Article reprinted with permission of DVM360 – July 18,
2018. DVM360 MAGAZINE is a copyrighted publication of
Advanstar Communications inc. All rights reserved
Sacrococcygeal blocks
Sacrococcygeal blocks will make your life much easier
when it comes to blocked toms, tail amputations, and
basically any surgery you’re doing in the urogenital
and perineal regions, says the Fetch dvm360 team.
According to Dr. Barletta, the beauty of this block
compared with an epidural is that your patient
will retain its ability to walk immediately after the
procedure.
McNerney singlehandedly convinced me to try this
the next time I encounter a blocked tom that proves
difficult to catheterize. “Instead of wrestling with the
penis until it becomes a swollen, bloody mess, just
sacrococcygeal-block that baby,” she says. “The penis
pops right out.”
She also says to Instagram-story her when that
happens and she’ll do a happy dance for you. It’s a
win-win-win situation. You win, the cat wins and
McNerney wins.
What not to do
As I realized when I used lidocaine after a neuter,
there are definite no-nos when it comes to local nerve
blocks. Here are a couple:
Tips from the tech
In McNerney’s experience, local nerve blocks are
most commonly used in dentistry—specifically the
caudal mandibular block and the maxillary block. Her
favorite anesthetic for these blocks is bupivacaine.
Other common applications include:
• Retrobulbar blocks for enucleation
• Testicular blocks for neuters, which can cut
down on the need for inhalant anesthetic
(McNerney usually uses lidocaine)
• Incisional blocks—inject a local anesthetic along
the incision site
Sacrococcygeal blocks for urethral obstruction in
cats—using a 5/8-in needle, inject bupivacaine in the
space where the tail goes up and down and wait 60
to 90 seconds.
The anesthetic will affect the tail, anus, penis
and perineum. And no, pets do not poop all over
afterward.
1. Thou shalt not mix two anesthetic agents.
For example, don’t mix bupivacaine and lidocaine
in hopes of achieving a middle ground in terms of
speed of onset and duration of effect. They don’t
work that way, Dr. Barletta says—you’ll end up with an
in-between onset and duration, deriving the benefits
of neither. It’s better to use anesthetics sequentially
when necessary: first a fast-acting agent, followed by
a longer-lasting one—for example, at the end of the
procedure for more postoperative analgesia.
Building better business
Nerve blocks make a lot of sense for the business
and management side of veterinary practice, says
manager Ori Scislowicz. Here are the reasons:
• Nerve blocks require a minimal equipment
investment. For most blocks, all you need are a
syringe and needle, although Dr. Mike Barletta
does say you can use a nerve locator and
ultrasound machine to help with the process.
• Nerve blocks result in a smoother recovery
for the patient and help pets maintain greater
comfort throughout a procedure and the
recovery period. This can set your practice apart
if you educate clients about the details and even
market these services more broadly.
• If you empower techs to learn how to do nerve
blocks, you build positive morale on your team
and allow technicians to build their patient
advocacy toolbox.
2. Thou shalt not use epinephrine mixed with a
local anesthetic on terminal blood supply areas.
For example, don’t use epinephrine on the tail area or
ears because it causes vasoconstriction, and you may
cause ischemic necrosis of the area because you cut
off the blood supply for too long.
An eternal conundrum
Last but not least, I leave you with the eternal sodium
bicarbonate conundrum: to mix or not to mix? The
Fetch dvm360 experts say yes, it’s OK to mix sodium
bicarb with your anesthetic to decrease the sting of
a local block. However—and this is a big however—
some local anesthetics precipitate out when mixed
with sodium bicarb, so it’s important to know which
ones! Commit them to memory—they are bupivacaine
and etidocaine
All in all, Scislowicz says, you’ll have happier
employees who are more skilled, and you’ll have
happier patients that are more comfortable.
Issue 05 | NOVEMBER 2018 | 5