Local anaesthetic blocks

Re: Local anaesthetic blocks

John Flynn — Tue, 08 Apr 2014 21:38:49 GMT

[quote user="ChrisBVSc"]I think you get more effective loss of peritoneal sensation with paravertebral though?[/quote]

agreed - I did like that bit

Re: Local anaesthetic blocks

ChrisBVSc — Tue, 08 Apr 2014 21:35:53 GMT

We were taught paravertebral as the method of choice at college, but I never got to try it in real life. During my first few years in mixed practice I worked in 2 practices where almost everyone did inverted L, so that's what I ended up using for cow & sheep caesars - always found them to work well and really easy to perform. Tried line blocks a few times but mine never seemed as effective as L blocks for some reason and I didn't like the tissue distortion. One vet did use paravertebral, only assisted with him a couple of times and seem to remember there was a lot more bleeding than with the L. I think you get more effective loss of peritoneal sensation with paravertebral though?

Looking at the last few responses it's probably a case of the best technique is the one you're most familiar with, as long as there are no major problems. If you're already happy with line blocks I'd give inverted L a try.

Re: Local anaesthetic blocks

John Flynn — Tue, 08 Apr 2014 21:22:31 GMT

[quote user="Michael Woodhouse"]para-vertabaral, but with a lateral approach.[/quote]

that sounds like what I did

Re: Local anaesthetic blocks

Michael Woodhouse — Tue, 08 Apr 2014 21:00:05 GMT

Personally my 1st choice is para-vertebral. If done correctly you get great anaesthesia, muscle relaxation and easy surgery. If you are not blocking dorsal branches adequately then you get kicked lower down. I always test intended incision line with a 18G needle first.....

2nd choice is inverted L block - I use these in both cattle and sheep caesers. By moving the line of infiltration cranial to your incision you don't get the tissue distortion with local at the site. If you remember your anatomy the nerves innervate dermatomes caudally.

I stopped doing line blocks after a skin breakdown about 6 months qualified. I haven't missed them. Just because they are easy isn't a reason to discount better techniques.

I was at a CPD day at Edinburgh uni the other day and they are apparently teaching their students para-vertabaral, but with a lateral approach. Never tried it, but it warrants further investigation.

My decision making for para-vertebral/inverted L comes from how fat the cow is and if I can easily palpate the anatomy.

Re: Local anaesthetic blocks

karen jones — Tue, 08 Apr 2014 19:52:48 GMT

Line blocks for me , I always clip and scrub before putting local in and use around 120ml. Have done inverted l before but now think line blocks better. I don't like my cow Caesars to kick me!

Re: Local anaesthetic blocks

John Flynn — Tue, 08 Apr 2014 19:46:35 GMT

It's been a while, but it took me a few years to decide that overall for consistency I really did prefer line blocks!

I went through a phase of "distal paravertebral" (if I've got the right term...), but perhaps I either made my cut lower than others or "missed" one of the nerve-areas as I'd say about 1 in 3 cows the ventral portion of the incision didn't block fully. I spent a while after that doing my distal paravertebral thing, shaving and scrubbing and then using the needle on a further 50ml syringe of lidocaine to score down the skin where I was going to be cutting and if there was any reaction then reverted to a line block. I actually quite liked this latter approach, but as it was probably an unecessary phaff, I did eventually revert back to line blocks again

I often gave a "caudal" epidural - if nothing else, it stopped the tail swishing in my face

Re: Local anaesthetic blocks

Linda Filshie — Tue, 08 Apr 2014 19:39:48 GMT

I always did line blocks (ditto for sheep caesars, of which we had loads) and never had a problem but if I was doing them now I'd probably do paravertebral.