Nerve blocks ( long)

Re: Nerve blocks ( long)

Anthony Todd — Mon, 20 Apr 2015 23:43:30 GMT

[quote user="Michael Woodhouse"]I never felt any necessity to do so. Smooth anaesthetics with teeth and apparently painless recoveries.[/quote]

+1,

Standard advice was, if the animal is not eating normally by the next night we wanted to see it. The owners' comment usually were "the cat [particularly] seems brighter than it's been for sometime...

I really can't see how an hour or two of local anaesthesia will make much difference to post op pain, and there was never any signs of pain when the animal was under a GA.

Re: Nerve blocks ( long)

Michael Woodhouse — Mon, 20 Apr 2015 22:38:16 GMT

Suzann - please don't take this personally - I'm not directing this at you.

I never felt any necessity to do so. Smooth anaesthetics with teeth and apparently painless recoveries.

I'm quite happy to change our practices if something is better.

Re: Nerve blocks ( long)

Suzanne Kelly — Mon, 20 Apr 2015 22:34:02 GMT

[quote user="Michael Woodhouse"]

And that is a smooth anaesthetic? To me that is a disaster.

[/quote]

If you read my post I said "I'd a near disaster"! My point was I stupidly let the nurse have the anaesthetic so light that the cat reacted to a simple manipulation of the ET tube. The cat would normally have needed to be on at least 2%, possibly more for surgical extractions, but because the nerve blocks had worked she was kept way too light and almost ran away. As I said in the previous post it's a learning curve and I'm here to ask for advice and help on how to minimise the often significant pain associated with dental procedures.

Re: Nerve blocks ( long)

Michael Woodhouse — Mon, 20 Apr 2015 21:18:36 GMT

[quote user="Suzanne Kelly"]You know normally when you start burring bone/tooth the heart rate goes up and you've to turn up the gas?[/quote]

Never happened to me, ever. We have animals on the ECG and capnograph - still occasionally happens during bitch spays, but maybe need to turn things up 1 in 5. We would know if it did.

[quote user="Suzanne Kelly"]I'd a near disaster last week, moved the ET tube of a cat to get a better access to the lingual caudal mandible, the cat felt that and suddenly jumped up and literally nearly ran off the table[/quote]

And that is a smooth anaesthetic? To me that is a disaster.

I like 2% iso on a non rebreather. Steady, smooth anaesthesia, but they don't try and leave half way through the operation.

NSAID at licensed dose rate with pre-med.

Re: Nerve blocks ( long)

John Flynn — Mon, 20 Apr 2015 21:09:14 GMT

[quote user="Michael Woodhouse"]

Cow vet question - what are you hoping to achieve with the addition of local anaesthesia?

[/quote]

Local anethetic enthusiast's perspective:

What I consider to be "safer" general anaestetics. Lower doses of other agents that are depressing or messing with the body's more vital functions are required if noxious stimuli aren't getting to the brain, eg less iso causing less of drop in blood pressure and cardiac output. I have certainly had to "deepen" an anaesthetic in the past by turning up iso and depressing the brain further so it doesn't repsond to the noxious stimuli when I would now simply use local to stop those signals getting to the brain. In older patients, such as those getting teeth out, this may be of benefit if they have subclinical cardiac or renal disease etc.
What I subjectively consider to be "smoother" anaesthetics and recoveries (as a result of lack of noxious stimuli).
If yuo believe in "wind-up" (I have an open mind on the subject), then less noxious stimuli reaching CNS results in less feelings of pain after a surgical procedure requiring lower amounts of subsequent analgesics administered for shorter periods of time.
Lidocaine is pennies.

Re: Nerve blocks ( long)

Anthony Dennison — Mon, 20 Apr 2015 19:27:35 GMT

[quote user="Anthony Todd"]So nothing to do with the arthroscopy then? [/quote]

Well yes that was the main factor, but the recovery time was so rapid. I've had a knee arthroscopy previously and it took a bit of time to walk comfortably.

