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This Concept Map, created with IHMC CmapTools, has information related to: Perineural Nerve Blocks, Palmar Digital Nerve Block Regions Blocked The following are all the area desensitized: > Navicular bone > Navicular bursa > Distal sesamoidean ligaments > Deep Digital Flexor tendon & sheath > Digital cushion > Corium of frog > Palmar 1/3-2/3 of sole > Palmar pastern and coffin joints > Palmar distal phalanx/ wings of coffin bone > Palmar Skin, Abaxial Sesamoid Nerve Blocks Followed by Palmar Digital Nerve Block, Abaxial Sesamoid Nerve Blocks Then Low 6 point Nerve Blocks, Palmar Digital Nerve Block Proceedure Use a 25G 5/8" needle 1-1.5 mls of mepivicaine per site. 1. After skin prep., elevate foot. 2. Palpate n-v bundle, abaxial to flexor tendons on the palmar aspect of the pastern. 3.Insert needle on axial side of n-v bundles at the level of the collateral cartillages. Point needle slightly abaxial and distally. 4. Aspirate and inject SQ 1-1.5 mls at both medial & lateral nerve sites. 5. Wait 5-10 mins and check for desensitisation. Reassess lameness., Use a 25G 5/8" needle 2-2.5 mls of mepivicaine per site. 1. After skin prep., elevate foot (forelimb) or perform with limb weight-bearing (hindlimb). 2. Find landmarks and insert needle at DORAL boarder of the prox. sesamoid bones on axial side of n-v bundle. Point needle slightly abaxial and distally. 3. Aspirate and inject SQ 2-2.5 mls at both medial and lateral nerve sites. 4. Wait 5-10 mins and check for desensitisation. Reassess lameness. Loss of skin sensation at the dorsal coronary band indicates a successful block!!!, High 6 point Nerve Blocks Prodecure needles: 21-22g 1" 5ml for each block (2 medial and lateral and a ring block) 1.Inject 1 ml of agent subcutaneously plantar to MT IV, about 1.5 cm distal to the tarsometatarsal joint. 2. Redirect the needle axial to MT IV, until it meets resistance. 4. Inject 5 ml agent. 5. Partly withdraw needle and redirect it dorsomedially toward the axial aspect of the MT IV. 6. Inject another 5 ml., Low 6 point Nerve Blocks Anatomical Landmarks Groove between DDFT and suspensory ligament at the level of the distal tip of the plint bone (bulb), Forelimb: Low 4 point Nerve Block Anatomical Landmarks distal aspects (‘buttons’) of the second and fourth metacarpal bones., Abaxial Sesamoid Nerve Blocks Proceedure Use a 25G 5/8" needle 2-2.5 mls of mepivicaine per site. 1. After skin prep., elevate foot (forelimb) or perform with limb weight-bearing (hindlimb). 2. Find landmarks and insert needle at DORAL boarder of the prox. sesamoid bones on axial side of n-v bundle. Point needle slightly abaxial and distally. 3. Aspirate and inject SQ 2-2.5 mls at both medial and lateral nerve sites. 4. Wait 5-10 mins and check for desensitisation. Reassess lameness., Abaxial Sesamoid Nerve Blocks Regions Blocked The following are all the area desensitized: > Three phalanges > Coffin & Pastern Joints > Entire corium > Entire sole > Dorsal branches of suspensory ligaments > Digital extensor tendon > Distal sesamoidean ligaments > +/- Proximal sesamoid bone > +/- Palmar fetlock joint., High 6 point Nerve Blocks Anatomical Landmarks Metatarsal bones 4 and 2, 1.5 cm below the tarsometatarsal joint, Palmar Digital Nerve Block Anatomical Landmarks Palmar aspect of the pasturn Collateral cartillages of the fetlock., High 4 point nerve block Procedure Needle size 20-25g 1" 2-3 ml per site., Forelimb: Low 4 point Nerve Block Procedure Needle size 20-25g 1" 2 mls at each site, Abaxial Sesamoid Nerve Blocks Then Forelimb: Low 4 point Nerve Block, Low 6 point Nerve Blocks Regions blocked Nerves: medial and lateral plantar metatarsal nerves all structures distal to the carpus including the proximal suspensory digament, Low 6 point Nerve Blocks and High 6 point Nerve Blocks, High 4 point nerve block Indications This block may be done to localize pain distal to the metacarpus. Swelling, pain or heat on palpation may indicate inflammation. Usually done after distal blocks have been carried out, High 4 point nerve block Anatomical Landmarks axial to the distal aspect of the heads of the second and third metacarpal bones, High 4 point nerve block Regions blocked Palmar metacarpal nerves, entire metacarpus and limb distal to site of injection