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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.

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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 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


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 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


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,


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 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


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


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 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,


equipment, 119general considerations, 119–121

anesthesia requirements, 119animal positioning, 119


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


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


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 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


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 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


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


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 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


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


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