Index COPYRIGHTED MATERIAL · Anatomy nervous system, 11–12 peripheral nerve, 12, 12f Animal...
Transcript of Index COPYRIGHTED MATERIAL · Anatomy nervous system, 11–12 peripheral nerve, 12, 12f Animal...
Small Animal Regional Anesthesia and Analgesia, First Edition. Edited by Luis Campoy and Matt R. Read.
© 2013 ISUP, a division of John Wiley & Sons, Inc. Published 2013 by John Wiley & Sons, Inc.
273
Index
Abdomen. See Trunk, anesthesia ofAbdominal wall, nerves of, 190fAbducens nerve, 106Accidental drug administration, as epidural
anesthesia complication, 252–253Acepromazine, for ophthalmic procedures, 107Acoustic shadowing, 81, 81fACTH, 91, 92fAction potential, 28–29, 28f, 66, 66fAdjuncts, in intravenous regional anesthesia, 263Air, ultrasound appearance of, 82Allergic reactions, 16, 37–38α
2 adrenergic agonistsas adjunct in intravenous regional
anesthesia, 263for epidural analgesia, 247t, 250as local anesthetic adjuvant, 32
Alveolar nerve. See Inferior alveolar nerve blockAmerican Society of Regional Anesthesia
(ASRA), 11Amputation, wound soaker catheter
use in, 96, 96fAmylocaine, 6Analogue-digital-converter (ADC), 70
Anatomynervous system, 11–12peripheral nerve, 12, 12f
Animal positioning, 19–20. See also specific procedures
for epidural anesthesia, 236–238, 237f–238flateral recumbancy, 238, 238fsternal recumbancy, 237–238, 237f
for eye loco-regional anesthesia, 107for oral cavity nerve blocks, 119for pelvic limb anesthesia, 200
for electrolocation techniques, 200for ultrasound-guided techniques, 200
for spinal anesthesia, 251for thoracic limb anesthesia, 143–144
electrolocation techniques, 143–144ultrasound-guided techniques, 144
Anisotropy, 80–81, 83Aristotle, 3Arrhythmias
arrhythmogenicity of local anesthetics, 35as complication in intravenous regional
anesthesia, 262Articaine, 120t
Page numbers followed by f denote figures; page numbers followed by t denote tables.
Index.indd 273Index.indd 273 11/15/2012 3:21:32 PM11/15/2012 3:21:32 PM
COPYRIG
HTED M
ATERIAL
274 Index
Aschenbrandt, Theodor, 4Aseptic preparation, 20, 20f, 21fAseptic technique, components of, 20Auriculopalpebral nerve, anatomy of, 106Auriculopalpebral nerve block, 108–109,
108f, 109fanatomic landmarks, 108clinical tips, 109equipment, 108location for, 104fstep-by-step procedure, 108–109technique, 108–109
Autonomic blockadecardiovascular, 234epidural anesthesia, 234–235metabolism and hormones, 235
Avicenna, 3Axillary artery and vein, 141, 144, 153, 154, 157Axillary nerve, 151tAxon activation, 68
Baricity, 234, 234tBier, August, 5–6, 261Bier block, 6, 261Blood pressure, in epidural anesthesia, 253Blood vessels, ultrasound appearance of, 81Bone, ultrasound appearance of, 81Brachial plexus block, 150–158
combined ultrasonography/electrolocation-guided, 155–157
advantages, 155clinical tips, 156–157equipment, 155technique, 155–157, 156f
anatomic landmarks (ultrasound anatomy), 155
patient positioning, 155step-by-step procedure, 155–156, 156f
complications, 158tcontinuous peripheral nerve block (CPNB),
157–158, 157f, 158fcatheter placement and securing, 157–158,
157f, 158fdrug choice and infusion rate, 158
distribution of local anesthesia and analgesia, 151tfunctional regional nerve anatomy, 150nerve stimulation-guided (traditional
approach), 151–154clinical tips, 152–154equipment, 151
technique, 151–154, 152f–154f, 153t, 154tanatomic landmarks, 151, 152f, 153fmotor responses to nerve root
stimulation, 154tmotor responses to peripheral nerve
stimulation, 153tpatient positioning, 151, 152fstep-by-step procedure, 151–152
Bradycardia, as epidural anesthesia complication, 253
Bupivacainechemical structure of, 26fdensity of, 234tdescribed, 30development of, 6for epidural analgesia, 247t, 249t, 250for extrapleural infusion, 172intercostal use, 172, 173for interpleural analgesia, 178f, 179–182, 183for intra-articular analgesia, 222for intravenous regional anesthesia, 263onset and duration of action, 27tfor oral nerve blocks, 121, 121tfor pelvic limb anesthesia, 201, 222physicochemical properties of, 26tproperties of, 120tselective blockade by, 30for thoracic limb anesthesia, 144–145, 152, 158toxicity of, 34, 35, 35tin wound catheter use, 97
Buprenorphine, 33for epidural analgesia, 247tfor pelvic limb intra-articular analgesia, 222
Butorphanolfor epidural analgesia, 247tfor ophthalmic procedures, 107
Cardiac accelerator nerve fibers, 234Cardiovascular system
spinal and epidural anesthesia effects on, 234toxicity of local anesthetics, 34, 35–36, 35t
Catheters, 53–61connectors, 56, 57ffor continuous regional anesthesia, 53–56epidural, 55, 55ffixation (anchoring) devices, 56–57, 57f, 58fstimulating, 55–56, 56fuse in epidural anesthesia, 243–246, 244f–246fwound soaker, 57, 58f, 59, 59f, 60f, 93–100
Cauda equina, 228f, 230
Index.indd 274Index.indd 274 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
Index 275
Cauda equina syndrome, 16, 36Caudal inferior alveolar nerve block, 126t,
133–136clinical tips, 135complications, 136distribution of local anesthesia and analgesia,
133–134equipment, 134functional and clinical anatomy, 133technique, 134–135, 135f, 136f
extraoral (transcutaneous) approach, 126t, 135, 136f
intraoral approach, 126t, 134–135, 135fCentral nervous system toxicity of local
