Abstract
Objective
To develop a technique for ultrasound-guided continuous median and ulnar peripheral
nerve block in horses.
Study design
Anatomical and prospective experimental study.
Animals
A total of 16 thoracic limbs from horse cadavers and 18 adult horses.
Method
This study was conducted in three phases. Phase 1: Dissection of median and ulnar
nerves in the antebrachial region of two cadaver limbs to identify localizing landmarks.
Description of sonoanatomy in 14 cadaver limbs using ultrasound-guided perineural
infiltration of a combination of cellulose gel (5 mL), contrast medium (4 mL) and
methylene blue (1 mL). Catheters were inserted between the perineural sheath and epineurium
in six limbs, followed by computed tomography. Phase 2: Ultrasonographic images of
the limbs of 18 healthy horses of different breeds were used to define an acoustic
window and optimize the approach to nerves. Phase 3: Two case reports of horses with
chronic pain of different etiologies. Catheters were inserted between the epineurium
and paraneural sheath of the median and/or ulnar nerves guided by ultrasound, followed
by continuous infusion of 0.4% ropivacaine.
Results
Information from phase 1 was used to direct needle insertion, solution dispersion
and catheter implantation in phase 2, which resulted in 100% technique accuracy. In
response to the peripheral nerve block, pain reduction was apparent in the two clinical
cases by increased weight bearing in affected limbs and decreased requirement for
systemic analgesic medications. No local reactions were observed.
Conclusions and clinical relevance
The ultrasound technique allowed real-time visualization of needle, catheter and drug
dispersion and resulted in a high success rate for nerve blocks. The horses administered
a median and ulnar nerve block exhibited no discomfort or signs of infection at the
catheter insertion site. Further studies are warranted to validate the efficacy of
this technique.
Keywords
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Article info
Publication history
Published online: February 06, 2020
Accepted:
December 29,
2019
Received:
April 15,
2019
Identification
Copyright
© 2020 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.
