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Ultrasound guidance horn anesthesia in Water buffaloes, Bubalus bubalis (Linnaeus, 1758) Ultraschallkontrollunterstützte Anästhesie der hornversorgenden Nervenäste von Wasserbüffeln, Bubalus bubalis (Linnaeus, 1758)
Mohamed Moustafa Shokry a,∗ , Abdel Haleem El-Kasapy b a Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Egypt b Department of Surgery, Faculty of Veterinary Medicine, Benha University, Egypt
Received 19 March 2015
Abstract Successful and adequate regional horn anesthesia in buffaloes was achieved using ultrasoundguided nerve block of the zygomatico-temporal (cornual) and infratrochlear nerves with only 2 ml of mevipacaine HCl 3%. Keywords: Ultrasound-guide; Horn; Nerve block; Anesthesia
Introduction The advancement in ultrasound equipment and methods enabled the identification of vascular and neural structures with high accuracy, greatly facilitated easy induction of nerve blocks, when compared to classical techniques (Neal, Brull, Chan, Grant, Horn et al., 2010). Currently the technique become increasingly frequent in human (Gautier et al., 2011;
∗ Corresponding
author. E-mail addresses:
[email protected],
[email protected] (M.M. Shokry).
Please cite this article in press as: Shokry, M. M., & El-Kasapy, A.H. Ultrasound guidance horn anesthesia in Water buffaloes, Bubalus bubalis (Linnaeus, 1758). Zool. Garten N.F. (2015), http://dx.doi.org/10.1016/j.zoolgart.2015.07.005
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M.M. Shokry, A.H. El-Kasapy · Ultrasound guidance horn anesthesia in Water buffaloes
Ferraro et al., 2014) and in animals (Shilo et al., 2010, Costa-Farré, Blanch, Cruz, & Franch, 2011; Shokry & Berbish, 2012; Morath, Luyet, Spadavecchia, Stoffel, & Hatch, 2013). Ultrasound guidance nerve blockade ensures accurate deposition and reduced dose of local anesthetic, avoiding unintentional intraneural and intravascular puncture and injection (Champan, Johnson, & Bodenham, 2006). However, the use of large volumes of local anesthetic increases the likelihood of systemic toxicity (Groban, 3003; Mather, Copeland, & Ladd, 2005). In bovine practice, veterinarians are frequently called upon to manage horn injuries or even dehorning in buffaloes, therefore the horn anesthesia was chosen to be the aim of this study to develop an ultrasound-guided technique for horn nerve block in buffaloes.
Materials and Methods This study was conducted on ten adult female buffaloes of different ages belonging to the animal farm of the faculty of veterinary medicine, Benha University. The technique of ultrasound horn anesthesia in buffaloes was adapted to the horn anatomy of buffaloes described by (Fouad, Shokry, & Fahmy, 1979). They found that the horn core and skin around its base are supplied by the corneal branches of the zygomatico-temporal nerve (cornual) of the ophthalmic nerve, courses caudally over the orbit and traverses the retroorbital fat and proceeds parallel to the lateral ridge of the frontal bone and terminates by branching at the base of the horn. The well developed horn core of buffaloes is also supplied by the infratrochlear nerve of the nasociliary division of the ophthalmic nerve that mounts the orbital rim adjacent to the medial canthus (Figs. 1 and 2). Each buffalo was secured in a stanchion and a mild dose of Rompun 2% (Bayer) (0.05 mg/kg b.w.) was initially injected i.m. to minimize the normal excitement and resentment of the animal during manipulation (Fouad & Shokry, 1973). The sites of perineural injections at the lateral ridge of the frontal bone (the zygomaticotemporal nerve) and the orbital rim (the infratrochlear nerve) were clipped and disinfected by routine methods and coupling gel was heavily applied over the skin. Ultrasound images of the concerned nerves were visualized in both sagittal and transverse planes using ultrasound (Logiq TM 180 G.E., Medical System, Japan) with a linear transducer 7.6 MHz (Figs. 3 and 4). The zygomatico-temporal(cornual) nerve block was performed by placing the ultrasound transducer under the lateral ridge of the frontal bone to locate the nerve, guide placement of the needle (2.5 cm, 18 g) and visualize the perineural injection of mepivacaine HCl 3% (Alexandria Co. for pharmaceuticals, Alexandria, Egypt). The infratrochlear nerve block was performed by placing the ultrasound transducer over the orbital rim (supraorbital process) to locate the nerve and continuing as before (Fig. 5). The contralateral horn was used as a control by ultrasound –guide perineural injection with saline. The onset of action was determined after the end of injection to assess blockade effectiveness which was evaluated by pinprick, surgical incision and stitching of the skin of the horn region. The duration of regional horn anesthesia was also determined. Please cite this article in press as: Shokry, M. M., & El-Kasapy, A.H. Ultrasound guidance horn anesthesia in Water buffaloes, Bubalus bubalis (Linnaeus, 1758). Zool. Garten N.F. (2015), http://dx.doi.org/10.1016/j.zoolgart.2015.07.005
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Fig. 1. Zygomatico-temporal (cornual) nerve in situ.