anesthetics, 34, 35, 35tCerebrospinal fluid (CSF), 230Cervical paravertebral block, 145–149
complications, 148–149, 150fdistribution of local anesthesia and
analgesia, 146equipment, 146functional and clinical anatomy, 145–146, 146fLemke’s modified approach, 147–148
anatomic landmarks, 148patient positioning, 148step-by-step procedure, 148
overview, 145technique, 146–147, 147f
anatomic landmarks, 146, 146f, 147fpatient positioning, 146step-by-step procedure, 147
Chlorhexidine gluconatecomplications, 21, 23, 23fuse of, 21, 22–23, 22f
Chlorprocaineonset and duration of action, 27tphysicochemical properties of, 26ttoxicity of, 35t
Chondrolysis, 222Chronaxy, 67, 68fClipping of the puncture site, 20Clonidine
for intra-articular elbow and shoulder joint analgesia, 162
for pelvic limb intra-articular analgesia, 222Cobo, Bernabe, 4Cocaine, 4–6Cocoa leaf, 3–4Color Doppler, 79, 79fCommon peroneal nerve, 209, 209f
Complications, 13–16. See also Toxicity; specific procedures
allergic reactions, 16, 37–38incidence of, 14infection, 16, 253, 262neurological injuries, 13–16
drug error, 16needle/mechanical trauma, 15, 43–44, 174neuronal ischemia, 15neurotoxicity, 16, 36, 253
systemic toxicity, 14, 185Conductors, 65Constant current generator, 70Continuous peripheral nerve block (CPNB)
brachial plexus block, 157–158, 157f, 158fpsoas compartment (lumbar plexus) block,
206–207Continuous wound infusion with local
anesthetics, 91–93Contrast resolution, 78Corning, G.L., 5Corticosteroids, for pelvic limb intra-articular
analgesia, 222Coulomb’s Law, 68Current density in biological tissues, 68
Dental anesthesia. See Oral cavity, nerve blocks for
Depolarization, 28–29, 66–67Dermatome, 11Detail resolution, 78Dexmedetomidine
dosage for sedation, 19for epidural analgesia, 247tfor intra-articular analgesia, 222for intra-articular elbow and shoulder joint
analgesia, 162as local anesthetic adjuvant, 32for ophthalmic procedures, 107for pelvic limb anesthesia, 199, 201, 222
Diaphragmatic paralysis/paresis, 144, 148–149, 185–186
Dibucaine, 6Diffusion catheters. See Wound soaker cathetersDiphenhydramine, for topical anesthesia
of eye, 115Disinfectant
chlorhexidine gluconate, 21, 22–23, 22f, 23fcomponents of “ideal,” 21povidine-iodine, 21, 22–23, 22f
Index.indd 275Index.indd 275 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
276 Index
Distribution of local anesthesia, with intravenous regional anesthesia, 263–264
Documentation, 17Doppler effect, 79, 79fDouble-bubble sign, 155, 156Doughnut sign, 84, 144Drug error, 16Dural sac, 230Dura mater, 230
Echogenic needles, 51, 52fEDTA (ethylenediaminetetra-acetic acid),
neurotoxicity and, 16Elastic bandage, 264, 266Elastomeric pumps, 60f, 61–63, 61f, 62fElbow joint analgesia, 161–163, 163fElectrodes, of peripheral nerve stimulator, 67Electrolocation of epidural space, 239–240, 240fElectrophysiology, 65–66EMLA (Eutectic Mixture of Local Anesthetics), 13Endoneurium, 12, 12fEnucleation
peribulbar block for, 113, 113fretrobulbar block for, 110–113, 111f
Epidural anesthesia, 227–254anatomic landmarks, 240animal positioning, 236–238, 237f–238f
lateral recumbancy, 238, 238fsternal recumbancy, 237–238, 237f
autonomic blockade, 234–235catheter placement, 243–246, 244f–246fcatheter removal, 246complications, 252–254
accidental drug administration, 252–253of continuous administration, 254delayed hair growth, 253Horner’s syndrome, 254hypotention/bradycardia, 253inadvertent intravascular injection, 253–254inadvertent subarachnoid/spinal or subdural
injection, 253infections, 253of local anesthetics, 253–254neural damage/neurotoxicity, 253of opioids, 254respiratory depression, 254
contraindications/precautions, 235–236defined, 227distribution of anesthetics, factors affecting,
232–234
age and physical condition, 233baricity and specific gravity, 234, 234tdirection of needle bevel, 233fatty tissue in epidural space, 233position of animal, 233site of injection, 232size of venous and lymphatic plexus, 233speed and pressure of injection, 232, 233fvolume and concentration, 232
doseslocal anesthetics, 247fopioids and α
2 adrenergic agonists, 247f
drug choices, 248–251continuous delivery through catheters, 250–251pharmacology, 248–250, 249t
equipment, 240indications, 235injection volume, 246–248, 247t, 248f
body weight and, 246, 247tspinal length and, 246–248, 248f
locating epidural space, methods for, 238–240, 238f–240f
lumbar approach, 242–243, 243flumbosacral approach, 240–242, 241f, 242fmorbidity and mortality decreases with
use of, 8morphine use, 32–33sacrococcygeal approach, 243, 244fsedation and anesthesia requirements, 236somatic blockade, 231–234
Epidural catheters, 55, 55fEpidural space, 229f, 230
fatty tissue in, 233methods for locating, 238–240, 238f–240f
electrolocation, 239–240, 240fhanging drop, 239, 239floss of resistance (LOR), 238–239, 238f–239f
Epinephrineas local anesthetic adjuvant, 32for local anesthetic toxicity, 35neurotoxicity and, 16
Epineurium, 12, 12fEquipment, 43–64. See also specific equipment items;
specific items; specific proceduresbattery-powered pumps, 63–64, 63fcatheters, 53–61elastomeric pumps, 60f, 61–63, 61f, 62finjection accessories, 51, 52f, 53, 53ffor intravenous regional anesthesia, 264–265needles, 43–51
