Hindlimb bilateral Epidural anesthesia L7S1

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Indication

Operations on pelvis, hindlimbs, perineum and abdomen

Equipment

Step by step

Local anesthetics

Epidural anesthesia L7S1

Onset of effect and duration:
Lidocain 2%: 5 min/1-2 h
Mepivacain 2%: 5-10 min/1-3 h
Bupivacain 0.5%: 10-20 min/4-6 h
Ropivacain 0.75%: 10-20 min/3-5 h
(Cruz et al. 1997, Feldman und Covino 1988, Duke et al. 2000)

Injection volumes dog (kg):
1 ml/10 kg: blockade perineum and tail
1 ml/7 kg: blockade Hglm (L3)
1 ml/5 kg: blockade caudal abdomen (L1)
0.36 ml/kg: ovariohysterectomy (T10)
(Freire et al. 2010, Almeida et al. 2007)

Injection volumes dog (Loc):
0.5 ml/10 cm: 30-35% LOC
1.0 ml/10 cm: 55-60% LOC
1.5 ml/10 cm: 70-75% LOC
(Otero et al. 2009)
Maximum volume / dog: 6ml

Injection volumes cat (kg):
0.2 ml/kg: blockade to L1/2
0.4 ml/kg: blockade to T6-10
1-1.5 ml per Cat
(Lee et al. 2004a)

Adjunktiva

Epidural anesthesia L7S1

Opioids:
Morphin (10 mg/ml)

Injection volume:
0.1 ml/10 kg
(Valverde et al. 1989a)

Alpha2 agonists:
Medetomidin (1 mg/ml)

Injection volume:
0.05 ml/10 kg
(Branson et al. 1993)

 

Video

  • Epidural anesthesia "hanging-drop" technique

    The puncture of the ligamentum flavum and the control of the correct needle position in the epidural space can also be done with the "hanging-drop" technique.

Regional anesthesia of the hindlimb

Examples of possible applications

(1) TPO (2) FHNE (3) Pantarsal arthrodesis (4) TPLO (5) Hemipelvectomy (6) THR

Regional anesthesia of the perineum

Examples of possible applications

(1) Perineal hernia (2) Perineal urethrostomy (3) Episiotomy (4) Epidural anesthesia for perineal hernia surgery (5) Castration with scrotal ablation

Regional anesthesia of the abdomen

Examples of possible applications

(1) Urethral rupture (2) Pyometra (3) Linear intestinal foreign body

Advantages/Disadvantages/Contraindications

Advantages:

  • Simple technique with a wide range of indications
  • Postoperative analgesia in combination with morphine (up to 24 h)
  • Single-shot or catheter

Disadvantages:

  • Sympathic blockade (vasodilation leads to hypotension/hypothermia)
  • Inefficient blockade
  • Urine retention

Contraindications:

  • Coagulopathy
  • Hypovolemia/hypotension
  • Infections or neoplasms in the puncture area
  • Neuropathies

Epidural catheter

Control of the correct position of the epidural catheter with contrast agent

Repeatable injection:
Ropivacain 0.2% (+ Morphin)

CRI:
Ropivacain 0.2% + 2µg Fentanyl / ml admixed solution
0.02-0.05 ml/kg/h
(Otero und Campoy 2013)

With the friendly assistance of
Dr. Georg Papadopoulos
Veterinary Specialist for Small Animals
Additional Certification: Anesthesia in Small Animals
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Andreas Kuntz
B. Braun Vet Care GmbH Product Manager, Anaesthesia & Internal Medicine

Disclaimer

As with any intervention in the body, peripheral nerve blocks also carry the risk of complications. The presented procedures and dosages are thoroughly reviewed and based on currently available scientific data and clinical experience but should only be considered as guidelines along the contents of the course. The responsibility for performing the nerve blocks shown on this site as part of any anesthesia regimen or pain management lies with the executing clinician. B. Braun Vet Care GmbH and Dr. Papadopoulos cannot be held responsible for any complications or adverse effects, that may arise from the described techniques or for any mistakes in the information provided.