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Distal limb intravenous regional anesthesia
Synonym(s): IVRA, Bier block
Introduction
- The use of intravenous regional anesthesia for clinical examination and surgical procedures of the distal limb.
Uses
- Facilitates clinical examination and treatment of painful conditions of the distal limb, including wounds and foot lesions.
- Enables claw amputation Digit amputation and joint lavage Joint lavage: through-and-through.
- As an adjunct in a patient under general anesthesia Anesthetizing cattle as part of multi-modal anesthesia and analgesia.
Advantages
- Inexpensive and minimal equipment needs.
- Minimal side effects.
- Allows standing surgery.
- Minimal patient recovery time.
Disadvantages
- Depending on accuracy of block placement, the area of desensitization can be variable.
- Venipuncture is required.
- Excellent handling facilities, good restraint Restraint techniques of the animal and its limb is required.
Technical problems
- Identification of a suitable vein can be difficult where marked edema, inflammation or cellulitis is present.
Alternative techniques
- For examination or treatment, ring or perineural infiltration.
- For examination, deep sedation Sedating cattle (for example, with xylazine HCl Xylazine).
- For surgical procedures, general anesthesia.
Time required
Preparation
- Site preparation (clipping and surgical scrub): 5-10 min.
- Analgesia protocol considered and non-steroidal anti-inflammatory drugs Anti-inflammatory drugs: overview administered in advance, as necessary.
Procedure
- 5-10 min.
- Allow 15-20 min for block to take effect.
Decision taking
Criteria for choosing test
- Lesion type and location.
- Generic factors that determine most appropriate type of anesthesia, ie:
- Risk of anesthesia, eg compromised patient.
- Anticipated length of surgery.
- Temperament of patient.
- Local logistics.
- Availability of expertise and equipment.
- Risk of drug toxicity.
- Desired positioning of patient.
Risk assessment
- Good general restraint of the animal and specific restraint of the limb is required to allow accurate placement of nerve block and avoid injury to the patient and practitioner (including self-injection).
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed Papers
- Recent references from PubMed and VetMedResource.
- Kumar S, Khangembam S D, Gangwar A K, Yadav V P & Verma R K (2020) Distal intravenous regional anaesthesia for claw diseases in bovines. Indian J Anim Res 54 (5), 614-618 VetMedResource.
- Mendez-Angulo J L, Granados M M, Modesto R et al (2020) Systemic and local effects of lidocaine or mepivacaine when used for intravenous regional anaesthesia of the distal limb in standing sedated horses. Equine Vet J 52 (5), 743-751 PubMed.
- Yavari S, Khraim N, Szura G et al (2017) Evaluation of intravenous regional anaesthesia and four-point nerve block efficacy in the distal hind limb of dairy cows. BMC Vet Res 13 (1), 320 PubMed.
- Edmondson M A (2016) Local, regional and spinal anesthesia in ruminants. Vet Clin North Am Food Anim Pract 32 (3), 535-552 PubMed.
Other sources of information
- Dugdale A (2010) Veterinary Anesthesia: Principles to Practice. Wiley-Blackwell.