Index.indd 276Index.indd 276 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
Index 277
peripheral nerve stimulators, 65–75ultrasound, 79–80, 80f, 82
Ethmoidal foramen, 104, 104fEthylenediaminetetra-acetic acid (EDTA),
neurotoxicity and, 16Etidocaine, 6Eutectic Mixture of Local Anesthetics
(EMLA), 13Exsanguination, 266Extension tubing, 51, 52f, 53Eye, 103–116
auriculopalpebral nerve block, 108–109, 108f, 109f
anatomic landmarks, 108clinical tips, 109equipment, 108step-by-step procedure, 108–109technique, 108–109
frontal nerve block, 109, 109finfiltration anesthesia, 113–115, 114finfratrochlear nerve block, 110loco-regional anesthesia, 106–116
animal positioning, 107in cats, 116contraindications for, 108general considerations, 106–109indications for, 107–108sedation and anesthesia requirements, 107
peribulbar block, 113, 113fregional nerve anatomy, 103–106, 105f, 106f
abducens nerve, 106auriculopalpebral nerve, 106facial nerve, 106frontal nerve, 105, 105f, 106finfraorbital nerve, 105infratrochlear nerve, 105, 105f, 106flacrimal nerve, 105, 105f, 106fmaxillary nerve, 105–106, 105fnasociliary nerve, 105oculomotor nerve, 105ophthalmic nerve, 105, 105foptic nerve, 104oribital foramina, 103–104, 104f, 104tpterygopalatine nerve, 105trigeminal nerve, 105–106, 105ftrochlear nerve, 105zygomatic nerve, 105–106, 105fzygomaticofacial nerve, 106, 106fzygomaticotemporal nerve, 106, 106f
retrobulbar block, 103, 104f, 110–113, 111f
topical anesthesia, 115–116advantages/disadvantages, 115–116drugs used, 115
zygomatic and lacrimal nerve block, 110
Face masks, 20Facial nerve
anatomy of, 106paralysis, 106
Facial tissue, ultrasound appearance of, 81Fat, ultrasound appearance of, 81Fatty tissue in epidural space, 233Feline oncologic surgery, wound soaker catheter
use in, 95f, 96Femoral nerve block, 208–215
combined ultrasonography electrolocation-guided, 212–215, 213f, 214f
equipment, 212femoral triangle approach, 212–213, 213fventral suprainguinal approach, 214–215
complications, 213, 214tdistribution of local anesthesia and analgesia,
209functional and clinical anatomy, 208–209, 208f,
209fnerve stimulation-guided, 210–215, 210f–211f
Campoy technique, 210–212anatomic landmarks, 210, 210fclinical tips/pearls, 211–212patient positioning, 210, 210fstep-by-step procedure, 210–211, 210f, 211f
equipment, 210Mahler technique, 212
Fenestrated catheters. See Wound soaker cathetersFentanyl
dosage for sedation, 19for epidural analgesia, 247t, 250for pelvic limb anesthesia, 199
Field block, 89Freud, Sigmund, 4, 5Frontal nerve, anatomy of, 105, 105f, 106fFrontal nerve block, 109, 109f
Gaedcke, Friedrich, 4Galen of Pergamon, 3Galvani, Luigi, 7Gauge, needle, 45–46General anesthesia, for ophthalmic procedures,
107Gray, Tyrell, 6
Index.indd 277Index.indd 277 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
278 Index
Hair growth, delayed as epidural anesthesia complication, 253
Halsted, William, 5Hand washing, 20Hanging drop technique for locating epidural
space, 239, 239fHartley, 3Hip joint, intra-articular injection of, 224Hirschel, Georg, 6History of regional anesthesia, 3–8Horner’s syndrome, 254Hyperpolarization, 67Hypersensitivity reactions, with local
anesthetics, 37–38Hypodermic needles, 4, 43–44, 44f. See also NeedlesHypotention, as epidural anesthesia
complication, 253Hypothalamic-pituitary (HPA) axis, 91
Incisional infiltration of local anesthetics, 89–102, 90fchoice of anesthetic, 97clinical tips for, 99complications, 99–100continuous wound infusion, 91–93distribution of anesthetic, 96–97, 97fwound soaker catheters, 93–100
Infection, 16as epidural anesthesia complication, 253with intravenous regional anesthesia, 262
Inferior alveolar nerve blockcaudal, 126t, 133–136
clinical tips, 135complications, 136distribution of local anesthesia and analgesia,
133–134equipment, 134functional and clinical anatomy, 133technique, 134–135, 135f, 136f
rostral, 127t, 136–138, 138fanatomic landmarks, 137clinical tips, 137–138distribution of local anesthesia and
analgesia, 137equipment, 137functional and clinical anatomy, 136–137technique, 137, 138f
Infiltration anesthesiadescribed, 13eye, 113–115, 114foral cavity, 127t, 138
Infraorbital canal, 122
Infraorbital foramen, 123, 132Infraorbital nerve, anatomy of, 105, 122–123, 122fInfraorbital nerve block, 126t, 129f, 131–133
clinical tips, 133distribution of local anesthesia and analgesia, 132equipment, 132functional and clinical anatomy, 131–132technique, 126t, 132–133
Infratrochlear nerve, anatomy of, 105, 105f, 106fInfratrochlear nerve block, 110Infusion pumps. See PumpsInjection accessories, 51, 52f, 53, 53fInjection pressure, 53, 53f, 54f
epidural injection, 232, 233fInline pressure gauge, 53, 53fInsulated needles, 45f, 48–49, 49f, 50–51, 50f, 52fIntercostal nerve, anatomy of, 168–169, 169f, 171fIntercostal nerve blocks, 169–178
anatomy and, 170, 170f, 171f, 172complications, 177–178distribution of local anesthesia, 173equipment, 173–174indications, 173local anesthetics used, 173overview, 169–173technique, 174–176, 174f–177f
Intercostal space, anatomy of, 170, 170fIntercostal vessels, 168–169, 171fInterpleural regional anesthesia, 178–186
