Locoregional Anesthesia Flashcards by Kimberlee Ward

What are the types of Local Anesthesia?

Topical
SQ/Line block
Wound soaker

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What are specific blocks for locoregional anesthesia?

Head
Thoracic limb
Pelvic limb
Thorax

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What are some Topical Anesthesias?

EMLA cream
Lidoderm
Ophthalmic: Tetracaine or proparacaine
Laryngeal: Lidocaine for intubation in cats

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What anesthetic is used for Intubation in cats?

Lidocaine

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When is subcutaneous anesthesia used?

Utilized for wounds, masses, skin biopsy

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When is a wound soaker catheter placed?

Total ear canal ablation
Oncologic surgery
Large wound closure

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What are the complications of a wound soaker catheter?

Catheter dislodgement
disconnection
Local anesthetic toxicity
Delayed wound healing

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What are the advantages of a wound soaker catheter?

technically simple
consistent and prolonged analgesia
decreased need for systemic analgesics

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What are the peripheral nerve blocks?

Plexus
Intercostal
Paravertebral

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What are the central/neuraxial nerve blocks?

Epidural

Spinal

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“Bier Block”

Intravenous regional anesthesia (IVRA)

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IVRA

Intravenous regional anesthesia

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When is the Bier Block indicated?

Distal extremity

Procedure that is less than 60-90 mins

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What are the advantages of the Bier Block?

Simple and reliable

Minimal blood loss/clear surgical field

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What are the IVRA complications?

Tourniquet pain 
Ischemia/nerve injury 
Limb swelling 
Hematoma
Local anesthesia toxicity

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What are the peripheral nerve blocks of the head?

Retrobulbar block 
Maxillary block 
Infraorbital block 
Inferior alveolar block 
Mental block

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What are the indication for the retrobulbar block?

Enucleation
Evisceration/prothesis
Intraocular surgery

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What are the nerve affected by the Retrobulbar block?

CN II
CN III
CN IV
CN V
CN VI 
Ciliary ganglion (parasympathetic)

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What are the advantages of the Retrobulbar block?

Post-op analgesia
Globe immobility during surgery
Decreased anesthetic and NMBD requirements

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What are the complications of the Retrobulbar block?

Retrobulbar hemorrhage 
Damage to optic nerve, extraocular mm. 
Globe penetration 
Intravascular injection 
Intrathecal injection (into optic nerve/ subarachnoid space)

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What are the four dental blocks?

Infraorbital foramen
Middle Mental foramen
Vascular notch (mandible)
zygomatic arch

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What nerve does the Maxilllary nerve block?

Sensory branch of CN V

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What does the Maxillary nerve block provide anesthesia for?

Maxilla
teeth
soft tissues
Lateral aspect of nasal mucosa

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What are the three techniques/approaches to the maxillary nerve block?

Subzygomatic
Maxillary tuberosity
Infraorbital

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What does the | Infraorbital nerve block supply anesthesia to?

3rd premolar and teeth rostral Rostral Maxilla Soft tissues

What does the | Inferior alveolar nerve block supply anesthesia to?

Mandibular teeth Rostral lower lip Intermandibular space

What does the Mental nerve block supply anesthesia to?

Rostral lower lip

What are the Peripheral nerve blocks of the thoracic limb?

Cervical paravertebral block Brachial plexus block RUMM block "declaw" block - Distal, radial, ulnar, median

What does the cervical paravertebral nerve block supply anesthesia to?

Entire thoracic limb including scapular and shoulder joint

What does the Brachial Plexus nerve block supply anesthesia to?

Distal to and including the elbow

What nerves are blocked with the Brachial plexus nerve block?

C6 - suprascapular C7 - Musculocutaneous C8 - Radial T1 - median and ulnar

What does the | RUMM Block supply anesthesia to?

Distal thoracic limb

What nerves are blocked by the RUMM block?

Radial Ulnar Median Musculocutaneous

What anesthetic is used in a declaw?

Bupivacaine

What are the Peripheral nerve blocks for the pelvic limb?

Femoral nerve | Sciatic nerve

What nerve block is used for Thoracotomys or rib fractures?

Intercostal nerve block

What is the positioning for an epidural?

Sternal recumbency

What is the concern for using a higher volume of drug in an epidural?

sympathetic blockade and hypotension

What is the most common local anesthetic + opioid combo?

Bupivacaine + Morphine

Where does Morphine L-S epidural provide analgesia?

Thoracic wall | Thoracic limbs

What does the Auriculopalpebral nerve block cause?

Paralysis of orbicularis oculi mm.

What is the common use for a Supraorbital nerve block in equine?

Placement of sub-palpebral lavage catheter

What nerve block is used for standing enucleation in equine?

Retrobulbar block

What blocks are used for equine dentals?

Infraorbital nerve block Mental nerve block Inferior alveolar nerve block

What are the uses for a caudal epidural?

Control of rectal tenesmus Correction of uterine torsion, fetotomy, obstetric manipulations Tail amputation, rectovaginal fistula repairs, Caslick's procedure Hind limb procedures and pain

Where do you place an epidural in an equine?

First coccygeal space (Co1-Co2)

What drug is used for equine epidurals?

2% Lidocaine

What are the alpha 2 agonists used with equine epidural?

Xylazine | Detomidine

What is the common drug combinationfor equine epidural?

Detomidine + Morphine

When is intra-articular morphine used?

analgesia post-arthroscopy

What does the Peterson block block?

Oculomotor trochlear abducens 3 branches of trigeminal

What do you block for dehorning in cattle?

Cornual branch of zygomaticotemporal nerve

What do you block for dehorning in goats?

Cornual brainch of zygomaticotemporal nerve | cornual branch of infratrochlear nerve

What are the two blocks for Regional Ruminant flank laparotomy?

Proximal paravertebral | Distal paravertebral

What are the two blocks for Infiltration ruminant flank laparotomy?

Line Block | Inverted L block

What region does the proximal paravertebral thoracolumbar anesthetize?

Dorsal and ventral branches of T13, L1, L2 spinall nerves

What are the signs of the proximal paravertebral thoracolumbar blockade?

Absent reaction to pinprick Increased skin temperature due to vasodilation Spinal scoliosis towards desensitized side due to paralysis of paravertebral mm.

What are the advantages of the proximal paravertebral thoracolumber block?

No disruption of incision site | Faster than line blocks

What are the disadvantages of the proximal paravertebral thoracolumber block?

Technical difficulty Scoliosis may cause difficulty closing incision Risk of penetrating great vessels Loss of motor control if LA migrates to femoral nerves

What are the advantages of the distal paravertebral thoracolumber block?

Lack of scoliosis | Less risk of penetrating major blood vessels

What are the disadvantages of the distal paravertebral thoracolumber block?

Larger amount of local anesthetic vessels | May be less effective

What animals do you use the Lumbosacral epidural on?

Immature cattle small ruminants camelids pigs

Where do you place the Lumbosacral epidural?

L6-S1 space

What drugs are commonly used with Lumbosacral epidurals?

Alpha 2 agonists

What are the blocks used in teats?

Ring block Inverted V block Teat cistern infusion IV regional anesthesia of the teat

What blocks are used for the cranial aspect of udder and teats?

Paravertebral block of L1, L2, and L3 | High caudal epidural

What are the blocks used for the foot?

Ring block | IVRA

What drug is used for testicular blocks for castration?

Lidocaine