlimb

A

2-3 ml per site; 23G
- Lateral and medial plantar nerves
- Lateral and medial plantar metatarsal nerves
- Lateral and medial dorsal metatarsal nerves (fan dorsally)

Y4 EQ - Orthopaedics (14 decks)

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