complications, 184–186catheter dislocation, 185diaphragmatic paralysis, 185–186local anesthetic systemic toxicity, 185pain on injection, 186pneumothorax, 184–185
distribution of local anesthesia and analgesia, 182–183
equipment, 183indications, 181–182local anesthetics used, 182overview, 178–181technique, 183–184, 184f
Intra-articular analgesiafor elbow and shoulder joints, 161–163
distribution of local anesthesia and analgesia, 162
drugs used, 161–162clonidine, 162local anesthetics, 162opioids, 162steroids, 162
Index.indd 278Index.indd 278 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
Index 279
equipment, 162indications, 161purpose, 161techniques, 163, 163f
for pelvic limb, 222–224choice and dosing of local anesthetics, 222clinical tips, 224complications, 224distribution of local anesthesia and
analgesia, 222equipment, 222–223hip joint injection, 224indications, 222stifle joint injection, 223–224, 223ftoxicity issues, 222
Intraligamentary injection, 127t, 139Intraneural injection, 15Intraosseous anesthesia, oral cavity, 127t, 138–139Intrapulpal injection, 127t, 139Intraseptal injection, 127t, 139Intrathecal anesthesia, 251–252Intravascular injection
inadvertent as epidural anesthesia complication, 253–254
Intravenous regional anesthesia (IVRA), 261–270choice/dosing of local anesthetics, 263clinical tips for, 268–270complications, 269t, 270contraindications/precautions, 262defined, 13distribution of local anesthesia, 263–264equipment, 264–265indications, 262rationale for, 261–262step-by-step procedure
for pelvic limb, 267–268for thoracic limb, 265–267, 265f–267f
Ischemia, neuronal, 15Ischemic pain, 269IV catheterization, for intravenous regional
anesthesia, 265IVRA. See Intravenous regional anesthesia (IVRA)
Ketamineas adjunct in intravenous regional anesthesia, 263for epidural analgesia, 250for ophthalmic procedures, 107
Koller, Karl, 4–5
Labat, Louis Gaston, 6Lacrimal nerve, 105, 105f, 106f
Lateral articular nerve, stifle, 209, 209fLevobupivacaine
described, 30for epidural analgesia, 249tonset and duration of action, 27tphysicochemical properties of, 26tselective blockade by, 30toxicity of, 35, 35t
Lidocainedescribed, 30development of, 6for epidural analgesia, 249tfor intravenous regional anesthesia, 263onset and duration of action, 27tfor oral nerve blocks, 121, 121tfor pelvic limb intra-articular analgesia, 222physicochemical properties of, 26tproperties of, 120ttoxicity, 34, 35, 35t
in cats, 116neurotoxicity, 16
transdermal patches, 13in wound catheter use, 97
Lingual nerve, 133, 136Lipid rescue, 36Lipid solubility, of local anesthetics, 26, 26tLocal anesthetics
adjuvants to, 31–33α
2 adrenergic agonists, 32
opioids, 32–33sodium bicarbonate, 32vasoconstrictors, 31–32
chemical structure and classification, 25–26, 26f
common, 30–31continuous wound infusion with, 91–93for epidural analgesia, 247t, 249, 249textrapleural infusion with, 172for eye infiltration anesthesia, 113–115incisional infiltration, 89–102, 90ffor intercostal nerve blocks, 173for interpleural regional anesthesia, 178, 182for intra-articular elbow and shoulder joint
analgesia, 162mixtures of, 30–31mode of action, 27–30onset and duration of action, 27tfor oral nerve blocks, 120–121, 120t, 122tfor pelvic limb anesthesia, 201physicochemical properties of, 25–27, 26t
lipid solubility, 26, 26t
Index.indd 279Index.indd 279 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
280 Index
Local anesthetics (cont'd)pKa (dissociation constant), 26t, 27protein binding, 26–27, 26t
selective/differential blocks, 29–30toxicity, 33–38
cardiovascular system, 34, 35–36, 35tcentral nervous system, 34, 35, 35tclinical signs, 33thypersensitivity reactions, 37–38in intra-articular injections, 222lipid rescue, 36neurotoxicity, 36systemic, 185treatment for, 35–36wound healing, 36–37, 100–102
for trunk anesthesia, 173, 182ultrasound visualization of administration,
84–85, 84fLoco-regional anesthesia and analgesia
equipment for, 43–64rationale for, 7–8
Loco-regional anesthetic terminology, 12–13Loss of resistance (LOR), technique for locating
epidural space, 238–239, 238f–239fLower occlusion pressure, 265Lumbar plexus block. See Psoas compartment
(lumbar plexus) block
Mandibular foramen, 134, 135, 135fMandibular nerve, 133, 134fMantegazza, Paolo, 4Maxillary nerve
anatomy of, 105–106, 105fdistribution and branches of, 122–123, 122f
Maxillary nerve block, 121–128, 126t, 127f–129fclinical tips, 127distribution of local anesthesia and
analgesia, 124equipment, 124functional and clinical anatomy, 121–123technique, 125, 127, 127f, 128f
anatomic landmarks, 125infraorbital approach, 125, 127, 129fmaxillary tuberosity approach, 125, 127fsubzygomatic approach, 125, 128f
Medetomidine, for epidural analgesia, 247tMedial articular nerve, stifle, 209, 209fMedian nerve, 151t, 153t, 157, 159, 160f, 161Medulla spinalis, 230Membrane potential, 27–29, 28f
Meninges, 230Mental nerve. See Middle mental nerve blockMeperidine, for epidural analgesia, 247tMepivacaine
described, 30development of, 6for epidural analgesia, 249tonset and duration of action, 27tphysicochemical properties of, 26tproperties of, 120ttoxicity of, 35t
Methadone, for epidural analgesia, 247tMethylene blue solution, for epidural
analgesia, 247tMicroprocessor, of nerve stimulator, 69Middle mental nerve block, 127t, 136–138, 138f