Re: Nerve blocks ( long)

Suzanne Kelly — Mon, 20 Apr 2015 19:19:34 GMT

Local anaesthesia is to minimize the pain produced and greatly reduces wind-up, therefore minimizing post operative pain and minimizing the amount of NSAIDs and opioids required post op. So you can do surgical extractions with the animal under a very light GA. It's part of a multimodal analgesia. You know normally when you start burring bone/tooth the heart rate goes up and you've to turn up the gas? With local anaesthesia you don't. I'm still very new to it. I'd a near disaster last week, moved the ET tube of a cat to get a better access to the lingual caudal mandible, the cat felt that and suddenly jumped up and literally nearly ran off the table. She'd been fine for the extractions as well nerve blocked , just too light for a slight movement of the tube. I got an awful fright, it's a bit of a learning curve!

Re: Nerve blocks ( long)

Anthony Todd — Mon, 20 Apr 2015 19:08:39 GMT

So nothing to do with the arthroscopy then?

Re: Nerve blocks ( long)

Anthony Dennison — Mon, 20 Apr 2015 18:54:28 GMT

No, under GA as well. The block was done to speed up recovery time; was told to keep the sling on for 24 hours or so then get moving. Was digging up fence posts with a pick 48 hours later with minimal issues. Had the op done on the Friday, back to work with no issues or problems on the Monday. Weird waking up with no sensation in my arm and no motor control - got a cracking bruise from pinching myself so hard to see if I could feel it.

I went from constantly taking anti-inflammatories and tramadol all day to not needing anything. I got given dihydrocodeine for post op pain, used a total of 2 tablets, which was probably just me being a wimp.

According to the anaesthetist, I have a lovely brachial plexus.

Re: Nerve blocks ( long)

Anthony Todd — Mon, 20 Apr 2015 18:18:36 GMT

[quote user="Anthony Dennison"]I had a brachial plexus block for shoulder athroscopy [/quote]

So you had no GA? ie were conscious and talking during the procedure?

Re: Nerve blocks ( long)

Anthony Dennison — Mon, 20 Apr 2015 17:33:31 GMT

[quote user="Anthony Todd"]The reason why they use local anaesthetic in humans is to reduce anaesthetic risk.[/quote]

I had a brachial plexus block for shoulder athroscopy to limit pain and therefore lighten the anaesthetic required, surely reducing the risk?

Re: Nerve blocks ( long)

Anthony Todd — Mon, 20 Apr 2015 17:04:14 GMT

Dinovet question:

[quote user="Michael Woodhouse"] what are you hoping to achieve with the addition of local anaesthesia?[/quote]

At last, [I was too scared to be the first to ask.....]

As I understand it, you are giving a GA only to keep the patient still enough to place the local anaesthetic accurately?

[I'd hate to attempt it without a GA.....]

But you've already got anaesthesia generally....

The reason why they use local anaesthetic in humans is to reduce anaesthetic risk.

I just don't get it.

Re: Nerve blocks ( long)

Michael Woodhouse — Mon, 20 Apr 2015 14:20:04 GMT

Cow vet question - what are you hoping to achieve with the addition of local anaesthesia?

Decent pre-med (including and alpha 2), pre-operative NSAID and I've never recognised specific discomfort after any dental procedure. Never had to turn up the iso.

In people we avoid a GA, so I can see the reason there. I've had a root canal done and a filling without any anaesthetic, and it doesn't hurt very much.

If it was going to revolutionise the care of the patients then I'm all for it. I just can't see why we need to bother?

(we have people putting local anaesthetic into abdominal suture lines, and sending the dog home with a Buster collar - they never think of addressing the over-tight sutures....)

Re: Nerve blocks ( long)

Kate Richardson — Mon, 20 Apr 2015 14:07:33 GMT

Hi Suzanne,

Firstly I must apologise for not sending you the info on nerve blocks I originally said I would- if I don't do something immediately my memory is rubbish, so I am sorry but glad you found the info you needed

I use bupivacaine regularly and have done for a least a couple of years now and have never had this problem with drooling in any cases. I use Marcain- is there something else in the bupivacaine you are using that could be stimulating salivation?

Kate

Re: Nerve blocks ( long)

Suzanne Kelly — Sun, 19 Apr 2015 22:36:01 GMT

I guess it must be. It stops after a few hours and the cats are super happy and seem pain free which is the point, but the drool thing is upsetting for the cat, the owners and me. I did do a wetlab with nerve blocks, but that was several years ago, long before I was doing any significant amount of dentistry. Maybe I'll just stick to lignocaine with cats. I just thought the 6-8 hour effect of the bupivicaine would greatly reduce wind-up and make the recovery period more comfortable.