Fig. 2. Infratrochlear nerve in situ.
Please cite this article in press as: Shokry, M. M., & El-Kasapy, A.H. Ultrasound guidance horn anesthesia in Water buffaloes, Bubalus bubalis (Linnaeus, 1758). Zool. Garten N.F. (2015), http://dx.doi.org/10.1016/j.zoolgart.2015.07.005
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Fig. 3. Ultrasonographic image of the zygomatico-temporal (cornual) nerve (N) with a linear probe (7.6 MHz) placed in a sagittal plane just under and parallel the lateral ridge of the frontal bone.
Fig. 4. Ultrasonographic image of the infratrochlear nerve (N) with a linear probe (7.6 MHz) placed in a sagittal over the orbital rim and adjacent to the medial canthus.
Please cite this article in press as: Shokry, M. M., & El-Kasapy, A.H. Ultrasound guidance horn anesthesia in Water buffaloes, Bubalus bubalis (Linnaeus, 1758). Zool. Garten N.F. (2015), http://dx.doi.org/10.1016/j.zoolgart.2015.07.005
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M.M. Shokry, A.H. El-Kasapy · Ultrasound guidance horn anesthesia in Water buffaloes
Fig. 5. Sites of inserting the needles under ultrasonohraphic guide.
Fig. 6. Assessment of horn anesthesia by induction of skin incision and stitching.
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Results In all cases it was possible to visualize the target nerves i.e. the zygomatico-temporal (cornual) and infratrochlear nerves with needle depths of 4-6 mm and 2-4 mm respectively. Successful blockades were made with 2.0 ml of mepivacaine 3% with median onset of four minutes and duration of 55 minutes. Complete sensory block was evaluated by unresponsive pinbrick and adoption of satisfactory surgical incision and stitching at the base of the horn (Fig. 6). No adverse effects were noted. The other contralateral control horn did not show any loss of sensation.
Discussion This study demonstrated that with ultrasound guidance, it is possible to perform satisfactory horn anesthesia in buffaloes achieved by zygomatico-temporal (cornual) and infratrochlear nerve blockades with a minimum volume of local anesthetic (2 ml) over each nerve. Other authors reported effective blockade of the sciatic and saphenous nerves in dogs (Costa-Farré et al., 2011; Shilo et al., 2010), paravertebral nerves in buffaloes (Shokry & Berbish, 2012) and retrobulbar nerve in horses (Morath et al., 2013). Adopting of ultrasound guide perineural horn anesthesia, it is possible to perform dehorning or any surgery of the deeper structures of the horn without complications. In the present study, the used volume of local anesthetic was smaller than that described previously with the classic technique of horn anesthesia in buffaloes (Fouad et al., 1979). Successful and safe blockade with low doses of local anesthetics provides a less risk to the systemic toxicity of local anesthesia (Lesklw & Weinberg, 2009; Bem, Akpa, Kuo, & Weinberg, 2011; Ferraro et al., 2014). Also, according to some studies, the local anesthetics are potentially neurotoxic (Lambert, Lambert, & Strichartz, 1994). The proposed mechanisms include increase in intracellular calcium concentration, disturbance in mitochondrial function, interference with membrane phospholipids and cell apoptosis (Kitagawa, Oda, & Totoki, 2004; Johnson, Saenz, DaSilva, Uhl, & Gores, 2002; Floridi, Di Padova, Barbieri, & Areuri, 1999; Sturrock & Nunn, 1979). In conclusion, the present study confirms the validation of using ultrasound for visualization the zygomatico-temporal and infratrochlear nerves supplying the horn in buffaloes and the technique is potentially valuable for easy blocking of both nerves with minimal amount of local anesthetic.
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