anatomic landmarks, 137clinical tips, 137–138distribution of local anesthesia and
analgesia, 137equipment, 137functional and clinical anatomy, 136–137technique, 137, 138f
Minimum stimulating current, 73–74, 73fMorphine
for epidural analgesia, 247t, 250epidural use, 32–33as local anesthetic adjuvant, 32–33for pelvic limb intra-articular analgesia, 222for topical anesthesia of eye, 115
Muscles, ultrasound appearance of, 81Musculocutaneous nerve, 151t, 152, 153t, 157, 159,
160f, 161Mylohyoid nerve, 133
Na+-K+ pump, 27, 66Nalbuphine
for topical anesthesia of eye, 115for trunk analgesia, 172
Nasociliary nerve, 105Needles, 43–51
blunt, 44–45echogenic, 51, 52fgauge, 45–46hypodermic, 4, 43–44, 44finjection accessories for, 51, 52f, 53, 53finsulated 4, 8–49, 45f, 49f, 50–51, 50f, 52flength, 45–46pencil-point, 47, 47fperipheral nerve stimulator, 74–75
Index.indd 280Index.indd 280 11/15/2012 3:21:33 PM11/15/2012 3:21:33 PM
Index 281
Quincke, 47spinal, 46–48, 46f, 47f, 49fSprotte, 47, 47ftip design, 43trauma from, 15, 43–44, 174Tuohy, 44, 47, 48–49, 48f, 52f
Nerve activation, mechanism of, 66–67, 66fNerve block. See also Peripheral nerve block;
specific nerves; specific proceduresauriculopalpebral, 108–109, 108f, 109fbrachial plexus block, 150–158caudal and rostral palatine nerve blocks,
129–131caudal inferior alveolar nerve block, 126t,
133–136cervical paravertebral block, 145–149defined, 13femoral, 208–215infraorbital, 126t, 129f, 131–133infratrochlear, 110intercostal, 169–178maxillary, 121–128, 126t, 127f–129fmiddle mental, 127t, 136–138, 138fpsoas compartment (lumbar plexus) block,
201–208radial, median, musculocutaneous, and ulnar
(RUMM), 159–161rostral inferior alveolar, 127t, 136–138, 138fsciatic, 215–221thoracic paravertebral blockade, 186–191, 187ftransverse abdominis (TAP) block, 191–195zygomatic and lacrimal, 110
Nerve fiberscharacteristics and functions, 29fclassification, 29selective/differential blocks, 29–30
Nerve injuryas epidural anesthesia complication, 253injection pressure and, 53, 54ffrom needles, 44, 44f, 45, 46from tourniquets, 268, 270
Nerve roots, 230–231Nerve stimulation, history of, 7Nerve stimulation-guided blocks
brachial plexus block, 151–154femoral nerve block, 210–215, 210f–211fpsoas compartment (lumbar plexus) block,
203–205, 203f, 204fsciatic nerve block, 215–219, 217f–219fthoracic paravertebral blockade, 189
Nerve stimulators. See Peripheral nerve stimulators
Neuraxial anesthesiacomplications of, 252–254defined, 13
Neuronal ischemia, 15Neurotoxicity, 16
as epidural anesthesia complication, 253of local anesthetics, 36
Newton, Isaac, 3Nieman, Albert, 4Nonsteroidal anti-inflammatory drugs, as adjunct
in intravenous regional anesthesia, 263
Oculomotor nerve, 105Ohm’s Law, 66, 68Ophthalmic nerve, 105, 105fOpioids
after thoracotomy, 170, 172for epidural analgesia, 247t, 249–250for intra-articular elbow and shoulder joint
analgesia, 162as intravenous regional anesthesia
adjunct, 263as local anesthetic adjuvant, 32–33for ophthalmic procedures, 107
Optic foramen, 103–104, 104f, 104tOptic nerve, 104Oral cavity, nerve blocks for, 119–139
caudal and rostral palatine nerve blocks, 129–131
clinical tips, 131distribution of local anesthesia and analgesia,
129–130equipment, 130functional and clinical anatomy, 129technique, 130–131, 131f
caudal inferior alveolar nerve block, 126t, 133–136
clinical tips, 135complications, 136distribution of local anesthesia and analgesia,
133–134equipment, 134functional and clinical anatomy, 133technique, 134–135, 135f, 136f
equipment, 119general considerations, 119–121
anesthesia requirements, 119animal positioning, 119
Index.indd 281Index.indd 281 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
282 Index
Oral cavity, nerve blocks for (cont'd)choice and dosing of local anesthetics,
120–121, 120t, 122tcontraindications/precautions, 120indications/advantages, 119–120
infiltration anesthesia, 127t, 138infraorbital nerve block, 126t, 131–133
clinical tips, 133distribution of local anesthesia and
analgesia, 132equipment, 132functional and clinical anatomy, 131–132technique, 126t, 132–133
intraosseous anesthesia, 127t, 138–139intrapulpal injection, 127t, 139maxillary nerve block, 121–128, 126t, 127f–129f
distribution of local anesthesia and analgesia, 124
equipment, 124functional and clinical anatomy, 121–123technique, 125, 127, 127f, 128f
middle mental nerve block and rostral inferior alveolar nerve block, 127t, 136–138, 138f
clinical tips, 137–138distribution of local anesthesia and
analgesia, 137equipment, 137functional and clinical anatomy, 136–137technique, 137, 138f
splash block, 127t, 138table of, 126t–127t
Orbital fissure, 103–104, 104f, 104tOribital foramina, 103–104, 104f, 104tOxymorphone, for epidural analgesia, 247t
PABA (para-aminobenzoic acid), 16Pain
abdominal, 191adverse effects of, 8ischemic, 269peripheral nerve anatomy and, 12thoracic, 167–168
Pain management, history of, 3–8Palatine nerve blocks, caudal and rostral, 129–131
clinical tips, 131distribution of local anesthesia and analgesia,
129–130equipment, 130functional and clinical anatomy, 129
technique, 130–131, 131fanatomic landmarks, 130infraorbital approach, 130maxillary tuberosity approach, 130rostral or major palatine approach, 130–131,
