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LAS > Local Blocks to diagnose lameness > Flashcards

Local Blocks to diagnose lameness Flashcards

1
Q

what does abaxial/basisesamoid block anesthetize? (6)

A

Distopalmar P1 and down

  • distopalamar P1
  • P2
  • proximal and dital interphalangeal joints
  • distal SDFT/DDFT
  • distal sesamoidian ligament
  • digital annular ligament
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2
Q

landmarks for abaxial/basisesamoid block

A

abaxial border of each proximal sesamoid bone right along vascular bundle

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3
Q

criteria for using local blocks to diagnose lameness (3)

A
  • is the horse lame enough? (not good for intermittent lameness)
  • is the horse too lame? can risk injury/fracture
  • will the horse tolerate the needle?
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4
Q

lateral palmar nerve block: where is it inserted and in what direction?

A

mediolateral direction on the medial side of the accessory carpal bone

done while weight bearing

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5
Q

High 4 point block anesthetizes…(3)

A
  • suspensory ligament
  • some flexor tendons
  • some of MCIII and MCIV
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6
Q

reasons PD nerve block might fail (5)

A
  • adhesions between navicular bone and DDFT
  • OA of coffin
  • concurrent proximal disease (suspensory apparatus issue)
  • old anesthetic used
  • accessory nerve supply from dorsal branches
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7
Q

what to remember when using low 4 point block on hindlimb?

A

must also direct and inject a little cranially

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8
Q

what position are abaxial/basisesamoid and PD nerve blocks administered?

A

hold limb up/non weight bearing

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9
Q

agents used for local blocks in equines (3)

A
  • 2% lidocaine: cheap but burns; lasts 30 mins-2hours
  • 2% mepivacaine/carbocaine: G.S. lasts 30mins-2hours; once open goes bad within 5-7 days; don’t let freeze
  • 0.5% bupivacaine/Marcaine: duration 5-6 hours; only for shoeing/therapeutic; NOT for diagnostics
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10
Q

which nerve/nerves is targeted by abaxial/basisesamoid block and PD block?

A

palmar digital nerves

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11
Q

lateral palmar nerve block blocks _____

A

origin of suspensory ligament

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12
Q

which nerve block:

  • distopalamar P1
  • P2
  • proximal and dital interphalangeal joints
  • distal SDFT/DDFT
  • distal sesamoidian ligament
  • digital annular ligament
A

abaxial/basisesamoid block

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13
Q

which injection for the low 4 point block is more proximal and why?

A

-lateral and medial palmar nerves: between suspensory ligament and DDF (more proximal to avoid tendon sheath/flexor manica)

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14
Q

how much do you inject for low 4 point block?

A
  • lateral and medial palmar nerves: between suspensory ligament and DDF (more proximal): 3 mL
  • Lateral and medial palmar metacarpal nerves: find button on MIV and go just distal: 1 mL
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15
Q

needle usually used for nerve blocks?

A

25-23 G

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16
Q 
which nerve block:
coffin joint and down:
-sole
-navicular apparatus
-soft tissues of heel
-coffin joint
-digital portion of DDFT
A

PD block

17
Q

structures anesthetized by PD nerve block (5)

A

coffin joint and down:

  • sole
  • navicular apparatus
  • soft tissues of heel
  • coffin joint
  • digital portion of DDFT
18
Q

how long do most nerve blocks take before they have effect?

A

3-5 mins

19
Q

intra-articular anesthesia: what to remember? (6)

A
  • insert needle WITHOUT syringe
  • collect synovial sample prior to anesthetizing
  • MUST BE STERILE
  • inject vol > than that taken -> DISTEND joint
  • add 125 mg of amikacin
  • allow 5-30 min for effect
20
Q

true or false: presence of skin sensation does not mean block failed

A

true; skin first lost and first regained

21
Q

what’s important to remember about the low 4 point block?

A

MUST be sterile because you might hit tendon sheath

22
Q

where is high 4 point block injected?

A

below carpus in groove between DDFT and suspensory ligament

23
Q

how many injections for the 4 point block?

A

1-2

24
Q

most nerve blocks can be done with a clean prep. which must be sterile?

A

-low 4 point block: because you might hit the tendon sheath

also intra-articular anesthesia

25
Q

direction in which the needles are inserted for low 4 point block?

A

perpendicular to ground

26
Q

what’s important to remember about abaxial/basisesamoid block

A

must be superficial to DFTS

27
Q

landmarks for low 4 point block

A
  • lateral and medial palmar nerves: between suspensory ligament and DDF (more proximal)
  • Lateral and medial palmar metacarpal nerves: find button on MIV and go just distal
28
Q

PD nerve block: landmarks

A

groove between flexors and ergot, just proximal to the collateral cartilage; one injection medial and one lateral

VAN bundle there so redirect if you get blood

29
Q

methods for using blocks to diagnose lameness (4)

A
  • perineural: clean scrub; no sedation; use smallest volume possible
  • regional
  • direct infiltration of dite
  • IA
30
Q

how many injections needed for lateral palmar nerve block?

A

ONE

mediolateral direction on the medial side of the accessory carpal bone; anesthetizes lateral palmar nerve -> anesthetizing origin of suspensory ligament

31
Q

number of injections needed for low 4 point block

A

2-4

  • lateral and medial palmar nerves: between suspensory ligament and DDF (more proximal)
  • Lateral and medial palmar metacarpal nerves: find button on MIV and go just distal
32
Q

pro of the lateral palmar nerve block?

A

don’t have to inject directly into suspensory ligament (which can cause artifact on US)

33
Q

which block?

  • lateral and medial palmar nerves: between suspensory ligament and DDF (more proximal)
  • Lateral and medial palmar metacarpal nerves: find button on MIV and go just distal
A

low 4 point

34
Q

which nerve/nerves are targeted by the low 4 point block?

A
  • lateral and medial palmar nerves

- lateral and medial palmar metacarpal nerves

LAS (51 decks)

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