regional analgesia head -...

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REGIONAL ANALGESIA

Head Dr. Ahmed Hassan Khalil

Lecturer of Surgery, Anesthesiology & Radiology

Faculty of Veterinary Medicine, Benha University

Advantages: -

The amount of the used drug is less than local infiltration.

The used equipment are not expensive.

Used with or without sedation for surgery on standing position.

Produce large enough desensitized area and not need to increase

the size of analgesic field during surgery as in local analgesia.

The drug is injected far from surgical field so:

- Don't change the anatomical features of surgical field.

- Not delay healing. Dr. Ahmed Hassan Khalil



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Disadvantages: -

More complicated than local analgesia.

Risk of toxicity especially when the nerve is associated with

blood vessels

General complications of epidural including fracture, paralysis

& infection of neural canal.

Dr. Ahmed Hassan Khalil



The used local analgesic agent (LAA) is

Debocaine (Lidocaine HCL) 2%.

Time of induction is 5 min.

Time of analgesia is 1 hour. Dr. Ahmed Hassan Khalil



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Anatomy Nerve

lnfraorbital

Nerve block

العين تحت

Mandibular

Mandibuloalveolar

Mental n.b.

فى الفك السفلى

Supraorbital n.b.

فوق العين

Retrobulbar n.b.

خلف العين

Auriculopalpebrl

n.b. بين االذن والعين

Cornual n.b.

للقرون

Continuation of Mandibular division of trigeminal 5th cr.n.

enter the mandibular canal from the mandibular foramen

at medial aspect of the vertical rams of the mandible

Branch of Ophthalmic division of trigeminal 5th cr.n. exit

from supra-orbital foramen in supra-orbital process with

supraorbital artery

Optic, Oculomotor, Trochlear, Abducens & 3 branches of

Trigeminal nerves

Branch of the facial division of trigeminal 5th cr.n cr.n. runs from

the base of the ear along the zygomatic arch & supply eye lid

Branch of Ophthalmic division

of trigeminal 5th cr.n. runs at

base of the horn

Continuation of Maxillary division of trigeminal 5th cr.n.

enter the lnfraorbital canal from the pterygopalatine fossa

and exit from lnfraorbital foramen and run under the

naso-libialis muscle for 2-3 cm




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During its course in lnfraorbital canal it supplies:

- Dental & alveolar branches (to upper premolar, molar,

canine & incisor teeth with their alveoli and gum on its

side).

After emerging from the canal it supplies:

- Cutaneous branches to upper face as high as

the inner canthus of the eye

Cutaneous branches to lower

parts of face as high as the

lnfraorbital foramen including

upper lip, cheek & nostrils.

lnfraorbital Nerve Block




It may be injected (achieved) at the following sites:

Desensitized Tissue Site

At its point of emergence

from lnfraorbital foramen

Within the infra-orbital

canal (via the foramen)

At the pterygopalatine

fossa (point of nerve entry

to maxillary foramen)

Lower face as high as lnfraorbital

foramen including upper lip, cheek &

nostrils.

Upper premolar, molar, canine &

incisor teeth with their alveoli & gum.

Upper part of face as high as inner

canthus of eye

Desensitized in the previous two sites




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Indications:

Suturing of wounds or Surgical interferences at upper

lips, cheek & nostrils (as removal of polyps or

trephining of maxillary sinus).

Extraction of canine & incisor teeth is seldom in horse,

while extraction of molars is preferred by general

anaesthesia

Trephining of maxillary sinus is sufficiently achieved by

local anaesthesia Dr. Ahmed Hassan Khalil



Technique:

Reflecting the edge of the elevator naso-libialis muscle upwards

For blocking the nerve at its point of emergence form canal >>

• The needle inserted at 9-12 cm on imaginary line running down the

face from the medial canthus of the eye parallel with the line bisect

the skull longitudinally.

• The needle introduced until its point can be felt beneath the bony lip

of the foramen.

For blocking the nerve within the canal >>

• Pass the needle about 2.5 cm inside the canal.

Inject 5 ml of LAA by using 19 gauge 5 cm long needle




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Mandibular Nerve Block

- Dental & Alveolar branches to whole of the lower jaw

including all teeth, alveoli and gum.

In the mandibular canal just after the nerve enter from the

mandibular foramen (Mandibuloalveolar nerve) it supplies:

After emeging fom the mandibular canal

(mental nerve) it supplies:

- Cutaneous br. to lower lip of that side.