131fsubzygomatic approach, 130
Palpebral nerves, 106Para-aminobenzoic acid (PABA), 16Patient positioning. See Animal positioningPatient preparation
aseptic preparation, 20positioning, 19–20sedation and anesthetic requirements, 19skin preparation, 20–23
Pelvic limb, regional anesthetic techniques for, 199–224
femoral nerve block, 208–215combined ultrasonography electrolocation-
guided, 212–215, 213f, 214fcomplications, 213, 214tdistribution of local anesthesia and
analgesia, 209functional and clinical anatomy, 208–209,
208f, 209fnerve stimulation-guided, 210–215, 210f–211f
general considerations, 199–201animal positioning, 200choice of local anesthetics and adjuncts, 201contraindications/precautions, 201indications, 200sedation/anesthesia requirements, 199–200
intra-articular analgesia, 222–224choice and dosing of local anesthetics, 222clinical tips, 224complications, 224distribution of local anesthesia and
analgesia, 222equipment, 222–223hip joint injection, 224indications, 222stifle joint injection, 223–224, 223ftoxicity issues, 222
intravenous regional anesthesia, 267–268overview, 199psoas compartment (lumbar plexus) block,
201–208combined ultrasonography/electrolocation-
guided, 205–206, 206f
Index.indd 282Index.indd 282 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
Index 283
complications, 207–208, 207t, 208fcontinuous, 206–207distribution of local anesthesia and analgesia,
202–203functional and clinical anatomy, 201–202,
201f, 202fnerve stimulation-guided, 203–205, 203f, 204f
sciatic nerve block, 215–221combined ultrasonography/electrolocation-
guided, 219–221, 219f–221fcomplications, 221distribution of local anesthesia and
analgesia, 215functional and clinical anatomy, 215, 216fnerve stimulation-guided, 215–219, 217f–219f
Pencil-point spinal needles, 47, 47fPeribulbar block, 113, 113fPerineurium, 12, 12fPeriodontal ligament, 139Peripheral nerve, anatomy of, 12, 12fPeripheral nerve block. See also Nerve block;
specific blockshistory of, 6–7needle trauma, 15nerve stimulator-guided, 85ultrasound-guided, 77–86, 82–85, 83f, 84f
electrolocation combined with, 85–86“in-plane” technique needle positioning,
83, 83fnerve stimulator-guided compared, 85nerve visualization, 82–83“out-of-plane” technique needle positioning,
83, 84fvisualization of local anesthetic
administration, 84–85, 84fPeripheral nerve stimulators, 65–75
components, 68–72, 69f–72fconstant current output, 70controls, 71–72current adjustment, 71, 72fdisconnection and malfunction indicators, 72display, 70, 70f, 71fpulse width/frequency, 71–72
for epidural space location, 240fminimum stimulating current, 73–74, 73fneedle navigation rules, 74–75nerve stimulation-guided blocks
brachial plexus block, 151–154femoral nerve block, 210–215, 210f–211f
psoas compartment (lumbar plexus) block, 203–205, 203f, 204f
sciatic nerve block, 215–219, 217f–219fthoracic paravertebral blockade, 189
procedure for use, 74stimulus threshold of nerve, factors influencing,
67–68, 68fPerthes, Georg, 7Phenothiazines, for ophthalmic procedures, 107Phrenic nerve, 144, 145–146, 148, 150Physicochemical properties of local anesthetics,
25–27, 26tPia mater, 230pKa (dissociation constant), of local anesthetics,
26t, 27Pleura, ultrasound appearance of, 82Pneumothorax, as interpleural regional anesthesia
complication, 184–185Positioning. See Animal positioningPosterior articular nerve, stifle, 209, 209fPotassium (K+) channels, 28Potential gradient, 68Povidone-iodine, 21, 22–23, 22fPravaz, Charles Gabriel, 4Pressure gauges, inline, 53, 53fPrilocaine
development of, 6properties of, 120t
Procainechemical structure of, 26fdevelopment of, 6onset and duration of action, 27tphysicochemical properties of, 26ttoxicity of, 35t
Proparacaine, for topical anesthesia of eye, 115Propofol
dosage for sedation, 19for pelvic limb anesthesia, 199
Protein binding, of local anesthetics, 26–27, 26tProxymetacaine, for topical anesthesia of eye, 115Psoas compartment (lumbar plexus) block, 201–208
combined ultrasonography/electrolocation-guided, 205–206, 206f
anatomic landmarks (ultrasound anatomy), 205, 206f
clinical tips, 206equipment, 205patient positioning, 205step-by-step procedure, 205
Index.indd 283Index.indd 283 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
284 Index
Psoas compartment (lumbar plexus) block (cont'd)complications, 207–208, 207t, 208fcontinuous, 206–207
catheter placement and securing, 206drug choice and infusion rate, 206–207equipment, 206monitoring, 207
distribution of local anesthesia and analgesia, 202–203
functional and clinical anatomy, 201–202, 201f, 202f
nerve stimulation-guided, 203–205, 203f, 204fequipment, 203lateral pre-iliac technique, 204–205, 204fstandard technique, 203–204, 203f, 204f
Pterygopalatine fossa, 122, 124, 125, 129, 130Pterygopalatine nerve
anatomy of, 105, 122fblock of, 129
Pumpsbattery-powered, 63–64, 63felastomeric, 60f, 61–63, 61f, 62f
Quinicke-type needles, 47, 47f
Radial, median, musculocutaneous, and ulnar (RUMM) nerve blocks, 159–161
complications, 161tdistribution of local anesthesia and analgesia, 159equipment, 159functional and clinical anatomy, 159technique, 159–161, 159f–161f
anatomic landmark, 159, 160fpatient positioning, 159, 159f
