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Tibial Nerve Block and Skin Sensation
Bellitto N.A., Voute L.C., Withers...
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Background:
Loss of skin sensation (SSN) of the corresponding dermatome is typically used to assess efficacy of perineural analgesia. Use of loss of SSN as an indicator of tibial nerve desensitisation has not been validated and has been anecdotally reported as unreliable.
Objectives:
To validate loss of SSN for assessment of the efficacy of tibial perineural analgesia (TIB-PA).
Study design:
Prospective study.
Methods:
Inclusion criteria were horses presented for lameness investigation showing improvement in lameness following TIB- PA. TIB-PA was performed using mepivacaine hydrochloride 2% (w/v) with no other diagnostic analgesia in place. A hand- held digital algometer, with a 1 mm diameter pin, was used to test SSN at regular time points prior to and after TIB-PA in three locations (medial and lateral heel bulbs, and plantar-medial proximal metatarsus). A value of 25 Newtons would indicate complete loss of SSN. Gait assessment was performed at each time point prior to SSN measurements and lameness was graded subjectively and objectively with the aid of an inertial sensor-based system for lameness diagnosis. Timing and quantification of changes in SSN were analysed in relation to severity of lameness. Data analysis used General Linear Models implemented in R Statistical Computing Environment.
Results:
Seven horses were included in the study. There was significant positive correlation between time of loss of SSN and the time of lameness resolution for all skin locations: medial heel bulb (n = 7, R2 = 0.74, p = 0.008), lateral heel bulb (n = 7, R2 = 0.74, p = 0.008) and plantar-medial proximal metatarsus (n = 6, R2 = 0.83, p = 0.007). One horse did not lose skin sensation at the plantar-medial proximal metatarsus.
Main limitations:
Limited number of cases.
Conclusions:
These results suggest that loss of SSN at the heel bulbs is a reliable indicator of efficacy of TIB-PA.
Ethical animal research:
Approved by the School of Veterinary Medicine Research Ethics Committee, University of Glasgow (Ref EA28/20).
Informed consent:
Owners gave consent for horses’ inclusion in this study.
Competing interests:
None declared.
Sources of funding:
None.
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About
Affiliation of the authors at the time of publication
Glasgow Equine Hospital & Practice, School of Veterinary Medicine, University of Glasgow, Glasgow, UK;
Pool House Equine Clinic, Crown Inn Farm, Lichfield, Staffordshire, UK
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