I gave a Lunch & Learn session this week at a local practice and we covered four nerve blocks that are great options for every day use. You can view the videos within this post and also directly on the video section. Read the basics of local anaesthesia here first.
Dental blocks
Maxillary and inferior alveolar (mandibular) nerve blocks with lidocaine and bupivacaine administered prior to dental extractions resulted in a reduction in heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks (Aguiar et al 2014).
For dental work the maxillary and the mandibular blocks are the two you need. I use the subzygomatic approach to the maxillary nerve here - it's the one I find easiest as you will see here.
In this video I use the extra-oral approach to the mandibular nerve. This is a case of palpating the mandibular foramen which lies caudally on the mandible - just rostral to the medial pterygoid muscle. Your aim is to deposit a bleb of local over the foramen which will cover the nerve.
Locoregional techniques for castration are a great way to get started. One study examined the intra-testicular block and showed this reduces volatile agent requirements. The approach I use combines three techniques.
A line block is a technique applicable to a number of surgeries that we perform each day. It's really easy to perform and provides effective anaesthesia, meaning the patient does not react to skin incision. There is plenty of evidence that local anaesthesia does not impair wound healing and actually may offer advantages.
Save this post on your phone or tablet so you have these videos to hand. These four blocks are applicable to day to day work and will give your patients an optimal level of comfort and result in a smooth anaesthetic.
This post was written by Matt Gurney.
Matt & Carl established Zero Pain Philosophy to provide educational resources to veterinary professionals enabling optimal management of pain.
Matt Gurney is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and works at Anderson Moores Veterinary Specialists. Matt is Vice-President of the European College of Veterinary Anaesthesia & Analgesia.
Carl Bradbrook is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and is President of the Association of Veterinary Anaesthetists. Carl works at Anderson Moores Veterinary Specialists.
Hello. In the dental block webinar you mention that you use a standard of 0.03-0.04ml/kg for cats and dogs, is this per site/block or total volume allowed to be used?
I used to do line blocks to the skin preoperatively just like that, but was at a LVS lecture by Duncan Lascelles last year; he waits until closure and then injects into all layers - presumably getting more local coverage but sacrificing any attempt at preemptive analgesia. Not sure I've noticed much difference either way, although most commonly this is for caesarians who are I suspect too dosed up on enkephalins to feel much anyway. The main benefit seems to be that my nurses think I'm empathetic :-)