Radial nerve, 151t, 153t, 157, 159, 159f, 161Radial nerve paralysis, 155fRecord keeping, 17Regional anesthesia. See also specific procedures
defined, 13history of, 3–8pointers for successful service, 16–17
Respiratory depression, as epidural anesthesia complication, 254
Retrobulbar block (RBB)advantages, 112clinical tips, 112complications, 112–113equipment, 110injection location, 104f, 110, 111, 111f, 112techniques, 110–112
combined superior-inferior peribulbar, 112inferior-temporal palpebral, 110–111, 111flateral canthus, 112perimandibular, 111splash block, 111, 111f
uses for, 103Rheobase, 67, 68fRopivacaine
described, 30development of, 6for epidural analgesia, 249t, 250for intravenous regional anesthesia, 263onset and duration of action, 27tfor pelvic limb anesthesia, 201for pelvic limb intra-articular analgesia, 222physicochemical properties of, 26tselective blockade by, 30for thoracic limb anesthesia, 145toxicity of, 34, 35, 35t
Rostral alar foramen, 104, 104f, 104t, 106Rostral auricular nerves, 106Rostral inferior alveolar nerve block, 127t,
136–138, 138fanatomic landmarks, 137clinical tips, 137–138distribution of local anesthesia and analgesia, 137equipment, 137functional and clinical anatomy, 136–137technique, 137, 138f
RUMM. See Radial, median, musculocutaneous, and ulnar (RUMM) nerve blocks
Rynd, Francis, 4
Saphenous nerve, 209, 209fScapulohumeral joint analgesia, 161–163, 163fSchirmer tear test, 115Schleich, Carl-Ludwig, 55Sciatic nerve block, 215–221
combined ultrasonography/electrolocation-guided, 219–221, 219f–221f
anatomic landmarks (ultrasound anatomy), 220, 220f, 221, 221f
equipment, 219patient positioning, 219, 220technique (Campoy), 219–220, 220ftechnique (Shilo), 220–221, 221f
complications, 221distribution of local anesthesia and
analgesia, 215functional and clinical anatomy, 215, 216f
Index.indd 284Index.indd 284 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
Index 285
nerve stimulation-guided, 215–219, 217f–219flateral approach technique, 216–218, 217fparasacral approach technique, 219, 219ftransgluteal approach technique, 218–219,
218fSedation, 19. See also specific proceduresSENSe (Sequential Electrical Nerve Stimulation,
“BBraun”) technology, 71Sertürner, Freidrich Wilhelm, 3Shoulder joint analgesia, 161–163, 163f“Size principle,” 29Skin disinfectant, 21–23, 22fSkin preparation, 20–23
clipping of puncture site, 20disinfection, 21–23, 22f
Skullcanine, 123ffeline, 124f
Soaker catheters. See Wound soaker cathetersSodium bicarbonate, as local anesthetic
adjuvant, 32Sodium (Na+) channels, 28, 28fSodium metabisulfite, neurotoxicity and, 16Sodium-potassium (Na+-K+) pump, 27, 66Somatic blockade
distribution of regional anesthesia and analgesia, 231–234
age and physical condition, 233baricity and specific gravity, 234, 234tdirection of needle bevel, 233fatty tissue in epidural space, 233position of animal, 233site of injection, 232size of venous and lymphatic plexus, 233speed and pressure of injection, 232, 233fvolume and concentration, 232
epidural anesthesia, 231–234site of action of local anesthetics, 231, 231f
Specific gravity, 234, 234tSpinal anesthesia, 251–252
anatomic landmarks, 251, 252fclinical tips, 252defined, 227equipment, 251history of, 5–6injection volume, 251–252patient positioning, 251step-by-step procedure, 251, 252f
Spinal cord, 228–229, 228f, 229fSpinal needles, 46–48, 46f, 47f, 49f
Spinal nerves, trunk anesthesia/analgesia and, 168
Spine, anatomy of, 227–231, 228f, 229fepidural space, 230medulla spinalis and nerve roots, 230–231meninges, 230
Splash block, 89, 90oral cavity, 127t, 138orbit, 111, 111f
Sprotte spinal needles, 47, 47fSteroids, for pelvic limb intra-articular
analgesia, 222Stifle joint
innervation of, 209, 209fintra-articular injection, 223–224, 223f
Stimulus threshold of a nerve, 67Subarachnoid injection, inadvertent as epidural
anesthesia complication, 253Subarachnoid space, 229f, 230Subdural injection, inadvertent as epidural
anesthesia complication, 253Subscapular nerve, 151tSufentanil, for epidural analgesia, 247tSupraorbital foramen, 109Suprascapular nerve, 151t, 154Surgical gloves, 20Surgical gowns, 20Systemic toxicity, 14
TAP block. See Transverse abdominis (TAP) block
Tear production, decreased, 115Temporal resolution, 79Terminology, loco-regional anesthetic, 12–13Tetracaine
development of, 6onset and duration of action, 27tphysicochemical properties of, 26tfor topical anesthesia of eye, 115toxicity of, 35t
Thoracic limb, regional anesthetic techniques of, 141–163
anatomy, 142f, 143fbrachial plexus block, 150–158
combined ultrasonography/electrolocation-guided, 155–157
advantages, 155clinical tips, 156–157equipment, 155technique, 155–157, 156f
Index.indd 285Index.indd 285 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
286 Index
Thoracic limb, regional anesthetic techniques of (cont'd)
complications, 158tcontinuous peripheral nerve block (CPNB),
157–158, 157f, 158fcatheter placement and securing, 157–158,
157f, 158fdrug choice and infusion rate, 158
distribution of local anesthesia and analgesia, 151t
functional regional nerve anatomy, 150nerve stimulation-guided (traditional
approach), 151clinical tips, 152–154equipment, 151technique, 151–154, 152f–154f, 153t, 154t
