Video series: Pain blocks for neuter procedures

In the October issue of Veterinary Practice News, Michael Petty, DVM, addressed how local blocks can be used to prevent pain in spay and neuter procedures. You can read the full article here. He also shared three videos to demonstrate his technique. They, along with some related text from the article for each video, appear below. The procedure: orchidectomy In either a dog or cat, the method is the same. After an alcohol prep, the testicle is firmly grasped with the non-syringe hand, and the needle is inserted into the caudal pole of the testicle and advanced just shy of the cranial pole. While maintaining a firm grasp, aspirate to make sure you are not in a blood vessel, then start to inject just until you feel the slightest pressure under your fingers. Video 1: Testicular block — feline. For a cat, this will take perhaps ¼ cc of lidocaine per testicle. Withdraw the needle and repeat with the other testicle. https://vimeo.com/610094474 Video 2: Testicular block — canine. In dogs, you can also use the same needle to do a line block over your intended incision area. For a large dog, up to 1 cc of lidocaine per testicle might be needed. https://vimeo.com/610098447 The procedure: ovariohysterectomy Video 3: Ovarian block. For obvious reasons, the lidocaine injection during an ovariohysterectomy must be done by the surgeon. The drawback to this is it can take time for the lidocaine to take effect, which can slow down the procedure by several minutes. To overcome this time lag, once the ovary is exteriorized, an injection is made and it is dropped back into the abdomen. I then find the second ovary, inject and drop that one back into the abdomen. By the time this happens, the first ovary is blocked and ready for ligation. https://vimeo.com/610085941 Unlike the neuter, I do not inject directly into the ovary. Instead, I pass a needle through the combined ovarian and round ligaments, avoiding any obvious blood vessels, and dribble lidocaine as I withdraw the needle. For most animals, this is sufficient to provide analgesia to the ovary. In both dogs and cats, the amount of lidocaine is minimal: 1/4 cc per ovary for cats, 1/2 to 3/4 cc for dogs. The potential for complications is slightly larger, but manageable for this procedure. The only serious one is hitting a blood vessel while passing the needle through the ligaments. Despite avoiding obvious blood vessels, it can still happen. If it does, I immediately clamp below the bleed and proceed without waiting for the lidocaine to take effect. The other possible complication is in the hard-to-find ovaries. After a five-minute struggle to find and then inject an ovary, I am reluctant to drop it back into the abdomen. In these cases, I simply wait two or three minutes and then proceed with clamping and cutting that side. Michael Petty, DVM, is a graduate of the veterinary school at Michigan State University. As the owner of Arbor Pointe Veterinary Hospital and the Animal Pain Center in Canton, Michigan, he has devoted his professional life to the care and well-being of animals, especially in the area of pain management. Dr. Petty is the past president of the International Veterinary Academy of Pain Management. A frequent speaker and consultant, he has published articles in veterinary journals and serves in an advisory capacity to several pharmaceutical companies on topics of pain management. Petty has been the investigator/veterinarian in 12 FDA pilot and pivotal studies for pain management products. He has lectured both nationally and internationally on pain management topics.

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Video series: Pain blocks for neuter procedures

The fix is in on pain

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