Ultrasound-guided continuous block of median and ulnar nerves in horses: development of the technique

To develop a technique for ultrasound-guided continuous median and ulnar peripheral nerve block in horses. Anatomical and prospective experimental study. A total of 16 thoracic limbs from horse cadavers and 18 adult horses. This study was conducted in three phases. Phase 1: Dissection of median and ulnar nerves in the antebrachial region of two cadaver limbs to identify localizing landmarks. Description of sonoanatomy in 14 cadaver limbs using ultrasound-guided perineural infiltration of a combination of cellulose gel (5 mL), contrast medium (4 mL) and methylene blue (1 mL). Catheters were inserted between the perineural sheath and epineurium in six limbs, followed by computed tomography. Phase 2: Ultrasonographic images of the limbs of 18 healthy horses of different breeds were used to define an acoustic window and optimize the approach to nerves. Phase 3: Two case reports of horses with chronic pain of different etiologies. Catheters were inserted between the epineurium and paraneural sheath of the median and/or ulnar nerves guided by ultrasound, followed by continuous infusion of 0.4% ropivacaine. Information from phase 1 was used to direct needle insertion, solution dispersion and catheter implantation in phase 2, which resulted in 100% technique accuracy. In response to the peripheral nerve block, pain reduction was apparent in the two clinical cases by increased weight bearing in affected limbs and decreased requirement for systemic analgesic medications. No local reactions were observed. The ultrasound technique allowed real-time visualization of needle, catheter and drug dispersion and resulted in a high success rate for nerve blocks. The horses administered a median and ulnar nerve block exhibited no discomfort or signs of infection at the catheter insertion site. Further studies are warranted to validate the efficacy of this technique.