- Attempts to pass the needle 3 -

4 cm inside the canal to

desensitize canine & incisor

teeth). Dr. Ahmed Hassan Khalil



Mental Mandibuloalveolar

Ind.

Tec.

Dose

Dental interference in lower

jaw (preferred to carried

under general anaesthesia)

Suturing of wounds of lower

lip

Point of inj. lied at medial

aspect of ramus opposite to

point of intersection bet. 2

lines (one passing vertically

downwards from lateral

canthus of eye & one passing

backwards from tables of

mandibular molar teeth)

- The nerve injected at its

emergence from mental

foramen

(on lateral aspect of ramus at

middle of interdental space)

- Detect the Subcut. pencil like

tendon of depressor labii ms.

and reflect it

By using 19 gauge

10 cm long needle 5 cm long needle

Inject of 10 ml 5 ml L.A.A Dr. Ahmed Hassan Khalil



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Supraorbital (Frontal) Nerve Block

Supply: sensory supply of upper eye lid & forehead skin.

Indications: Operation or Suturing of a wound about

the upper eyelids or fore head of this side.

Technique:

- Supraorbital foramen felt as pit-like depression on

the midway of supraorbital process.

- A needle 19 gauge, 5 cm is passed in the foramen for

0.5 - 1 cm and injects 5 ml of LAA. Dr. Ahmed Hassan Khalil



Auriculopalpebrl Nerve Block

(Akinesia of Eye lid)

Supply: Motor fibres to the orbicularis oculi muscle.

Indication:

• Prevent closure of eyelid during ocular examination

but don't desensitize the eye or eye lid.

• So, in conjunction with topical analgesia of the

conjunctiva, this blocking is the most useful for

examination of eye or removal of foreign bodies

from the cornea and other minor ocular surgery.




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Technique:

- Site of injection is subcutaneously dorsal to the zygomatic arch,

about 2 cm cranial to the base of the ear.

- A needle 19 gauge, 5 cm long is used to inject 10 of LAA.




Retrobulbar Nerve Block

Blocked nerves:

Optic, Oculomotor, Trochlear, Abducens & 3 branches of

Trigeminal nerves. T-O-O-T-A

Indication:

- Enucleation of the eye ball.

- It produce corneal analgesia, mydriasis, proptosis and paralysis of

eyeball.




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Technique (Equine):

- 19 gauge 10 cm length needle is inserted 1.5 cm behind the middle of

supra orbital process and pushed toward the upper last premolar teeth

of the opposite side to penetrate the tough periorbita.

- Inject 20 ml of the local analgesic solution.




Peterson Technique

• Achieved by introduction of 19 gauge 15 cm long needle through

the skin cranio-ventraly to zygomatic arch and direct it cranio-

medially till penetration of tough retro-orbita.

• When no blood is obtained after aspiration, 20–30 ml LAA is

deposited behind the eye.

Technique (Ruminant):




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4-point Technique

• Achieved by inserting 19 gauge 10 cm long needle to inject 5 ml

LAA in 4 points around the orbit at 12, 3, 6 & 9º O'clock (5 ml for

each point = 20 ml).




Cornual Nerve Block

Technique:

- Site of injection at the upper third of temporal

ridge, 2.5 cm below the base of the horn (where the

nerve is relatively superficial covered by skin &

thin layer of frontalis muscle).

- A needle (19 gauge, 5 cm) is inserted to a depth of

0.5- 1 cm.

- Inject 5 ml of LAA.

Indication: Dehorning of adult cattle.




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Dehorning in buffaloes:

Needed to block Cornual branch in addition to infra trochlear

nerve (located at the middle of the supra orbital process 1 cm above

the orbital rime and the needle directed medially toward the medial

canthus to inject 5 ml of LAA).

In large animals with will developed horns:

Make a second injection 1 cm behind the first one to block posterior

division of the nerve.




Dehorning Sheep & Goat

Corneal branches of lacrimal

nerve

Corneal branches of infra-

trochlear nerve

Blocked close to

Dorso-lateral margin

of the orbit at depth

1-1.5 cm

Inject 2-3 ml analgesic solution.

Blocked close to

Dorso-medial margin

of the orbit at depth

0.5 cm




regional analgesia head -...

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