Page 203 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir skin until bone is encountered, at which • ith the patient in lateral recumbency,
point the needle is withdrawn half the
aseptically prepare the skin and insert a
spinal needle cm into the axillary
distance inserted and local anaesthetic
. ml in ected. region, medial to and at the level of the
• o block the greater auricular nerve, a shoulder oint caudally and parallel to
needle is inserted super cially between the vertebral column. he needle s
the caudal aspect of the vertical ear distal end should lie just caudal to the
canal and ust cranioventral to the wing spine of the scapula.
of the atlas, keeping the needle parallel • Always aspirate the syringe to avoid
to the vertical ear canal. In ect . to intravascular administration, and then
ml of local anaesthetic. in ect the calculated dose as you slowly
withdraw the needle.
• aximum suggested doses of lidocaine
Axillary brachial plexus are 8 mg kg in dogs and 4 mg kg in
block cats, and for bupivacaine and
ropivacaine are 1 mg kg in dogs and
■ Brachial plexus block provides analgesia to 1 mg kg in cats. It may be necessary to
the forelimb distal to, and possibly dilute the local anaesthetic in normal
including, the elbow. he techni ue should saline to increase the volume available
be performed in the anaestheti ed patient. for in ection.

Radial, ulnar, median and
musculocutaneous nerve
blocks

■ or procedures of the elbow and distal
forelimb, the radial, median, ulnar, and
musculocutaneous nerves may be blocked
proximal to the humeral epicondyles. hese
nerves can often be palpated, making this
techni ue relatively straightforward.
• After sterile preparation, approach the
radial nerve on the lateral aspect of the
distal humerus.
• Palpable ust proximal to the lateral
epicondyle, the radial nerve is located
between the brachialis muscle and the
lateral head of the triceps.
• he median, ulnar, and
musculocutaneous nerves are located
close to one another on the medial
aspect of the forelimb, proximal to the
medial epicondyle.
• he brachial artery is situated among
these nerves. he musculocutaneous
nerve is cranial to the artery while
Anatomical landmarks for performing axillary blockade the median and ulnar nerves are
of the brachial plexus in cats. located caudally.

198

Appendix 2.indd 198 19/12/2018 10:50