Re: Nerve blocks ( long)

Evelyn Barbour-Hill — Sun, 19 Apr 2015 16:07:49 GMT

I was just wondering if the LA has not completely worn off and the cat is suffering from that ghastly semi-numb yet hypersensitive feeling. Does that seem to fit with the timescale? Bupivacaine is very long acting compared to lignocaine.

Otherwise, I don't know.

Re: Nerve blocks ( long)

Suzanne Kelly — Sat, 18 Apr 2015 23:51:53 GMT

Between 15 minutes and a couple of hours, depending on what needs to be done. The dogs have all been fine. Cats fine with lignocaine on it's own, it's just the bupivicaine.

Re: Nerve blocks ( long)

Evelyn Barbour-Hill — Sat, 18 Apr 2015 17:39:30 GMT

[quote user="Suzanne Kelly"]few cats hyper salivate like mad when they come around. I'm talking ropes of drool several inches long. [/quote]

How long after the LA infiltration are they being allowed to wake up?

Re: Nerve blocks ( long)

Suzanne Kelly — Sat, 18 Apr 2015 01:01:46 GMT

[quote user="CatherineThomas"]

I've got a copy of an article from the DVM newsmagazine which has some nice pictures and explanations of dental nerve blocks. I found it quite useful.

http://veterinarynews.dvm360.com/regional-nerve-blocks-key-delivering-quality-dental-care

[/quote] Nerve block update. It's a similar article to this I was referring to, Brett Beckmann does a YouTube video too. I've been doing pretty well, it's 0.25mg/ml bupivicaine I have and I mix it with lignocaine. The rostral blocks have worked really well, I'm getting better at the caudal ones. However I've had a few cats hyper salivate like mad when they come around. I'm talking ropes of drool several inches long. What am I doing wrong?

Re: Nerve blocks ( long)

mariette asselbergs — Wed, 17 Dec 2014 22:05:34 GMT

I did scaling and polishing conscious under local anaetshetic in my 15 year old English Bull Terrier with enormous heart murmur and CHF. (And terrible tartar on all teeth). Worked a treat. (I am sure it helped that she was stone deaf too).

Mariette

Re: Nerve blocks ( long)

Peter Southerden — Wed, 17 Dec 2014 18:03:05 GMT

There are no studies to my knowledge that look at the effect of mixing bupiacaine and lidocaine. They are both effective at different pH and therefore they may inactivate each other.

We use regional analgesia routinely for all extractions in dogs and cats. There are significant advantages for both analgesia and anaesthesia. I only use mandibular and maxillary blocks in cats (never infraorbital) and mandibular, maxillary and occasionally infraorbital in dogs. There are a number of reasonable texts to follow which will give you enough information to give mandibular blocks safely. I would recommend that you attend a practical course demonstrating maxillary blocks before you give them as there is a higher risk of complications.

Re: Nerve blocks ( long)

Evelyn Barbour-Hill — Wed, 17 Dec 2014 12:55:53 GMT

[quote user="Kate Richardson"]What is the advantage? Is it just more precise and thus effective?[/quote]

I think it's more precise. And I'd prefer to put a needle through oral mucosa rather than skin. And if truth be told, it just feels more right to me.

Re: Nerve blocks ( long)

Kate Richardson — Wed, 17 Dec 2014 12:35:47 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"] How do you do the intra-oral mandibular block?[/quote]

Palpate the medial surface of the mandible with the forefinger of your spare hand (best, palpate right mandible with right hand, left with left). You can palpate the foramen, or near enough (if you're not getting it, look at a skull as you do it). Then slide the needle under your finger.

[/quote]

Thankyou. What is the advantage? Is it just more precise and thus effective?

Re: Nerve blocks ( long)

CatherineThomas — Wed, 17 Dec 2014 11:14:08 GMT

I've got a copy of an article from the DVM newsmagazine which has some nice pictures and explanations of dental nerve blocks. I found it quite useful.

http://veterinarynews.dvm360.com/regional-nerve-blocks-key-delivering-quality-dental-care

Re: Nerve blocks ( long)

Evelyn Barbour-Hill — Wed, 17 Dec 2014 10:50:45 GMT

[quote user="Kate Richardson"] How do you do the intra-oral mandibular block?[/quote]