cervical paravertebral block, 145–149complications, 148–149, 150fdistribution of local anesthesia and
analgesia, 146equipment, 146functional and clinical anatomy, 145–146,
146fLemke’s modified approach, 147–148overview, 145technique, 146–147, 147f
general considerations, 143–145animal positioning, 143–144choice of local anesthetics and adjuncts,
144–145contraindications/precautions, 144indications, 144sedation/anesthesia requirements, 143
intra-articular elbow and shoulder joint analgesia, 161–163
distribution of local anesthesia and analgesia, 162
drugs used, 161–162equipment, 162indications, 161purpose, 161techniques, 163, 163f
intravenous regional anesthesia, 265–267, 265f–267f
overview, 141radial, median, musculocutaneous, and ulnar
(RUMM) nerve blocks, 159–161complications, 161tdistribution of local anesthesia and
analgesia, 159
equipment, 159functional and clinical anatomy, 159technique, 159–161, 159f–161f
sensory and motor nerve distribution, 151tThoracic paravertebral blockade, 186–191, 187f
equipment, 189overview, 186–189technique, 189, 191
Thoracic paravertebral space, anatomy of, 187fThoracotomy, analgesia for, 168, 170, 172–173Thorax. See Trunk, anesthesia ofTopical anesthesia
described, 12–143eye, 115–116
advantages/disadvantages, 115–116drugs used, 115
Total ear canal ablation-bulla osteotomy in dogs, 94–96, 94f
Total spinal, 254Tourniquet, 264–265
application to thoracic limb, 266injury from use of, 268–269, 270nonpneumatic, 264pneumatic, 265, 266f, 268pressure, 270release, 270removal, 267, 268
Toxicitylocal anesthetics, 33–38, 33t, 36t, 185neurotoxicity, 16, 36, 253systemic, 14, 185in wound catheter use, 100
Transdermal lidocaine patches, 13Transverse abdominis (TAP) block, 191–195
equipment, 194ultrasound-guided technique, 194–195use in animals, 193–195, 194fuse in people, 191, 192f, 193
Trigeminal nerve, 105–106, 105f, 122Trochlear nerve, 105Trunk, anesthesia of, 167–195
intercostal nerve blocks, 169–178anatomy and, 170, 170f, 171f, 172complications, 177–178distribution of local anesthesia, 173equipment, 173–174indications, 173local anesthetics used, 173overview, 169–173technique, 174–176, 174f–177f
Index.indd 286Index.indd 286 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
Index 287
interpleural regional anesthesia, 178–186complications, 184–186distribution of local anesthesia and analgesia,
182–183equipment, 183indications, 181–182local anesthetics used, 182overview, 178–181technique, 183–184, 184f
overview, 167–168regional nerve anatomy, 168–169, 169fthoracic paravertebral blockade, 186–191, 187f
equipment, 189overview, 186–189technique, 189, 191
transverse abdominis (TAP) block, 191–195equipment, 194ultrasound-guided technique, 194–195use in animals, 193–195, 194fuse in people, 191, 192f, 193
Tuohy needles, 44, 47, 48–49, 48f, 52f
Ulnar nerve, 151t, 153t, 157, 159, 160f, 161Ultrasound
artifacts, 80–81acoustic shadowing, 81, 81fanisotropy, 80–81contact, 80
combined ultrasonography/electrolocation-guided blocks
brachial plexus block, 155–157femoral nerve block, 212–215, 213f, 214fpsoas compartment (lumbar plexus) block,
205–206, 206fsciatic nerve block, 219–221, 219f–221f
echogenic needles and, 51, 52fequipment selection, 82guided peripheral nerve blockade, 82–85, 83f, 84f
electrolocation combined with, 85–86“in-plane” technique needle positioning, 83, 83fnerve stimulator-guided compared, 85nerve visualization, 82–83“out-of-plane” technique needle positioning,
83, 84fvisualization of local anesthetic
administration, 84–85, 84fguided techniques, 7
thoracic paravertebral blockade, 189, 191transverse abdominis (TAP) block, 194–195
history of, 7
physics and technology, 77–79Doppler effect, 79, 79fresolution, 78–79schematic of basic machine, 78f
resolution, 78–79compound imaging, 78, 82contrast, 78detail, 78spectrum imaging, 78temporal, 79
settings/controls, 79–80, 79f, 80fdepth, 79–80focus and zoom, 80frequency, 79gain, 80persistence or temporal averaging, 79power, 80time gain compensation, 80, 80f
tissue appearance, 81–82blood vessels, 81bone, 81facial tissue, 81fat, 81muscles, 81pleura and air, 82
Urine retention, 33
Vasoconstrictors, as local anesthetic adjuvant, 31–32
Vertebrae, 227Vertebral canal, 227–228, 230Von Anrep, Vasili Konstantinovich, 4
Wavelength, 77“Wet tap,” 230Whitacre spinal needles, 47Wood, Alexander, 4Wound healing, local anesthetic effect
on, 36–37, 100–102Wound soaker catheters, 57, 58f, 59, 59f, 60f,
93–100choice of local anesthetics, 97clinical tips for use, 99complications of use, 99–100described, 97–98, 98fdistribution of local anesthetics, 96–97, 96fequipment required for placement of, 98human studies, 93–94placement technique, 98–99, 98fveterinary studies, 94–96
Index.indd 287Index.indd 287 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM
288 Index
Wound soaker catheters (cont'd)amputation, 96, 96ffeline oncologic surgery, 95f, 96total ear canal ablation-bulla osteotomy
in dogs, 94–96, 94f
Xylazine, for epidural analgesia, 247t
Zygomatic and lacrimal nerve block, 110
Zygomatic branch of facial nerve, 106Zygomatic nerve, 105–106, 105fZygomaticofacial nerve, 106, 106fZygomaticotemporal nerve,
106, 106f
Index.indd 288Index.indd 288 11/15/2012 3:21:34 PM11/15/2012 3:21:34 PM