Nerve Block notes

Question 1

Carbocaine

Answer 1

onset is 60-90 sec and duration is up to 2 hours, 3mL usually used per nerve to effectively eliminate sensation in 5-10 mins

Question 2

Palmar digital nerve block goal-

Answer 2

block the PD nerve to eliminate sensation to caudal 1/3 of the hoof and entireeee sole

Question 3

Palmar nerve block blocks what anatomical features?

Answer 3

sole, digital cushion, impar ligament, NB, DDFT, Suspensory branches of NB, collateral cartilages, most of P3

Question 4

Palmar nerve block technique and how to performed successfully–

Answer 4

palpate PD neurovasc. bundle just proximal to collateral cartilage of P3, insert 25G 5/8 in needle directed distally subQ over the nerve

Question 5

Checking the palmar nerve block and what to expect-

Answer 5

allow 10 mins and then apply light pressure to med. and lat. bulbs

Question 6

What causes of lameness should resolve 80-100% with the Palmar nerve block???

Answer 6

Heel or/and sole pain, pedal osteitis, Navicular degen, DDFT tendinopathies, Navicular bursitis

Question 7

Abaxial Nerve block goal-

Answer 7

Anesth. the palmar nerve at level of the sesamoids

Question 8

Abaxial nerve block what anatomical feature-

Answer 8

dorsal coronary band

Question 9

Checking the abaxial nerve block and what to expect-

Answer 9

dorsal coronary band will be blocked but mid pastern will still have sensation

Question 10

Abaxial nerve block technique and how to performed successfully-

Answer 10

palpate the nerve as it comes over the sesamoids and place a 25G 5/8 needle subQ to the nerve, administer 3mL of anesthetic

Question 11

What causes of lameness should resolve 80-100% with the Abaxial nerve block???

Answer 11

Coffin jt OA, laminitis, hoof abscesses, P3 fx, pastern jt OA, P2 fx, DDFT tendinopathies in zone 4 (level of the pastern)

Question 12

Low 4- point nerve block- FORELIMB goal:

Answer 12

Anesth. the palmar metacarpal nerve and palmar nerve

Question 13

How to do a low 4 point nerve block-

Answer 13

palpate the button of the splint deposit approx. 0.5mL of anesth. under the splint, then advance the needle under the splint until contacting the palmar aspect of the cannon. Deposit 2.5mL in a fanning pattern

Second part is to desent. the palmar nerve at the level of the buttons of the splint bt the suspensory and the deep flexor tendon. STERILEEEE

Question 14

How to test Low 4 point nerve block-

Answer 14

apply light to increasing steady pressure on the proximal aspect of the fetlock

Question 15

What causes of lameness should resolve 80-100% with the Low 4-point nerve block???

Answer 15

Fetlock jt OA, prox. P1, chip fractures, sesamoiditis, sesamoid fx’s, suspensory branch avulsions/Desmitis, annular ligament Desmitis, digital sheath tenosynovitis, distal MC3 degen.

Question 16

Low 6 point block- rear limb, what does it block?

Answer 16

Similar to 4 point nerve block

HL ONLYYY

Question 17

:

Answer 17

ks

Question 18

Low 6 point nerve block needs to be done sterilely- use __-__ mL at each location and give ___ mins to be effective

Answer 18

3-5mL; 15 minutes

Question 19

How to test the low 6 point nerve block?

Answer 19

check the dorsal and plantar skin proximal to the fetlock

Question 20

Things to consider for the low 6 point block—

Answer 20

start with 6 point for HL, less than 1% of lameness are within the HL, patient must be sedated for blocking HL

Question 21

Proximal suspensory infiltration block how to do-

Answer 21

HL only, STERILE, place 1.5 inch needle with 22 G 2cm distal to the head of the lateral splint bone angling 45 degrees in a cranial and prox. direction, advance needle until it is compressing the palmar/plantar aspect of the cannon then inject 10 mL of anesth. Give 15-20 mins for block to work

Question 22

Proximal suspensory infiltration block GOAL-

Answer 22

blocks the structures distal to the head of the splint bone by inserting anesth. into the origin of the suspensory and the lateral palmar nerves

Question 23

Proximal suspensory infiltration block how to check-

Answer 23

Should block all structures distal to the head of the splint bone after 15-20 mins

Question 24

Peroneal nerve block goal:

Answer 24

eliminate sensation to the cranial aspect of the hock

Question 25

Peroneal nerve block how to do-

Answer 25

Palpate the superficial peroneal nerve in between the long and lateral digital extensor muscle bellies and infuse 200mL in a fanning pattern proximal and distal using 20G 1.5 needle

Question 26

Tibial nerve block goal:

Answer 26

Eliminate sensation to the caudal aspect of the hock, part of the tarsal sheath, SSFT, DSFT, and suspensory

Question 27

Tibial nerve block how to do:

Answer 27

Palpate the tibial nerve under the Gastroc tendon and place 1mL anesth to block the skin…. SubQ on med and lat sides, use 20G 1.5 in needle with 30mL of anesth. takes 30 mins to work

Question 28

Tibial nerve block- beware of this–>

Answer 28

this MUST be the LAST block of the day, horses may severely drag their toe from loss of extensor functioning

Question 29

What do we NOT use with tibial nerve blocks for anesth. agent??

Answer 29

Bupivacaine- bc will last too long and horse will drag toes and will prob need to stay in hospital

Question 30

Tibial nerve block landmarks–

Answer 30

About 4 inches above the point of the hock, insert 22G needle from lateral side until point can be felt under skin medially

Question 31

How long to scrub for superficial nerves? How long to scrub for nerves near synovial structures?

Answer 31

5 minutes; 10 minutes

Question 32

If horse was L FL limb and we did a regional block and now it is sound but lame on the R FL, what that a successful block?

Answer 32

Yessss

Question 33

Why is it called low 4 point block?

Answer 33

4 locations being blocked-
medial and lateral metacarpal nerve
medial and later palmar nerve

Question 34

if horses have effusion of their sheath, we should go around it because we want to block the nerve, not the synovial structures. T/F

Answer 34

True!!!

Question 35

6 point nerve block is called 6 point because…

Answer 35

dorsal lateral metatarsal nerve 
Dorsal medial metatarsal nerve 
lateral metatarsal nerve 
medial metatarsal nerve 
lateral plantar nerve 
medial plantar nerve

perform this block first in HL, dont do PD or abaxial nerve blocks on HL

Question 36

horses with ___ limb lameness are usually more ____

Answer 36

hind; severe

Question 37

after low 6 point block, what block do we do next?

“High two point block of the HL”

Answer 37

proximal suspensory infiltration block- directly into suspensory to block all structures distal to head of the splint bone
STERILE- directly into suspensory
i. Generally perform this on HL
ii. Use high 2-point in FL
Use 1/2 inch 20-22 g needle, go 2 cm distal to the head of the lateral splint bone angled at 45 degrees in a cranial and proximal direction
Advance the needle until it is compressing the palmar/plantar aspect of the cannon and then inject 10mL of anesthetic
Give 15-20 mins for the block to work, will block all structures distal to the head of the splint bone

Question 38

peroneal nerve blocks blocks the ____ and ___ nerves

Answer 38

tibial and peroneal nerves